About

➀ Read and Learn

The following course content

Introduction   

Prostate cancer is the third most common type of cancer in males and those who were assigned as males at birth (AMAB), secondary to skin cancer except melanoma. In this course, we will discuss the risks of prostate cancer, prevention, and treatment, specifically radical prostatectomy. We will discuss the rates of prostate cancer, review the pathophysiology and role of the prostate in this group of patients, and discuss research on newer treatments that are or may become available. 

Definition 

Prostate cancer occurs in the outer part of the prostate, which is a walnut-sized gland sitting below the bladder and in front of the rectum (6). It secretes fluid to mix with sperm, keeping the sperm healthy for conception. There are several types of treatment for prostate cancer. The most radical treatment is complete removal of the prostate or radical prostatectomy. We will discuss the different types of prostatectomies, nursing considerations, and post-operative eff

Epidemiology  

According to the Journal of American Medicine, the number of people with prostate cancer will more than double worldwide over the next 2 decades from 1.4 million in 2020 to 2.9 million by 2040 (3). More people will also die from the condition, with an estimated 700,000 patients dying by 2040 compared with 375,000 people in 2020. (3) the survival rate of prostate cancer is approximately 98% if diagnosed early before metastases. According to research in the UK, a random assignment of 1643 people with a prostate (61.7%) underwent active monitoring, prostatectomy, or radiotherapy plus a short course (3 to 6 months) of androgen deprivation therapy. (2) 

Prostate cancer increases with age. 1,350 men under 50 will be diagnosed with this cancer. (4) After 65, that number increases to 6 cases in 10. The survival rate in the U.S. is high at 98%. (4) 

Rates of mortality from prostate cancers had steadily decreased between 2007 and 2014 because fewer people were screened. As the screening parameters changed, prostate cancer diagnosis has increased by 3% per year since 2014. (3) This number will also increase between 2020 and 2040 from 1.4 million to 2.9 million because of longer lifespans and the growth of populations worldwide. (3)  Prostate cancer is also higher in African Americans and people of Caribbean descent. The underlying reason is being studied currently. The results, after a 10-year study of people with prostate cancer, show that, at minimum, approximately 50% of those in active surveillance remain free of disease progression, and less than 2% develop metastatic disease. (7) One study from Frontiers in Surgery states that mortality rates for prostate CA deaths will increase to 379,005 worldwide, with Africa having the highest mortality rate. (4) 

Costs of prostate cancer vary depending on treatment and insurance coverage. A study from the Journal of American Medical Association (JAMA) states the actual cost is difficult given the many variables of radical prostatectomy. (5) The costs associated with prostate cancer are PSA testing, MRI imaging, intraoperative adverse events, and post-operative costs for complications and follow-up care. (5) At the time of writing this article, robotic-assisted prostatectomy during hospitalization was $2367, and by the year 2030, estimated costs for all cancer treatments will be around $220 billion. (5) 

Etiology 

As we mentioned previously, prostate cancer begins in the prostate gland. Currently, research is ongoing to determine why these cells divide faster than usual. When normal cells die, cancer cells continue to grow. Since the cancerous prostate cells grow out of proportion, they may move outside the gland itself.  

Most prostate cancers are adenocarcinomas and develop from the gland cells of the prostate. Other rare types of cancer can develop in the prostate, but most are either androgen-sensitive or non-sensitive, meaning testosterone drives them (2). Some of these rare types can grow very quickly and spread to other body parts, but most adenocarcinomas grow slowly and are usually detected through increased PSA numbers (2).  

Most people with prostate cancer are diagnosed before exhibiting symptoms. If symptoms are present, they may include frequent nocturia, hematuria, weak or interrupted urinary flow, pain, or burning on urination. (7) As we know, these can be caused by other illnesses as well, such as benign prostatic hyperplasia or BPH. Some other worrisome symptoms may include erectile dysfunction, blood in semen, painful ejaculation, and fecal incontinence. (7) Lower extremity and back pain at rest and swelling in conjunction with the above symptoms may be caused by advanced prostate cancer (7). 

Risks of Prostate Cancer 

So, we know that anyone with a prostate is at risk for developing prostate cancer, but what are some factors that can contribute to it? 

Age is a factor in that approximately 60% of prostate cancers occur between 40 and 60 years of age. (2) If the patient is African American or from the Caribbean, they are at higher risk after age 50 and may have cancers that spread more readily. (2) 

Genetics has been proven to play a role in prostate cancers as in other cancers, and heredity is the main cause of gene mutation and dysplasia. (2) 

Western diets may contribute as studying immigrants from areas with lower numbers of prostate cancer to more industrialized countries showed a higher incidence in these people after becoming more westernized. (4) Environmental and lifestyle issues are also major causes of prostate cancer.  

Other risks found to be associated with prostate cancer are eating red meat and saturated fat, smoking, prostatitis, obesity, and exposure to Agent Orange, a chemical used in the Vietnam War. (4) 

Standard Treatments  

We know that PSA is the standard for detecting prostate cancer; however, according to a study from the NLM, there is no one test for diagnosing prostate cancer. (2) When a patient has a high PSA, an appointment with their MD is imperative. A digital rectal exam will be performed to ascertain how large the tumor is. However, a high PSA can also mean the patient has BPH or prostatitis. (2) 

If the provider feels the tumor is growing more slowly, they may watch it for several months.  This is called active surveillance. If it is determined to be fast growing or the PSA is rising during the surveillance period, more tests and a biopsy will be performed. MRI or transrectal ultrasound will show if any areas need further examination. (2) 

Prostate cancer, like other cancers, is staged.  There are two separate types of staging.  One is the Gleason score, which helps doctors to determine how severe cancer is. (2) The Gleason score will increase if there are more abnormal cells. (6) 

Treatment depends on whether the cancer stays local in the prostate or has invaded other organs and how fast it is growing. If a PSA is suspicious but not extremely high, screenings or surveillance will be done every 1-3 years. If the cancer grows quickly or is causing symptoms, treatment may be started. (2) 

Treatments may include radiation therapy, one of which places radioactive seeds inside the prostate. It destroys cancer cells but preserves healthy ones. External beam therapy delivers strong X-ray beams to the prostate and, again, does not harm healthy tissue. A newer method called targeted therapy zeroes in on gene mutations and prevents them from growing and multiplying into cancer cells.  

