There are three key risk factors to think about: We know that in the UK one in four black men will be diagnosed with prostate cancer, which is double the risk of a white man (one in eight). Impaired Urinary Elimination related to an enlarged prostate, and bladder distension. Improving Supportive and Palliative Care for Adults with Cancer. All patients diagnosed with prostate cancer will have a review of their medical history, histology and any imaging that has been performed, and a risk category will be assigned to their disease (NICE, 2014). The MRI scan will show if tumours are confined to the prostate or if there is any local or distant spread of disease (Kirkham et al, 2013). Making sense of screening, Second edition 2015 –, Prostate Cancer UK – This is so we can be sure that they work and that they are safe. A biomarker can be defined as a measureable characteristic that highlights a difference between two biological states. Shields are used to protect surrounding healthy tissues and reduce the risk of damaging nearby organs including the bladder and bowel (Colley, 2014; Dasgupta and Kirby, 2012). Citation: Bagnall P (2014) Diagnosis and treatment of prostate cancer. A large clinical trial called Procure, looking at EN2 as a potential biomarker for prostate cancer, is aiming to complete and publish by Autumn 2016. Hormone therapy and radiotherapy in combination increase the time before disease progresses and overall length of survival, compared with radiotherapy or hormone therapy alone (NICE, 2014). Prostate cancer usually affects men over the age of 50, and the risk increases with age. The aim of hormone therapy is to block the production of androgens, including testosterone, upon which most prostate cancers depend for growth. External-beam radiotherapy may be offered at any stage of disease. Analysis of 20 studies selected according to these criteria revealed four important aspects of specialized nursing care: care provided 1) at the time of prostate cancer diagnosis; in the 2) pretreatment and 3) posttreatment periods; and 4) in the assistance of partners and family members of … When men are off treatment, serum testosterone levels may rise, reducing side-effects and increasing wellbeing (NICE, 2014). Men whose father was diagnosed with prostate cancer have a 112-140% increased risk; those who also have a brother with the disease have a 187-230% greater risk. During the course of the pandemic, a tree has sprouted in the…, South Eastern Health and Social Care Trust, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Prostate cancer is the most common neoplasm in males older than age 50; it’s a leading cause of male cancer death. Prostate-specific antigen (PSA) – PSA is an enzyme and cancer marker for Prostate cancer. To protect patients from this rise (known as “flare”), they are given an antiandrogen such as cyproterone acetate and bicalutamide for 1-2 weeks before and after their first injection. London: NICE. He may also have a greater risk if his mother or sister has been diagnosed with a type of breast cancer that is due to a fault in the genes BRCA1 or BRCA2. BPH is not cancer and does not increase the risk of developing cancer. Every year over 44,000 men are diagnosed with the disease in the UK and it kills more than 10,000, – Prostate cancer is the most common cancer in men, – Current diagnostic tests for prostate cancer can give false negatives and false positives and are therefore currently unsuitable for a national screening programme, – Men need support to make an informed decision on whether or not to be tested for prostate cancer. Having a biopsy to diagnose prostate cancer. Although the death rate has fallen by 20% over the last 30 years, it remains the second most common cause of death from cancer among men, accounting for 13% of all male cancer deaths (CRUK, 2013a). It also includes recommendations on follow-up in primary care for people diagnosed with prostate cancer. The current first step to diagnosis is the PSA blood test via an informed choice programme, but it is not a definitive test and can only indicate a problem with the prostate. The PCRMP recommends that age-related PSA referral values are used: 3ng/ml and above for men aged 50-59, 4ng/ml and above for men aged 60-69 and above 5ng/ml for men aged 70 and over. Before new tests can be introduced they need to be tested thoroughly. Also the PSA test does not differentiate between slow and fast growing cancers, which can lead to unnecessary treatment and side effects for a cancer that would never cause the man any harm within his lifetime. prostate cancer diagnosis The initial step for diagnosing