Prostate Cancer – Risk factors, Symptoms and Prevention.

Definition – Prostate Cancer

Prostate cancer occurs in the prostate gland which is found in males that secretes seminal fluids and transport sperm. The fluid is essential for reproduction. The prostate gland is located in the pelvis below the bladder. Just behind the prostate are glands called seminal vesicles that produce most of the fluid for semen. Usually, the prostate gland grows slowly and it is confined to the prostate gland. This type of cancer is comprised nearly always of adenocarcinoma cells that arise from glandular tissue.

History

• 1536- First prostate described by Venetian anatomist Niccolò Massa
• 1538- Illustrated by Flemish anatomist Andreas Vesalius
• It was initially considered a rare disease, probably because of shorter life expectancies and poorer detection methods in the 19th century. Removal of the entire gland (radical perineal prostatectomy) was first performed in 1904 by Hugh H. Young at Johns Hopkins Hospital.
• Radiation therapy for prostate cancer was first developed in the early 20th century.
• Systemic chemotherapy for prostate cancer was first studied in the 1970s.

Prevalence of Prostate Cancer

• Prostate cancer develops primarily in men over fifty. It is the most common type of cancer in men in the United States, with 186,000 new cases in 2008 and 28,600 deaths.
• It is the second leading cause of cancer death in U.S. men after lung cancer. In the United Kingdom, it is also the second most common cause of cancer death after lung cancer, where around 35,000 cases are diagnosed every year and of which around 10,000 dies of it.
• More than 80% of men will develop prostate cancer by the age of 80. However, in the majority of cases, it will be slow-growing and harmless. In such men, diagnosing prostate cancer is overdiagnosis the needless identification of a technically aberrant condition that will never harm the patient and treatment in such men exposes them to all of the adverse effects, with no possibility of extending their lives.

Types of Prostate Cancer

Types of prostate cancer are as follows:

Acinar adenocarcinoma

Adenocarcinomas are cancers that develop in the gland cells that line the prostate gland. They are the most common type of prostate cancer. Nearly everyone with prostate cancer has this type.

Ductal adenocarcinoma

Ductal adenocarcinoma starts in the cells that line the ducts (tubes) of the prostate gland. It tends to grow and spread more quickly than acinar adenocarcinoma.

Transitional cell (or urothelial) cancer

Transitional cell cancer of the prostate starts in the cells that line the tube carrying urine to the outside of the body (the urethra). This type of cancer usually starts in the bladder and spreads into the prostate. But rarely it can start in the prostate and may spread into the bladder entrance and nearby tissues.

Squamous cell cancer

These cancers develop from flat cells that cover the prostate. They tend to grow and spread more quickly than adenocarcinoma of the prostate.

Small cell prostate cancer

Small cell prostate cancer is made up of small round cells. It’s a type of neuroendocrine cancer.

Risk Factors of Prostate Cancer

The main cause of prostate cancer is unknown. But some of the risk factors may be possible for the cause of prostate cancer. Some of the risk factors such as follow:

Age: prostate cancer occurs in men who are above 40 age and rare in younger men. The chances of getting prostate cancer rise rapidly after age 50.

Race: Most often it occurs in African- American men and in Caribbean men of African ancestry than in men of other races. Mostly black men carry a risk of prostate cancer than do men of other races.

Family history: Prostate cancer may run in families due to the inherited genetic factors. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease.

Genetic factors: Some of the genetic factors such as the mutation in the portion of the gene called BRCA2 can increase the risk of prostate cancer as well as other cancers.

Other factors: certain other factors such as obesity, increased calcium intake, and dairy foods may increase the risk of prostate cancer.

Causes of Prostate Cancer

• Like other types of cancer, prostate cancer cause also not easy to examine. Prostate cancer begins when some cells grow abnormally due to gene mutations
• Several inherited genes have been identified that increase the risk of prostate cancer, including RNASEL, BRCA 1, and BRCA 2, DNA mismatch genes, HPC1, and HoxB13
• The abnormal cells start to multiply and other good cells would die, this abnormal cell forms the tumor that can invade surrounding tissue
• Some abnormal cells can break out and spreads to other organs of the body called metastasize. But some risk factors may also cause prostate cancer

Signs and Symptoms

Symptoms of prostate cancer in men can be of a bladder and urinary problems that result in:

• Difficult and repeating urination. Especially, during the night time.
• Loss of control of the bladder
• The velocity of the urine flow is reduced
• Burning during urination but it is less common
• Haematuria, a condition in which blood passes along with the urine
• Discomfort while in sitting posture because of an enlarged prostate

Other symptoms of prostate cancer

• Blood in semen
• Erectile dysfunction
• Pain during ejaculation
• Swelling of the pelvic area
• Numbness in the hips, legs or feet
• Bone pain that leads to fractures and doesn’t go away

Sometimes, men do not have these symptoms in rare cases and can be symptoms of other medical conditions that are not cancer. Non-cancer conditions like BPH or an enlarged prostate can pose similar symptoms as in prostate cancer. Metastatic prostate cancer (Beyond the prostate) has the following symptoms:

• Pain in the back, hips, thighs, shoulders, or other bones
• Swelling of the legs or feet
• Extreme weight loss
• Fatigue
• Change in bowel movements

Complications due to Prostate Cancer

There are two types of complications arise in prostate cancer:

1. Disease-related complications
2. Treatment-related complications.

Disease-related complications

• Urethral obstruction
• Blockage of the ureters
• Destructive pain in the pelvic region
• Bony pain
• Tiredness
• Death

Treatment-related complications

• Impotence
• Incontinence
• Disease recurrence
• Loss of muscle mass
• Cardiovascular disease
• Diabetes
• Night sweat
• Extreme weight gain during testosterone reducing therapy
• Difficulty with concentration and memory
• Depression

How to diagnose and test Prostate Cancer?

Biopsy

When performing the biopsy, your doctor inserts a small probe into the rectum and cut a sample of small tissue from the prostate for histopathology study to stage cancer. This will help a doctor to determine and examine the suitable treatment options.

Bone scan

Prostate cancer tissue can proliferate into the bone, thus bone scan is required during diagnosis. If you are experiencing pain in the bone, a blood test will show the increased calcium levels and your doctor says for a bone scan to check the level of metastasizes. The bone scan will give an image of the bone, which shows cancerous cells, fractures, and monitor other bone conditions such as arthritis and infection.

CT scan

A CT scan image will show blood flow and the tissue anatomy around the prostate gland, and paves the appropriate way for monitoring tumor growth.

Digital rectal exam

The digital rectal exam is the initial step in diagnosing the health of the prostate and is often performed as routine screening. During this diagnosis, a doctor inserts a gloved finger into the rectum, to check the shape, texture, and size of the prostate.

Genetic tests

Two types of genetic testing are performed after the digital rectum exam.

Provision: Three prognostic molecular biomarkers such as PTEN, ERG, and HOXD3 are present in prostate cancer cells. If a patient with ERG translocation, PTEN deletions, and methylation of HOXD3 typically have less prognosis. A genetic test is performed using the prostate tissues.

PCA3 (Prostate cancer antigen 3) gene testing: In prostate cancer cells this gene is overexpressed. It is performed using the urine sample after the digital rectal exam.

MRI

Using MRI image a clear image of the entire prostate gland is identified. Using this image, the stage of cancer can be revealed and precisely pinpoints the cancerous cells in the body.

PET/CT scan

A PET scan is very much useful for prostate cancer because its image can reveal the cancerous cells efficiently before the formation of a  tumor. It can catch the disease as early as possible. Before performing this scan, a sugar solution with the small amount of radioactive material is injected into the vein of a patient. The pet can able to visualize the cancerous as it up takes the glucose along with radioactive materials and also the rate at which the cancerous cells uptakes the glucose (helps to find the tumor grade).

ProstaScint scan

A radioactive material called prostaScint is injected into the body to detect the spread of cancer into lymph nodes, adjacent tissue, and bones. The radioactive materials that are uptake by the cancer cells show hotspot using a camera.

PSA test

Prostate-specific antigen (PSA) that is present in the blood is measured. PSA is produced by prostate gland shows as a sign of prostate cancer. the high level of PSA in the blood also indicates the noncancerous conditions such as prostate inflammation and enlargement.

Ultrasound

Ultrasound image shows the size, shape, and tumor activity of the prostate cancer in adjacent tissues.