If the cancer has spread outside of the prostate, hormone therapy may be used, for example, to lower testosterone.  Orchiectomy, which is the removal of testicles where testosterone is made, is another option for those who prefer not to use hormones or chemotherapy. (6) 

Radical Prostatectomy 

A prostatectomy is a surgery that is performed to remove the whole prostate and lymph nodes surrounding the prostate. It is most often performed for prostate cancer but can also be used to treat BPH when the person is having urinary symptoms, such as stopping mid-stream, urinary tract infections, or increased nocturia. (4) These symptoms can also be due to BPH or chronic prostatitis. There are several methods for performing this surgery. 

Open radical prostatectomy 

This is an older surgery that involves the surgeon making a single abdominal incision from the person’s naval to the pubic bone to remove the prostate and any surrounding tissue. (8) It is an older type of surgery that is not used as often anymore.  It can also be done through the perineum; however, it can lead to erection issues, so it is also used less often. 

Laparoscopic radical prostatectomy 

For this type of surgery, the surgeon makes several small incisions into the abdomen and uses long instruments to find the prostate and remove it. Again, this surgery is less common because of the use of robotics. (8) 

Robotic prostatectomy 

This is the most common surgery used today. The surgeon makes several tiny incisions into the abdomen or perineum and, while sitting at a computer, uses robotic arms to find and remove the prostate. This robotic machine is called the DaVinci surgical system, which has replaced laparoscopic prostatectomy as it is more likely to reach the tumor and allows the surgeon to have more precise movements than using their own hands. (4) 

Risks Related to Radical Prostatectomy 

As with any surgery, there are risks for radical prostatectomy. The most common side effects are erectile dysfunction (ED), which often improves between 6-12 months. Infertility may also occur, so it may be wise to preserve sperm if the patient is hoping to have children in the future. (2) 

Robotic prostatectomy also leads to fewer side effects, such as bleeding during the procedure, less pain post-operatively, less time in the hospital, and a quicker recovery at home. (7) Since a urinary catheter is always placed during any of these surgeries, it can be removed sooner with robotic surgery. 

Recovery from radical prostatectomy 

Patients should expect to stay overnight in the hospital following surgery. In the recovery room, nurses will be checking for any mental status changes and monitor heart and lung function as well as the surgical site for bleeding. Once on the floor, the nurse will continue to check mental status and measure urinary output and the amount of hematuria in the catheter.  A complete assessment of major organs will be performed, and, of course, the patient’s pain.  

IV pain medication will be administered and changed to oral on discharge. Depending on when the surgery is performed, the patient will be asked to walk on the day of surgery or the next day. The nurse will teach the patient to do lower extremity exercises in bed. There may be a pelvic drain that will be removed before discharge. The patient will go home with a Foley catheter in place for 7-10 days. If staples are in the incision, they will be taken out at a follow-up visit by the surgeon. 

The nurse will also educate the patient about things to be aware of, such as continued large amounts of hematuria with clotting, urine output, how to change the leg bag, and severe pain.  Also important is how to care for the surgical site, understand what an Infection might look like, and when to call the doctor. 

Sexual activity can begin after full recovery. However, any problems with erections or urinary incontinence during arousal or orgasm (climacteric) should be followed up with the surgeon.  Other side effects that can occur after radical prostatectomy are erectile dysfunction (ED), which may depend on the age of the patient, baseline sexual function, and if the patient has high blood pressure, diabetes, or is a smoker. (4) 

Research 

There are numerous studies on the etiology of prostate cancer, which is still unknown in comparison to other cancers. (4) Research focuses on determining causes, detection, prevention, testing, and treatment. Research on changes in prostate cells could help scientists and pharmaceutical companies design medications that target changes in the prostate. (6)  

Studying and identifying genes may be useful in identifying which persons are at risk or already have prostate cancer and who may need a second biopsy if the first one was negative. Artificial intelligence (AI) algorithms have recently advanced, allowing for updated classifications of this cancer. (2)   

There are also recent advances in biomarkers and MRIs called “multiparametric magnetic resonance imaging” (mpMRI) and a PET scan that will provide risk stratification and individualized, appropriate treatment for each patient. (2) The recent guidelines state that MRIs should be performed before biopsy to mitigate complications. (2) 

Conclusion

We have discussed prostate cancer and the risks of developing it with the knowledge we have at this time, but it appears there is much more to be studied and discovered. We have learned who is at the highest risk and which of these risks can be modified. 

Radical prostatectomy can be performed in several ways. However, robotic-assisted prostatectomy appears to be the most frequently used surgery and has the least side effects and quickest recovery. As with any surgery, there are side effects, and nurses should be able to identify and educate the patient about them before they become major issues. 

From my research, I believe there is still much to learn about newer preventive testing, education, and treatments for prostate cancer patients. 

➁ Complete Survey

Give us your thoughts and feedback

➂ Click Complete

To receive your certificate