Prostatic cancer
Prostatic cancer: Excerpt from Handbook of Diseases
One in 11 men will develop prostatic cancer, the second most common neoplasm found in men older than age 55. (In black men, it’s the most prevalent cancer.) Adenocarcinoma is its most common form; sarcoma occurs only rarely. Most prostatic cancer originate in the posterior prostate gland; the rest, near the urethra.
Malignant prostatic tumors seldom result from the benign hyperplastic enlargement that commonly develops around the prostatic urethra in elderly men. Prostatic cancer seldom produces symptoms until it’s advanced.
Causes
Although androgens regulate prostate growth and function and may also speed tumor growth, no definite link between increased androgen levels and prostatic cancer has been found. When primary prostatic lesions metastasize, they typically invade the prostatic capsule and spread along the ejaculatory ducts in the space between the seminal vesicles or perivesicular fascia.
Prostatic cancer accounts for about 18% of all cancers. The incidence is highest in Blacks and lowest in Asians. Incidence also increases with age more rapidly than any other cancer.
Signs and symptoms
Manifestations of prostatic cancer appear only in the advanced stages and include signs and symptoms of urinary obstruction, such as difficulty initiating a urinary stream, dribbling, urine retention, unexplained cystitis and, rarely, hematuria.
Diagnosis
A digital rectal examination that reveals a small, hard nodule may help diagnose prostatic cancer. The American Cancer Society advises a yearly digital examination for men older than age 40, a yearly blood test to detect prostate-specific antigen (PSA) in men older than age 50, and ultrasonography if abnormal results are found.
Biopsy confirms the diagnosis. PSA is produced by the normal neoplastic ductal epithelium of the prostate and secreted into the lumen; its concentration in the blood is proportional to the total prostate mass. PSA levels will be elevated in all patients with prostatic cancer, and serum acid phosphatase levels will be elevated in two-thirds of men with metastatic prostatic cancer. Therapy aims to return the serum acid phosphatase level to normal; a subsequent rise points to recurrence. Magnetic resonance imaging, computed tomography scan, and excretory urography may also aid the diagnosis.
CLINICAL TIP: Elevated alkaline phosphatase levels and a positive bone scan point to bone metastasis.
Treatment
Management of prostatic cancer depends on clinical assessment, tolerance of therapy, expected life span, and the stage of the disease. Treatment must be chosen carefully because prostatic cancer usually affects older men, who commonly have coexisting disorders, such as hypertension, diabetes, or cardiac disease. If the patient is younger than age 70, a radical prostatectomy is commonly performed. If the patient is age 70 or older, radiation (including implants) or cryosurgery may be performed to ablate the cancer.
Therapy varies with each stage of the disease and generally includes radiation, prostatectomy, orchiectomy to reduce androgen production, and hormone therapy with synthetic estrogen (diethylstilbestrol [DES]) and antiandrogens, such as cyproterone, meges-trol, and flutamide. Radical prostatectomy is usually effective for localized lesions.
Radiation therapy is used to cure some locally invasive lesions and to relieve pain from metastatic bone involvement. A single injection of the radionuclide strontium-89 is also used to treat pain caused by bone metastasis.
If hormone therapy, surgery, and radiation therapy aren’t feasible or successful, chemotherapy (using combinations of cyclophosphamide, doxorubicin, fluorouracil, cisplatin, etoposide, and vindesine) may be tried. However, current drug therapy offers little benefit. Combining several treatment methods may be most effective.
Special considerations
Care should emphasize psychological support, postoperative care, and treatment for the adverse effects of radiation.
Before prostatectomy:
❑ Explain the expected aftereffects of surgery (such as impotence and incontinence) and radiation. Discuss tube placement and dressing changes.
❑ Teach the patient to do perineal (Kegel) exercises 1 to 10 times an hour. Have him squeeze his buttocks together, hold this position for a few seconds, then relax.
After prostatectomy or suprapubic prostatectomy:
❑ Regularly check the dressing, incision, and drainage systems for excessive bleeding; monitor the patient for signs of bleeding (pallor, falling blood pressure, and rising pulse rate) and infection.
❑ Make sure the patient receives plenty of fluids.
❑ Give antispasmodics, as necessary, to control postoperative bladder spasms. Also give analgesics as needed.
❑ Urinary incontinence is common after surgery; keep the patient’s skin clean, dry, and free from drainage and urine.
❑ Encourage perineal exercises within 24 to 48 hours after surgery.
❑ Provide meticulous catheter care — especially if a three-way catheter with a continuous irrigation system is in place. Check the tubing for kinks and blockages, especially if the patient reports pain. Warn him not to pull on the catheter.
After transurethral prostatic resection:
❑ Watch for signs of urethral stricture (dysuria, decreased force and caliber of urinary stream, and straining to urinate) and for abdominal distention (from urethral stricture or catheter blockage). Irrigate the catheter as needed.
After perineal prostatectomy:
❑ Avoid taking a rectal temperature or inserting any kind of rectal tube. Provide pads to absorb urine leakage, a rubber ring for the patient to sit on, and sitz baths for pain and inflammation.
After perineal or retropubic prostatectomy:
❑ Explain that urine leakage after catheter removal is normal and will subside.
❑ When a patient receives hormonal therapy, watch for adverse reactions. Gynecomastia, fluid retention, nausea, and vomiting are common with DES. Thrombophlebitis may also occur, especially with DES.
After radiation therapy:
❑ Watch for common adverse reactions: proctitis, diarrhea, bladder spasms, and urinary frequency. Internal radiation usually results in cystitis within the first 2 to 3 weeks.
❑ Urge the patient to drink at least 2 qt (2 L) of fluid daily.
❑ Provide analgesics and antispasmodics as ordered.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Prostate conditions
More Medical Textbooks Online about Prostate conditions
Review other book chapters online related to Prostate conditions:
Medical Books Excerpts
- Prostatitis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
|
|
» Next page: Prostatitis (Handbook of Diseases)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
