BY: CHARMAINE A.

VILLA

WHAT IS PROSTATE GLAND?

The prostate is part of the male reproductive system Its major function is to secrete a fluid to nourish semen during intercourse The prostate is about the size of a walnut but it can grow with age

It is located below the urinary bladder, in front of the rectum surrounding the urethra (the canal for the discharge of urine that extends from the urinary bladder to the outside)

WHAT IS PROSTATE CANCER?

It is cancer that occurs in a man's prostate a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

CLINICAL MANIFESTATION:
Prostate cancer may not cause signs or symptoms in its early stages. Prostate cancer that is more advanced may cause signs and symptoms such as: Trouble urinating Decreased force in the stream of urine Blood in the urine Blood in the semen Swelling in the legs Discomfort in the pelvic area Bone pain

PATHOPHYSIOLOGY:

Prostate cancer develops when the rates of cell division and cell death are no longer equal, leading to uncontrolled tumor growth. Following the initial transformation event, further mutations of a multitude of genes, including the genes for p53 and retinoblastoma, can lead to tumor progression and metastasis. Most (95%) prostate cancers are adenocarcinomas.

DETECTION:
Prostate Screening Test: Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer. PSA testing combined with DRE helps identify prostate cancers at their earliest stages, but studies haven't proved that these tests save lives. For that reason, there is much debate surrounding prostate cancer screening.

DIAGNOSING PROSTATE CANCER:

If an abnormality is detected on a DRE or PSA test, your doctor may recommend tests to determine whether you have prostate cancer, such as:

Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to make a picture of your prostate gland.

DIAGNOSING PROSTATE CANCER:

Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of suspicious cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a laboratory to determine whether cancer cells are present.

DETERMINING WHETHER PROSTATE CANCER IS AGGRESSIVE :

When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly. More-aggressive cancer cells have a higher grade. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Scoring combines two numbers and can

DETERMINING HOW FAR THE CANCER HAS SPREAD :

Once a cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. Many men won't require these additional tests. But if your doctor suspects your cancer may have spread beyond your prostate, imaging tests such as these may be recommended: Bone scan Ultrasound Computerized tomography (CT) scan Magnetic resonance imaging (MRI)

PROSTATE CANCER STAGES:

Stage I. This stage signifies very early cancer that's confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren't considered aggressive. Stage II. Cancer at this stage may still be small, but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland. Stage III. The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues. Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.

TOP 10 CONSIDERATIONS FOR PREVENTING PROSTATE CANCER:

To understand how to prevent prostate cancer, one must first understand what causes it. There are four major factors that influence one's risk for developing prostate cancer, factors which unfortunately cannot be changed.

RISK FACTORS:

Age: The risk increases with age, but 25% of diagnoses are made under age 65. Race: African-Americans have a rate of incidence double that of Caucasian men Family history of prostate cancer: Men with a family history have two- to three-fold increase in the risk of prostate cancer Diet: A diet high in saturated animal fat can double the risk of developing prostate cancer.

TOP 10 CONSIDERATIONS FOR PREVENTING PROSTATE CANCER

Eat fewer calories or exercise more so that you maintain a healthy weight. Try to keep the amount of fat you get from red meat and dairy products to a minimum. Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day. Eat more fish evidence from several studies suggest that fish can help protect against prostate cancer because they have "good fat" particularly omega-3 fatty acids. Avoid trans fatty acids (found in margarine).

TOP 10 CONSIDERATIONS FOR PREVENTING PROSTATE CANCER

Try to incorporate cooked tomatoes that are cooked with olive oil, which has also been shown to be beneficial and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals. Soy and green tea are also potential dietary components that may be helpful. Avoid smoking for many reasons. Alcohol in moderation, if at all. Seek medical treatment for stress, high blood pressure, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer

TOP 10 CONSIDERATIONS FOR PREVENTING PROSTATE CANCER

What about supplements? Avoid over-supplementation with megavitamins. Too many vitamins, especially folate, may fuel the cancer, and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin. Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.

TOP 10 CONSIDERATIONS FOR PREVENTING PROSTATE CANCER

Finally, eating all the broccoli in the world, though it may make a difference in the long run, does not take away your risk of having prostate cancer right now. If you are age 50 or over, if you are age 40 or over and AfricanAmerican or have a family history of prostate cancer, you need more than a good diet can guarantee. You should consider a yearly rectal examination and PSA test.

MEDICAL MANAGEMENT:

Radiation Therapy a cancer treatment that uses high-energy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

MEDICAL MANAGEMENT:

Hormone Therapy a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the production of male hormones or block them from working.

MEDICAL MANAGEMENT:
Hormone therapy used in the treatment of prostate cancer may include the following: Luteinizing hormone-releasing hormone agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin. Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide and nilutamide. Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.

MEDICAL MANAGEMENT:
Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, to decrease hormone production. Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.

MEDICAL MANAGEMENT:

Chemotherapy a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

MEDICAL MANAGEMENT:

Biologic Therapy
a

treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Sipuleucel-T is a type of biologic therapy used to treat prostate cancer that has metastasized (spread to other parts of the body).

SURGICAL MANAGEMENT:

Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.

SURGICAL MANAGEMENT:

Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are 2 types of radical prostatectomy: Retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time. Perineal prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen.

RADICAL PROSTECTOMY:

SURGICAL MANAGEMENT:

Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.

TURP:

ROLE OF THE PROSTATE CARE NURSE:

The role for the prostate care nurse can be varied, acting as counselor, provider of information, advocate and advisor for men and their families from diagnosis to treatment, through to follow-up care and palliation where appropriate.