Chapter 31 - Alterations in Male Genital and Reproductive Function

prostate cancer overview

• Malignant tumor of the prostate gland​

• Most common non‑skin cancer in men​

• Usually occurs in men over age 65​

• Most are adenocarcinomas​ (cancer that starts in the glandular cells)

• aggressive forms can metastasize to bone​

• younger males can lose sperm count

cause of prostate cancer

(etiology)

it is undetermined

risk factors

• Age (greatest risk factor)​

• Family history​ (genetic, men with first degree relative have higher risk)

• African American ethnicity​

• High‑fat diet​

• Obesity​

• Hormonal influence (testosterone)​

family history example

men with first degree relative who have prostate cancer have higher risk

• ex. if the father has it then the son is more at risk

pathogenesis

• Begins when normal prostate cells undergo genetic mutations

• Uncontrolled cellular growth​ (growth is slow)

• Overtime, abnormal cells form a malignant tumor​

• Then invasion of surrounding tissue​

• Metastasis to bone and lymph nodes​

hallmark of advanced prostate cancer

metastasis to bone and lymph nodes, especially to back and pelvis (can lead to fractures)

• ex. patient complains of bone pain, think prostate cancer

age (men 65 years and older)

greatest risk factor of prostate cancer

early stage CM

often asymptomatic

• no symptoms, so nurses encourage for early screening to detect cancer to avoid the spreading of the cancer

urinary symptoms CM

as tumor grows, tumor may compress urethra (the tube that carries urine out of the body) creating urinary symptoms similar to benign hyperplasia

• Weak stream​: urine comes out slowly or with less force

• Urinary frequency​: needing to urinate more often

• Nocturia​: having to wake up multiple times throughout the night to urinate

• Difficulty starting urination​: having trouble beginning to pee even when bladder feels full

tumor

is an abnormal mass of tissue caused by cells growing more than they should, also called neoplasm

• there are two types: benign and malignant

cancer

is a disease in which abnormal cells grow uncontrollably and can invade nearby tissues or spread to other parts of the body

• always malignant

• can invade and can spread through the blood or lymphatic system (metastasis)

• uncontrollable growth of malignant cells

benign hyperplasia

Noncancerous enlargement of the prostate.

advanced disease CM

When prostate cancer becomes more advanced, symptoms may include:

• Bone pain: Prostate cancer can spread (metastasize) to the bones, especially the spine, pelvis, and ribs.

• Weight loss: Unintentional weight loss due to advanced cancer.

• Fatigue: Feeling extremely tired or weak.

diagnosis

• Prostate‑specific antigen (PSA)​

• Digital rectal exam (DRE)​

• Prostate biopsy​

• MRI or CT scan​

• Bone scan​

• Gleason score (rang from 6 to 10)​

  • score of 6 is low-risk/slow-growing​

  • Score of 8–10 are high-risk/rapid growing/ aggressive​

prostate specific antigen

• A blood test that measures the amount of PSA, a protein produced by prostate cells.

• Elevated PSA may indicate prostate cancer

• High PSA does not automatically mean cancer

Digital rectal examination

• A healthcare provider inserts a gloved, lubricated finger into the rectum.

• They feel the prostate for abnormalities such as hard areas, lumps, or irregularities.

prostate biopsy

serves as conformation and helps with specifics to create treatment

• A small sample of prostate tissue is removed.

• The sample is examined under a microscope to look for cancer cells.

• A biopsy confirms the diagnosis of prostate cancer.

MRI or CT scan

• MRI: Provides detailed images of the prostate and surrounding tissues and can help identify suspicious areas.

• CT scan: May be used to evaluate whether cancer has spread, particularly in higher-risk cases.

• bone scan: Used to check whether prostate cancer has spread to the bones.Most commonly considered when there is concern for metastatic disease.

all three used to determine if cancer is extensive and how far its spread

gleason score

(range from range from 6 to 10)

describes how abnormal prostate cancer cells look under a microscope, the more abnormal the cells appear, the more aggressive the cancer may be

• score of 6 is low-risk/slow-growing​

• Score of 8–10 are high-risk/rapid growing/ aggressive

score of 6

Cancer cells are less abnormal and generally grow more slowly

• (low risk / slow growing)

score of 8-10

Cancer cells look very abnormal and are more likely to grow and spread quickly

• (high risk / rapid growing and aggressive)

• harder to treat

treatment

depends on…

1. stage of tumor / cancer (how aggressive and advanced)

2. person’s age and life expectancy (ex. 65 year old has greater life expectancy than a 90 year old)

treatment options

• Active surveillance​

• Radical prostatectomy​

• Radiation therapy​ (more aggressive)

• Hormone therapy​ (more aggressive)

• Chemotherapy​ (more aggressive)

• Immunotherapy​ (more aggressive)

active surveillance

The doctor closely monitors the prostate cancer without immediately treating it.

• Commonly used for low-risk, slow-growing prostate cancer.

• The patient receives regular PSA blood tests, examinations, MRIs, and sometimes biopsies.

• If the cancer shows signs of becoming more aggressive, treatment may begin

radical prostatectomy

Surgical removal of the entire prostate gland and usually the seminal vesicles.

• Commonly used when cancer is localized (has not spread to distant organs).

• The goal is to remove the cancer.

• Nearby lymph nodes may also be removed.

radiation therapy (advanced)

uses high-energy radiation to destroy, kill, and damage cancer cells.

Two common types:

• External beam radiation: A machine outside the body directs radiation toward the prostate.

• Brachytherapy: Radioactive sources are placed inside or near the prostate to target cancer cells.

hormone therapy (advanced)

Blocks or lowers testosterone to slow prostate cancer growth

1. Testosterone can stimulate prostate cancer growth.

2. Hormone therapy lowers testosterone levels or blocks its effects.

3. This slows down cancer growth.

used for advanced prostate cancer / higher risk cancers

chemotherapy (advanced)

Medications that kill rapidly dividing cancer cells throughout the body.

• Usually used for advanced or metastatic prostate cancer in selected patients.

• May be used when prostate cancer becomes resistant to hormone treatment.

• One commonly used chemotherapy drug is docetaxel.

immune therapy (advanced)

Helps the body's immune system recognize and attack cancer cells.

• Used for certain patients with advanced prostate cancer.

• One example is sipuleucel-T, which uses the patient's own immune cells to stimulate an immune response.

• Other immunotherapies may be appropriate for cancers with specific genetic features.

nursing considerations

• Monitor urinary function​

• Assess for bone pain​

• Monitor PSA levels​

• Manage treatment side effects​

• Provide emotional support​

patient education

• Importance of screening​

• Report urinary symptoms​

• Medication adherence​

• Kegel exercises after surgery​

• Healthy diet and weight​