prostate cancer in men will be a simple physical examination, and the doctor will ask you more about your physical history. Plan of Nursing Care: The Patient with Prostate Cancer Nursing Diagnosis: Anxiety related to concern and lack of knowledge about the diagnosis, treatment plan, and prognosis. The enlargement of the prostate may cause difficulty urinating, having to urinate more often, especially at night, and a weak urine stream. According to the American Cancer Society, more than two million men in the United States are prostate cancer survivors. It's usually done under a general anaesthetic (while you're asleep). Therefore, it is imperative to ensure that the man takes into account these pros and cons in the context of his own risk of prostate cancer, and his personal circumstances. Although it may reassure the man if their PSA level is within the normal range for their age, this can also be a limitation as it can miss cancer and provide false reassurance, along with causing unnecessary worry and testing if there is no cancer. Diagnostic biomarkers tell us if a man has prostate cancer or not. There is currently no national screening for prostate cancer as there is no clear evidence that screening using current tests brings more benefit than harm. Early studies investigating this protein have been encouraging, but further larger scale and longer-term clinical studies are required. For the first time, basketball legend Kareem Abdul-Jabbar is opening up about his private battle with prostate cancer since being diagnosed 11 years ago.. Cancer Research UK (2012c) Prostate Cancer Survival Statistics. It is thought that hormone therapy causes the volume of prostate cancer to shrink, making it more sensitive to radiotherapy (Kirby and Patel, 2014). The stage of the cancer will determine which types of treatments will be necessary. The blood test, known as a prostate-specific antigen (PSA) test, measures the level of … Nurses play a vital role in ensuring that all men concerned about prostate cancer are armed with the information they need to make an informed decision about testing. Treatments include pelvic floor muscle exercises, functional electrical stimulation, biofeedback and extracorporeal magnetic innervation to help patients recover after surgery (e.g. It is a major operation and offered only to men who are fit and have no other health conditions (NICE, 2014). Or, on the other hand, should we disregard the PSA test entirely and concentrate on other biomarkers? The benefits of having a PSA test include finding prostate cancer before symptoms develop and diagnosing the cancer at an early stage when it’s more likely it can be successfully treated. Below are five (5) nursing care plans (NCP) and nursing diagnosis for benign prostatic hyperplasia: 3 Nursing Diagnosis and Nursing Interventions for Prostate Cancer 1. Patients should be asked regularly whether their side-effects are troubling, as their views and quality of life may change over the years. Its incidence has risen by 22% in the past decade (Cancer Research UK, 2012a); in 2010, 40,975 cases were diagnosed (CRUK, 2012b). During a routine checkup,the nurse practitioner at the local health clinic performs a digital rectal examination and palpates a hard nodule on the surface of Mr. Turner’s prostate. Patients suspected to have metastatic prostate cancer - for example those with a PSA >20ng/ml or X-rays that show possible metastases as the cause of bone pain - will probably have a bone scan performed instead of a TRUS. Symptoms of metastatic disease include bone pain, pathological fracture, spinal cord compression, anaemia, leg lymphoedema, and hypercalcaemia (Dasgupta and Kirby, 2012). Goal: Reduced stress and improved ability to cope Expected Outcomes Rationale Nursing Interventions Appears relaxed . London: NICE. Prostate cancer is the most common cancer in men – one in eight will develop it at some time Prostate cancer Picture: iStock Essential facts Prostate cancer starts in the prostate gland, at the base of the bladder in men. Once the man has made an informed choice to have the PSA test, it is important to explain to him that he should avoid vigorous exercise and not ejaculate 48 hours prior to the test. Treatments for prostate cancer affect masculinity, as side-effects include erectile dysfunction, testicular shrinkage, breast development and loss of strength. Prostate cancer is the most common cancer in men. The next step to confirming a diagnosis of prostate cancer is a digital rectal examination (DRE). Nursing Care Plans for Prostate Cancer. He will also be unable to have the test if he’s had a prostate biopsy