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38 Cards in this Set
- Front
- Back
What is prostate cancer? |
It's an androgen-dependent adenocarcinoma that is usually slow growing |
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What is typical of younger men with prostate cancer? |
They usually have a more aggressive form |
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What part of the body does prostate cancer usually metastasize? |
To the bones, where it can be very painful |
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What are risk factors for prostate cancer |
1. Age > 50 2. Ethnicity (more common in blacks) 3. Family history 4. Obesity 5. Diet high in red/processed meat, high-fat dairy products and low intake of fruits/vegetables |
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What are unclear risk factors for prostate cancer? |
Smoking, BPH, lycopene, antioxidants; Vitamin E intake showed an increased risk |
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What are the 3 types of prostate cancer? |
1. Sporadic (most common); gene damage occurs by chance 2. Familial: 2+ first-degree relatives diagnosed; combination of genetics and environment 3. Hereditary (rare): gene mutations inherited |
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What are the S/S of prostate cancer? |
- May be asymptomatic in early stages - Similar to BPH (dysuria, dribbling, frequency, urgency, hematuria, nocturia, retention - Pain in lumbrosacral area that radiates to legs and hips may show metastasis |
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What are diagnostic studies for prostate cancer? |
1. PSA screen (but elevated levels may not always mean cancer); also used to monitor treatmen 2. DRE (PSA/DRE are not definitive for diagnosis) 3. Biopsy by TRUS is definitive diagnostic tool 4. Bone scan 5. CT 6. MRI |
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What is the controversy of PSA screening? |
More men live and die with prostate cancer than those who die from it, so slow-growing cancers in older men may not be treated |
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What factors can increase PSA levels? |
1. Aging 2. BPH 3. Recent ejaculation 4. Long bike rides causing acute/chronic prostatitis 5. Cytoscopy 6. Indwelling catheter 7. Prostate biopsy |
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What can decrease PSA levels? |
Meds such as finasteride and dutasteride |
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When should PSA screenings be done? |
Yearly after age 50, but earlier for high-risk pts (about age 40-45) |
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If PSA levels are elevated, what may be done before further testing? |
Give antibiotics to rule out infection |
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How does the prostate feel during a DRE if the pt has cancer? |
Asymmetrical, hard and nodular |
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What classification systems are most commonly used with prostate cancer? |
1. Tumor, node, metastasis (TNM) 2. Gleason scale of tumor histology - Grade 1 is well differentiated, Grade 5 is poorly differentiated 3. Gleason score (2-10) 4. Staging determined by combining TNM, Gleason score and PSA level |
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When is active surveillance/watchful waiting appropriate for a pt with prostate cancer? |
1. Life expectancy < 10 years
2. Low grade, low stage tumor 3. Serious co-existing medical conditions |
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When should the active surveillance approach be re-evaluated? |
If there are significant changes in PSA or DRE or development of further S/S |
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What is a radical prostatectomy? |
Removal of the entire prostate, seminal vesicles and part of the bladder neck (ampulla) - Retroperitoneal lymph node dissection usually done in a separate surgery |
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What are the 2 different types of radical prostatectomy? |
1. Retropubic: low midline incision; pelvic lymph nodes can be dissected 2. Perineal: incision made between scrotum and anus (increased infection risk) |
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What are newer surgical approaches for prostate cancer? |
1. Laparoscopic surgery 2. Robotic-assisted (da Vinci) surgery 3. Cryotherapy (freezing; may cause a fistula, damage the urethra, ED, incontinence, prostatitis or hemorrhage) |
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What are post-op concerns after prostate surgery? |
1. Pt has a large indwelling catheter with a 30 mL balloon 2. Pt has a drain; removed in a few days 3. Careful dressing changes, especially for pt with perineal surgery 4. Hospital stay for 1-3 days |
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What are 2 major adverse outcomes from a radical prostatectomy? |
