CONFIRMING DIAGNOSIS A biopsy confirms the diagnosis of prostatic cancer. PSA levels will be elevated in all men with metastatic prostatic cancer. 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 diagnosis.
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.
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, megestrol, 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 mitoxantrone with prednisone, estramustine, docetaxel, and paclitaxel) may be tried. However, current drug therapy offers limited benefit. Combining several treatment methods may be most effective.
Special considerations
The care plan for the patient with prostatic cancer should emphasize psychological support, postoperative care, and treatment of radiation adverse effects.
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 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; watch the patient for signs of bleeding (pallor, falling blood pressure, rising pulse rate) and infection.
❑Maintain adequate fluid intake.
❑Give antispasmodics, as ordered, to control postoperative bladder spasms. 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 urine stream, and straining to urinate) and for abdominal distention (from urethral stricture or catheter blockage). Irrigate the catheter as ordered.
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 and retropubic prostatectomy:
❑Explain that urine leakage after catheter removal is normal and will subside.
❑When a patient receives hormonal therapy, watch for adverse effects. Gynecomastia, fluid retention, nausea, and vomiting are common with DES. Thrombophlebitis may also occur, especially with DES.
After radiation therapy:
❑Watch for common adverse effects: proctitis, diarrhea, bladder spasms, and urinary frequency. Internal radiation usually results in cystitis in the first 2 to 3 weeks. Urge the patient to drink at least 67 ½ oz (2,000 ml) of fluid daily. Provide analgesics and antispasmodics, as ordered.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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- "Professional Guide to Diseases (Eighth Edition)" (2005)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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