within the previous six weeks or a DRE within the previous week before the test. The PCRMP is currently undergoing a review with updated guidance which is expected to be released by the end of 2015. Prostate Cancer. It is normal for men to have a small amount of PSA in their blood, and as men get older this amount can rise. Treatment, usually hormone therapy, is started when they develop symptoms of disease progression. National Institute for Health and Care Excellence (2014) Prostate Cancer: Diagnosis and Treatment. This is because prostate cancer is an oncology diagnosis. Tests that doctors are looking at include new types of MRI scans and breath tests. Prophylactic antibiotics are essential due to a 0-2% risk of serious infection including bacteraemia, urosepsis or abscess (NCCC, 2014). While some men joke about their feminisation, this may mask psychological distress. The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy. Cancer treatment may include chemotherapy, radiation, and/or surgery. Symptoms of cancer may already be present, and they will give the doctor a better idea. Prostate cancer is the most common cancer in men in the UK. Prostate cancer diagnosis and screening continues to be one of the most fiercely debated subjects surrounding the disease and gives rise to a number of questions that remain to be answered. The prostate health index (PHI) is designed to categorise men (aged 50 and over whose PSA levels are between 2-10ng/ml with negative DRE) into low, moderate and high probabilities of prostate cancer (found on biopsy). If histology or PSA surveillance demonstrates that there is disease progression following prostatectomy, salvage radiotherapy may be possible. 3. The PSA test is not an accurate diagnostic test for prostate cancer. 2. In an essay Abdul-Jabbar wrote for WebMD, the NBA’s all-time leading scorer revealed how he’s had prostate cancer, leukemia and heart bypass surgery to shed light on the health challenges facing Black people. These drugs prevent testosterone binding to androgen receptors. The prostate gland develops after puberty due to the testosterone surge. (accessed 26 October 2015). Though BPH does not cause prostate cancer, men with the former diagnosis are also at risk for the latter. Other factors that should be considered in conjunction with the PSA level are prostate size, DRE findings, age, ethnicity, co-morbidities, history of any previous negative biopsy and any previous PSA history. Trauma, for example from catheterisation, can also raise the PSA result. Although it may reduce the number of deaths from the disease, on a population-wide level this is outweighed by the harm it can cause – diagnosing many more men whose cancer is indolent, subjecting them to unnecessary treatment that can impact on their quality of life. Removal of the prostate gland and seminal vesicles aims to cure prostate cancer. It is an option for men with low-risk localised prostate care whose prostate gland volume is <50ml (NICE, 2014). At the end of nursing interventions, the patient and/or significant other is expected to: Verbalize feelings about changes in family processes; Participate in interventions to help resolve issues; The seeds remain radioactive for up to 10 months. Although it is currently only available in a few UK private hospitals and clinics, it is being assessed by NICE as we need more evidence to see how much PCA3 in the urine denotes prostate cancer. PSA is a protein produced by the prostate. This rise is due to the increasing age of the population and improvement in diagnostic tests. Only around 25% of men with a PSA of 4-10ng/ml who have a biopsy will be diagnosed with prostate cancer (Burford et al, 2009), while Thompson et al (2004) found that 15% of those with a PSA less than 4ng/ml had prostate cancer on biopsy. Prostate adenocarcinomas are graded using the Gleason sum score of 1 (well-differentiated cells) to 5 (poorly differentiated cells); the sum is calculated by adding the scores for the most widespread and second most widespread cells. London: Cancer Research UK. Chichester: Wiley. The identified risks of prostate cancer are age, family history and ethnic origin; there is no evidence that lifestyle changes reduce risk (CRUK, 2013b). It can be anything that changes in response to a biological transition (eg a gene, protein, part of a cell). First we have coping. It is more than 20,000 times more potent than PSA and some evidence suggests it activates and regulates PSA. It surrounds the first part of the urethra, which carries urine from the bladder. Burford DC et al (2009) Prostate Cancer Risk Management Programme: Information for