Treatment and medications for Prostate Cancer

Active surveillance

Active surveillance is recommended for cancer at the earliest stage and growing slowly. It is also preferred during the treatment of cancer patients. During the active surveillance, the signs that are worsening the cancer are monitored.

Surgery chemotherapy

Surgery involves the removal of the prostate gland and its affected surrounding tissues. It will help to eliminate the spreading of cancer outside the prostate. Surgical options such as:

Radical (open) prostatectomy

Radical prostatectomy involves the surgical removal of the prostate along with the seminal vesicles and lymph nodes in the pelvic area may also be removed. This choice of surgery creates a risk of disturbing sexual function. It is possible for a man to maintain his sexual function after nerve-sparing surgery by explicating the nerves that make erections and orgasm.

Robotic or laparoscopic prostatectomy

It is a type of surgery, which is operated entirely by robotic equipment. Robotic or laparoscopic prostatectomy is a less invasive procedure, in which a camera and endoscope are inserted into a small incision on the abdomen region. The surgeon operates the equipment’s through a computer screen and LED screen to remove the prostate gland and affected the surrounding tissue.

External beam radiation therapy

A radiology oncologist uses a beam of X-rays to pass into the affected area. Some cancer centers use conformal radiation therapy (CRT), which helps the radiologist to map the accurate spot of cancer rather than damaging the healthy tissues and organs.

Brachytherapy

Brachytherapy is an internal radiation therapy in which radioactive material is inserted directly into the prostate. These radioactive materials are called as ‘seeds’ which are allowed to emit radiation around the inserted area for a short time (High dose rate) or for a longer duration (low dose rate). Usually, low dose seeds are left in the prostate for up to one year, whereas the high dose seeds are left only for 30 minutes.

Hormone therapy

Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy (AST). This therapy reduces the androgens to stop them from affecting prostate cancer cells because androgen stimulates the cancer cells in the prostate to proliferate in numerously.

Stereotactic radiosurgery

Stereotactic radiosurgery (SRS) is non-surgical radiation therapy. It is a shorter course of focal high dose radiotherapy to eradicate the tumors. It is performed along with innovative imaging technologies combined with a sophisticated computer system to deliver a very accurate high dose of radiation under millimeter measurement.

Cryotherapy

Cryotherapy is also called cryosurgery or cryoablation which uses very cold temperature to freeze the prostate cancer cells to kill.  With the help of transrectal ultrasound (TRUS), a doctor inserts a hollow probe or needle through the skin between the scrotum and anus into the prostate. Very cold gases or liquid is injected into the prostate to destroy the cancer tissues. Thereby entire prostate tends to be destroyed.

Nursing care plans for Prostate Cancer

3 Nursing Diagnosis and Nursing Interventions for Prostate Cancer

1. Impaired Urinary Elimination related to an enlarged prostate, and bladder distension.

Intervention:

•     Encourage the patient to urinate every 2-4 hours and when it suddenly felt.
•     Observation of the flow of urine, note the size and strength.
•     Percussion/palpation of the suprapubic area.
•     Encourage fluid intake to 3000 ml per day.
•     Monitor vital signs closely
•     Collaboration in the provision of drugs.

2. Resti for Infection related to invasive procedures (tools during surgery)

Intervention:

• Maintain a sterile catheter system, provide catheter care and give regular antibiotic ointment around the catheter.
• Perform ambulation with a dependent drainage bag.
• Observation of wound drainage around the suprapubic catheter.
• Replace dressings with frequent (supra incision / retropubic and perineal), cleaning and drying of the skin over time.
• Collaboration in the provision of antibiotics.

3. Imbalanced Nutrition, Less Than Body Requirements related to nausea and weight loss

Intervention:

•      Assess the patient’s nutritional status.
•      Encourage the patient to eat small amounts frequently.
•      Collaborate with a nutritionist.
•      Collaborate with the physician in the delivery of antiemetic drugs.

Prevention of Prostate Cancers

Healthy diet

• Follow a low-fat diet.
• Take more fat from plants than from animals.
• Increase the number of fruits and vegetables you eat each day.
• Eat enough fish.
• Reduce dairy products in a day.

Maintain a healthy weight

• Do enough physical exercise daily.
• You can achieve this by reducing the number of calories consuming per day.
• Choose vegetables, fruits, and whole grains that are rich in antioxidants.
• 30 minutes of physical exercise per day reduces the risk of the prostate in men.