1. ED (depends on pt's age, pre-op sexual function and type of surgery done); may persist for up to 24 months as sexual function gradually returns 2. Urinary incontinence: Kegels help 3. Other complications are hemorrhage, urinary retention, infection, DVT, pulmonary emboli, wound dehiscence |
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When is a nerve-sparing procedure done with a radical prostatectomy? |
When the cancer is confined to the prostate and for men < 50 with good pre-op erectile function and low-stage prostate cancer; but no guarantee that potency will be maintained |
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What types of radiation therapy are done for prostate cancer? |
1. External beam radiation: most common; treated 5 days a week for 4-8 weeks; cure rates comparable to surgery in pts with localized cancer 2. Brachytherapy: radioactive seeds placed by using TRUS, ultrasound and a grid template; best for pts in early stages; more convenient because it's a one-time treatment |
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What are the adverse effects of external beam radiation? |
1. May be acute (< 90 days) or delayed (months or years); usually lessen in 2-3 wks 2. Skin changes (redness, dryness, irritation, pain) 3. GI (diarrhea, ab cramping, bleeding) 4. Urinary tract (dysuria, frequency, hesitancy, urgency, nocturia) 5. ED 6. Fatigue |
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What are adverse effects of brachytherapy? |
1. Urinary irritative/obstructive problems (most common) 2. ED |
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How is androgen-deprivation therapy (ADT) used to treat prostate cancer? |
It reduces the levels of circulating androgens to reduce tumor growth; can inhibit production (given IV or SQ) or block receptors (given PO) |
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What are the problems with ADT? |
1. It becomes hormone refractory (resistant) in a few years; usually indicated by elevated PSA 2. Increased risk of cardiovascular effects - Elevated cholesterol, triglycerides; CAD 3. May increase risk of metabolic syndrome 4. Osteoporosis and fractures |
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How does degarelix (ADT) treat prostate cancer and what are the adverse effects? (Not on drug list, but I have a note from class to know the side effects because it's a newer drug) |
- Blocks LH receptors - Immediate testosterone suppression - May cause pain, redness and swelling at injection site - May cause elevated liver labs |
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What drugs produce a chemical castration? |
Androgen synthesis inhibitors (a form of ADT); they produce effects similar to an orchiextomy (removal of testes); given IM or SQ; causes a lot of pain at the injection site |
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What are adverse effects of androgen synthesis inhibitors? |
Since they're similar to castration, they can cause gynomastia, decreased muscle mass and libido, ED, weight gain and hot flashes |
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When is chemotherapy used to treat prostate cancer? |
Usually only in those with hormone-refractory prostate cancer (HRPC) in late stages; it's mainly palliative |
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When is an bilateral orchiectomy (removal of the testes) done for prostate cancer? |
For advanced stages of cancer or for relief of bone pain; it may shrink the prostate and relieve urinary obstruction |
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What should be considered when treating African American men for prostate cancer? |
1. Higher mortality rates 2. Screenings not done due to lower socioeconomic status 3. More problems with transportation, finances and health care costs 4. White men perceived as getting better care 5. Use more religious coping strategies 6. Recommend PSA/DRE screenings starting at age 40-45 |
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What is the role of the RN in continuous bladder irrigation (CBI) after prostate surgery? |
1. Assess for bleeding, clots 2. Assess catheter patency and presence of bladder spasms; measure I/O 3. Manually irrigate if bladder spasms or decreased outflow 4. Discontinue CBI and notify MD if obstructed 5. Teach pt Kegel exercises 6. Provide cath care instruction to pt before discharge |
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What is the role of the LPN in continuous bladder irrigation (CBI) after prostate surgery? |
1. Monitor draining for increased blood/clots 2. Increase flow to maintain light pink color 3. Give antispasmotics and analgesics PRN |
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What is the role of the UAP in continuous bladder irrigation (CBI) after prostate surgery? |
1. Clean around catheter daily 2. Record I/O 3. Notify RN if large amount of bright red blood in urine 4. Report complaints of pain/bladder spasm |
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What are common problems with advanced prostate cancer? |
1. Fatigue 2. Bladder outlet obstruction R/T compression by the tumor 3. Severe bone pain/fractures 4. Leg edema R/T DVT, lymphedema 5. Spinal cord compression |