CARCINOMA OF PROSTATE GLAND

Definition: Cancer of the prostate gland is excessive proliferation of abnormal cells in the prostate gland which can be benign or malignant

Causes of Cancer of the Prostate Gland: The causes of cancer of the prostate gland are not clear but like in the enlargement of the prostate gland there predisposing factors among of which are:

·         Maturation process-during puberty the prostate gland enlarges rapidly until the age of 30 years

·         from the age of 50 years the gland also changes in size , consistency and firmness

·         The changes in size and consistency of the prostate gland is attributed to

·         Increased tissue mass resulting from cellular proliferation

·         Increase in hormones androgens and estrogen which stimulate its growth

·         Increase in the enzyme 5-alpha reductase (which converts testosterone to dihydrotestosterone) which stimulates prostatic growth

·         Repeated urinary tract and sexually transmitted Infections

·         The disease is rare before the age of 45 years so advancing age is a predisposing factor,70% of all cancers of the prostate occur in men over 65 years

·         Some research has shown that gene arrangement and fusion triggers the development of cancer of the prostate gland

Step 3 Pathophysiology of Cancer of the Prostate Gland (15 minutes)

·         Cancer of the prostate gland  is commonly adenocarcinoma which  develops as  a hard localized nodule in an area of atrophy

·         About 70% of cancer of the prostate gland arise in the peripheral zone (outer area of gland contiguous with a capsule)

·         20% in the transitional zone(midportion of the gland)and 10% in the central zone surrounding the urethra

·         Growth is generally on the outer portion of the gland compression of the urinary bladder and voiding symptoms  are not common until the cancer  has  advanced

·         The cancer may rapidly spread outside the capsule boundaries and be disseminated through the lymphatic and vascular systems

·         The most common sites for metastasis are the bones of the pelvis, lumbar and spine, femur and ribs

·         In the late stages of the disease there is involvement of the lungs, liver and kidneys

·         Because of its posterior location cancer of the prostate gland can be detected by rectal examination even before symptoms appear but unfortunately arise anterior to  the midline of the prostate and consequently they cannot be felt on rectal examination

Signs and Symptoms

·         There are no symptoms in the initial stage of the illness

·         Palpable mass felt on rectal examination

·         Elevated blood glycoprotein

·         Complaints of stiffness,back pain,hip pain

·         Urinary flow obstruction as seen in BPH

·         Severe bladder irritation

Step 4: Dignostic Procedures (10 minutes)

·         Blood screens for specific antigens(PSA)

·         Rectal examination digitally will reveal a hard palpable mass

·         Xray examination may whether cancer has spread to the lungs

·         Transrectalultrasonology(TRUS) where a n instrument inserted in the rectum produces sound waves directed at the prostate

·         Computed  tomography(CT) a picture produced by a computer from xrays  showing the prostate and other nearby parts of the body

·         Intravenous pyelography(IVP)

·         Tissue samples   (Prostate biopsy)

·         Lymphadenectomy(pelvic node dissection done to detect whether cancer has spread)

Step 5 Treatment  and Nursing Care of a Patient with  Cancer of the Prostate Gland (55 minutes)

Medication

·         Malignant cancer of the prostate gland is inoperable,or when  signs of metastasis occur after surgery ,pharmacological treatment is given,and some patients feel a relief with hormonal therapy ,the relief  may take about one year

·         Medications to block testosterone hormones in hormone dependant cancer  eg Zoladex are given for 1-3months depending on the preparation and condition of the patient

·         Antiandrogenic  drugs are used to inhibit the action of testosterone(androgenic blockade)

Radiation Therapy

·         Used if the patient cannot tolerate or chooses not to undergo surgery

·         Radiationcan be delivered by an external beam or by implant(brachytherapy 

·         The external beam therapy is given in short sessions

·         Internalretropubic prostatic implantation  is used usually after failure of the external beam therapy

Surgical Measures

·         Radical resection of the gland is curative for patients with low grade and confined cancer.

·         The entire gland is removed(prostatectomy)including the capsule and the adjacent tissues are removed and the remaining urethra is  anastomosed  to the bladder neck

·         The surgical approaches are –supra pubic,retropubic or perineal

• Suprapubic prostatectomy the prostate gland is removed from the urethra th
• rough the bladder and it is used when a large  mass of the tissue is to be resected,some hemosstatic agent is placed  in the prostatic fossa,and urine is drained fro a catheter,cystotomy tube or both
• Retropubicprostatectomy-a low abdominal incision similar to suprapubic prostatectomy is made but the bladder is not opened,but retracted and the prostatic tissue removed through an incision in the anterior prostatic capsule. Following this a large Foleys catheter is inserted
• Perineal prostatectomy ahole is made in the perineal area
• Orchiectomy (castration)is done to suppress  testosterone.The procedure is minor and is done under local anesthesia

Nursing care

Pre-operative care

·         Thorough explanation of the procedure to the patient is done to make him understand and cooperate

·         Ensure cleanliness to the patient

·         Patient should sign a consent form

·         Laboratory investigations are done to rule out conditions that can hinder or interfere  with the operation

Post-operative care

·         Receive the patient from theatre by making sure his alive

·         Make a quick assessment of the patient

·         Determine the level of consciousness

·         Check and record vital signs

·         Inspect the wound for bleeding and gapping

·         Make sure the drainage tubes ,(catheters ,infusions etc are working well)

·         Keep a record of intake and output

·         Perform passive exercises

·         Promote sexual function  by reassuring the patient that sexual ability returns gradually

·         Maintain a patent  catheter

·         Monitor for signs  of water intoxication

Step 6:  Complications of Enlargement of the Prostate Gland(10 minutes)

·        Retention of urine

·        Impotence

·        Metastasis

Post-operative complications

·         Impotence and sterility- the patient can be impotent for many months

·         Nerve damage leading to inability to control urine(incontinence)

·         Haemorrhage leading to anaemia

·         Wound infection