Primary Care; PSA Testing in Asymptomatic Men. A total of 500 men with a PSA between 4 and 20ng/ml and no previous history of prostate cancer will be enrolled from the Surrey area. National Institute for Health and Care Excellence. ‘The challenges for learning disability nurses must be recognised’, Cases of prostate cancer are increasing but significant advances have been made in the diagnosis and management of this condition. Long-term urinary incontinence and erectile dysfunction may be minimised by nerve-sparing techniques during surgery, or treatment with pelvic floor exercises, medication, further surgery or a combination of these (Kirby and Patel, 2014). A second-degree relative (uncle, nephew, grandfather) diagnosed with the condition increases risk by 90-95% (CRUK, 2013b). With no national screening programme, diagnosing prostate cancer remains one of the biggest challenges facing health professionals. At present, the PSA blood test is the best method we have of identifying an increased risk of prostate cancer in a man. This guideline covers the diagnosis and management of prostate cancer in secondary care, including information on the best way to diagnose and identify different stages of the disease, and how to manage adverse effects of treatment. Nursing Times; 110: 9, 18-19.Dasgupta P, Kirby R (2012) ABC of Prostate Cancer. A common condition in the aging cycle of men that causes enlargement of the prostate gland that surrounds the urethra. The cumulative risk of prostate cancer for men with Lynch syndrome was 6.3% at age 60 and 30% at age 80, versus a population-wide risk of … Most early stage prostate cancers do not cause any symptoms, mostly because either the tumour is small or in the outer part of the prostate and is therefore not putting any pressure on the urethra. After his PSA is found to be ele- vated,he is referred to a urolog ist,who diagnoses prostate cancer. Research into the diagnosis and causes of prostate cancer. n=226 of 320 patients. It can produce false positive and false negative results – approximately 76% of men with a raised PSA level do not have prostate cancer on biopsy (false positive), and around 15% of men with prostate cancer on biopsy (and 2% with a fast growing prostate cancer) do not have a raised PSA (false negative). For example, if most cells are poorly differentiated and the second most widespread are not quite so poorly differentiated the sum score would be 5+4=9; 3+3=6 is the lowest grade diagnosed by needle biopsy (Dasgupta and Kirby, 2012). A) Limit the time that visitors spend at the client’s bedside. It is often diagnosed incidentally, following investigation of lower urinary tract symptoms, which include: Men with locally advanced disease may present with symptoms of: haematuria; haemospermia (blood in semen); erectile dysfunction; difficulty passing urine; retention of urine or anuria; and pain in the penis, perineum or suprapubically. Bicalutamide can be given as monotherapy to men with locally advanced high-risk prostate cancer (NICE, 2014); serum testosterone is unaffected by bicalutamide, so fewer patients develop erectile dysfunction than those treated with LHRH and BSO. There are four main types of biomarker relevant to prostate cancer: risk, diagnostic, prognostic and predictive. Mutation of the BRCA2 gene, which is most commonly associated with breast cancer risk, causes a fivefold increased risk of prostate cancer; this risk can be more than sevenfold higher in men under 65 years (CRUK, 2013b). The rectum is close to your prostate gland, so your GP is able to … Nurses should be alert to cues and offer patients referral to professionals for help with psychosexual issues (NICE, 2014). The ejaculatory ducts open just lateral to the verumontanum, where the contents of the seminal vesicles are emptied; seminal fluid and prostatic secretions are mixed to form semen. Prostate cancer nursing management must be well understood because prostate cancer is the second most common cancer in men after skin cancer; however, prostate cancer can be successfully treated. Medical organizations don't agree on the issue of screening and whether it delivers benefits.Some medical organizations recommend men consider prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer.Discuss your particular situation and the benefits and risks of screening with your doctor. Radioisotope bone scans are performed to look for bone metastases. Prostate cancer is one of the most common forms of cancer diagnosed in men, second to skin cancer. Men whose mother was diagnosed with breast cancer have a 19-24% increased risk of prostate cancer (CRUK, 2013b). Gonadotropin-releasing hormone (GnRH) antagonists (degarelix) prevent the production of LHRH in the hypothalamus, and stimulate the pituitary gland to produce LH. London: Cancer Research UK. TRUS allows prostate volume to be assessed accurately and any abnormal areas seen in the peripheral zone can be targeted for biopsy. British Medical Journal; 344: d7894.Thompson IM et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0ng per milliliter. Prostate Cancer UK is a major beneficiary of Movember. Initially, testosterone levels rise with treatment but fall to castrate levels in approximately two weeks. In 2011, there were 10,793 deaths in the UK due to prostate cancer. Intervention: Encourage the patient to urinate every 2-4 hours and when it suddenly felt. Table 3 describes the staging of prostate cancer. NHS Cancer Screening Programmes. Another urine test is the prostate cancer gene 3 (PCA3) (Progensa) that detects the amount of PCA3 protein in the urine following prostatic massage. However, black men are more likely to be diagnosed at a younger age than white men, therefore should start to think about their risk from the age of 45. Cancer Research UK (2013b) Prostate Cancer Risk Factors. Ben-Shlomo Y et al (2007) The Risk of Prostate Cancer Amongst Black Men in the United Kingdom: The PROCESS Cohort Study. Urine testing for prostate cancer may be a possibility; either as a stand alone test or in combination with PSA testing. Colley W (2014) Incontinence following prostate cancer surgery. Luteinising hormone-releasing hormone agonists (LHRH), such as goserelin acetate or leuprorelin injections, work by stopping the production of luteinising hormone (LH), which stimulates the testicles to produce testosterone; these can be given monthly or every three months. 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Unfortunately the downside to tests that measure proteins in urine is that the amount of protein found varies depending on an individual’s urine concentration so this needs to be taken into account when analysing the results. Active surveillance is recommended for men with low-risk localised prostate cancer; they also have the choice of radical prostatectomy or radical radiotherapy. Treatment will depend on risk category and stage of disease. Hormone therapy, also called androgen deprivation therapy, is given to treat metastatic prostate cancer or in combination with external beam radiotherapy for localised or locally advanced prostate cancer. Between 2008 and 2010, only 1% of diagnoses were in men aged 50 years or under, and 75% of men were over 65 years of age (CRUK, 2012a). If the man has a father or brother who has been diagnosed with prostate cancer, his risk is two and a half times greater than if he has no affected first-degree relatives. Patients often expect doctors to recommend a treatment and can find it distressing to have to make a choice, particularly as there is a great deal of uncertainty about disease progression (NICE, 2014). Urinary infection should also be ruled out as this can elevate the PSA level for many months, even after treatment. However, it is essential that they are counselled in the limitations of the test beforehand so that they can make an informed choice. Although active treatment would be recommended to men with intermediate or high-risk localised prostate cancer, some choose active surveillance. To help men make this decision, there is a shared decision tool available that helps men through the process.3. National Collaborating Centre for Cancer (2014) Prostate Cancer Diagnosis and Treatment. Sign in or Register a new account to join the discussion. The patient should be involved in any decision about referral to another healthcare provider. Whether to test healthy men with no symptoms for prostate cancer is controversial. Author: Pauline Bagnall is uro-oncology nurse specialist, Northumbria Healthcare Foundation Trust. TRUS (without biopsy) is used to measure prostate volume and shape, and place radioactive seeds in the prostate gland through the perineum. Diagnosis of cancer/terminal cancer; Potential loss of a loved one due to cancer. Using a decision aid, such as the Localised Prostate Cancer Decision Aid (NHS, 2012), can be help guide them through the process while ensuring their own beliefs and values are considered; for example, remaining potent might be a key factor. Symptoms vary depending on the type. Okay. National Cancer Intelligence Network and Cancer Research UK (2009) Cancer Incidence and Survival by Major Ethnic Group, England, 2002-2006. Italian nurses are responsible for perioperative nursing and are involved in pain assessment and rehabilitation following prostate cancer therapies. Biopsies of the prostate, guided by an ultrasound probe inserted into the rectum, are performed for men with raised age-specific PSA and/or abnormal DRE. 1. Reg. One of the most important goals of palliative care is easing the physical symptoms of the cancer itself and any side effects from treatment. For example, if a man suffers from health anxiety, would knowing his PSA level create more or less concern? prostate cancer 3 diagnosis and interventions the word prostate comes from medieval latin prostate and medieval french prostate the ancient greek word prostates means ... prostate cancer nursing management in providing direct care to these patients the nurse has a unique opportunity to initiate a conversation with the patient about concerns. Report from a UK consensus meeting. Kirby R, Patel M (2014) Fast Facts: Prostate Cancer. Survival trends from 2005-09 indicate that 93.5% of men diagnosed with prostate cancer are expected to survive for at least one year, and 81.4% for five years or more (CRUK, 2012c). It is only available privately and ProstateHealth UK – who hold the licence – believes that when incorporated with the PSA test it can provide a more accurate method of detecting prostate cancer. Cancer Research UK (2013a) Prostate Cancer Mortality. It is found adjacent to the PSA gene and exists in multiple forms in serum and as free and complexed HK2. Suspected cancer: recognition and referral. Nursing care for patients with benign prostatic hyperplasia includes preparation for surgery (if possible) administration of medications for pain, and relieving urinary retention. Permanent seed brachytherapy is a form of radiotherapy. The Manual. This article provides an overview of the patient pathway. Although there is no national programme to screen for prostate cancer, men aged over 50 who request screening, after considering the consequences, should be given a PSA test (Burford et al, 2009). The transition zone is most commonly affected by benign enlargement, while 70% of prostate cancers are found in the peripheral zone (Dasgupta and Kirby, 2012). However, it is irreversible and men are often reluctant to agree to BSO as it can harm body image. Nursing diagnoses and NIC interventions in adult males undergoing radical prostatectomy ... Nearly 1.1. million men received a diagnosis of prostate cancer (Pca) around the world in 2012. It is monitored until the correct dose is reached; the tubes are then removed so patients do not need to take precautions following treatment (Dasgupta and Kirby, 2012). It is recommended to men with prostate cancer that is unlikely to affect their life expectancy. This can be done by your GP. Of the 4127 men involved in the study, 97 had prostate cancer. Asian men have a lower risk (National Cancer Intelligence Network and CRUK, 2009). Table 2 lists the benefits and risk of this test in asymptomatic men. Due to a risk of seeds being discharged in semen, they are advised to wear a condom for the first three ejaculations (Colley, 2014; Kirby and Patel, 2014). However, a side-effect of bicalutamide monotherapy is gynaecomastia (breast development) and men prescribed the treatment for six months or more should be offered radiotherapy to their breast buds to prevent this (NICE, 2014). Risk biomarkers indicate if a man is at a higher than average risk of prostate cancer. Abingdon: Health Press. Prostate cancer is diagnosed using a combination of prostate-specific androgen (PSA) blood testing, digital rectal examination (DRE), biopsy and magnetic resonance imaging (MRI) scan; a bone scan may be used for staging. One of the main disadvantages is anxiety, and some patients choose treatment over the uncertainty of living with untreated cancer (NHS, 2012). It is similar in size and shape to a walnut, and positioned at the base of the bladder, surrounding the urethra between the rectum and symphisis pubis (Fig 1). Urinary frequency, particularly at night; National guidance on the diagnosis and treatment of prostate cancer has been updated, Nurses have an important role in supporting patients to make treatment choices, Prostate cancer treatments can affect men’s masculinity and wellbeing, There have been recent improvements in prostate cancer knowledge and diagnostic technology, The PSA result is not an accurate diagnostic test for prostate cancer. Scientists are also looking into urine testing for a combination of transmembrane protease serine 2 (activated by testosterone) combined with a gene known to have potential to cause cancer – ERG (TMPRSS2-ERG). 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