1. ‫بسم ا الرحمن‬
‫الرحيم‬
Nursing management for
patient with prostate cancer
prepared by;
Shamsadeen A. Mohammad
2010-2011

2. What is the Prostate?
1. A male sex gland
2. The size of a walnut below
the bladder and infront of
the rectum
3. Produces the fluid that is
part of semen

4. What is Prostate Cancer?
• To understand prostate cancer, we need to
understand cancer because prostate cancer is
cancer that starts in the prostate gland. They
have three main characteristics:
• A cancerous cell's natural process of growth and
death is uncontrolled
• A cancerous cell has lost its normal structure
and, consequently, its ability to function as it
should
• A cancerous cell can escape the area in which it
first grew and invade other parts of the body

5. Risk factors for prostate cancer
.Age – Found mainly in
men over age 55. Average
age of diagnosis is 70
.Family History – Men’s
risk is higher if father or
brother is diagnosed
before the age of 60

6. Risk Factors continued
• Race – Prostate cancer is found
more often in African American men
then White men. It is less common
in Asian and American Indian men
• Dietary factors – Evidence suggests
that a diet high in fat may increase
the risk of prostate cancer and diets
high in fruits and vegetables
decrease the risk

8. Sign and Symptoms
1. need to urinate often, especially at night.
2. intense need to urinate (urgency).
3. difficulty in starting or stopping the urine flow.
4. inability to urinate .
5. weak, decreased or interrupted urine stream .
6. a sense of incompletely emptying the bladder.
7. burning or pain during urination.
8. blood in the urine or semen.
9. painful ejaculation.

9. pathophysiology
The pathophysiology of prostate cancer is poorly
understood,
Although prostate cancer typically manifests in men older
than 65 years,
 Prostatic intraepithelial neoplasia (PIN) is the histologic
entity widely
 considered to be the most likely precursor of invasive
prostate cancer.
 genetic abnormalities that affect the androgen
receptor(AR)and other
 molecules that are involved in cell survival and
apoptosis(programmed cell death)

10. Nodular prostate

11. There are a four stage of prostate cancer

12. Tests for Prostate Cancer:
1. The Digital Rectal Exam (DRE).
2. Ct scan
3. PSA - Prostate Specific Antigen.normal
range(<4ng/ml).
4. Beckman Coulter's Hybritech free PSA (fPSA)
test.
5. PSA density test.
6. Telomerase.
7. Ultra sound

13. Prostate exam
Prostate Cancer
1. Asymmetric shape .
2. Hard consistency.
3. Discrete nodule may be palpable.
4. Median sulcus often obscured.
Note: Hard areas of prostate are not always cancerous but
may indicate conditions such as prostatic stones or
chronic inflammation.

14. Treatment
.Laparoscopic Prostatectomy –
Removal of entire prostate gland and
nerves using a minimally invasive
surgery
.Radical Prostatectomy – Removal of
entire prostate gland and nerves
.Radiation Therapy – High-energy rays
to kill or shrink cancer cells
.Expectant Therapy – Regularly
scheduled screenings

15. Treatment continue
.Cryosurgery – freezes abnormal cells of the
prostate with a metal probe
.Hormone Therapy – Decreases the
androgen (testosterone) levels in the body
.Chemotherapy – Anticancer drugs injected
into a vein or taken by mouth
.TUPR-transe urethral prostate resection

16. Complication and side effect of
prostectomy;
1. Bleeding
2. Infection
3. Infertility
4. Incontinence
5. Erectile dysfunction
6. death

17. ASSESSMENT
Subjective data Objective data
Medications: General: Older adult male;
Testosterone pelvic lymphadenopathy (late
sign).
supplements; use of any
Urinary: Distended bladder on
medications affecting palpation; unilaterally hard,
urinary tract such as enlarged, fixed prostate on
morphine, rectal examination.
anticholinerqics, and Musculoskeletal:
tricyclic antidepressants. Pathologic fractures
(metastasis).

18. 1-NURSING DIAGNOSIS:
Urinary retention related to urethral obstruction secondary to prostatic
enlargement or tumor and loss of bladder tone due to prolonged
distention.
PLANNING: Improved pattern of urinary elimination.
IMPLEMENTATION:
1-Determine patients usual pattern of urinary function.
2-Assess for signs and symptoms of urinary retention.
3-Catheterize the patient to determine amount of residual urine.
4- Monitor catheter function.
5-Prepare patient for surgery if indicated.
6- Consult with physician regarding intermittent or indwelling.
EVALUATION:
Voids at normal intervals.

19. 2.NURSING DIAGNOSIS:
Pain related to progression of disease and treatment modalities.
PLANNING: Relief of pain.
IMPLEMENTATION:
1. Evaluate nature of patient’s pain, its location and intensity using pain
rating scale.
2. Avoid activities that aggravate or worsen pain.
3. Provide support for affected extremities.
4. Administer analgesics or opioids at regularly scheduled intervals as
prescribed.
EVALUATION:
1. Reports relief of pain.
2. Expects exacerbations, reports their quality and intensity, and obtain
relief.
3. Uses pain relief strategies appropriately and effectively.
4. Identifies strategies to avoid complications of analgesic use (e.g.
constipation).

20. 3-NURSING DIAGNOSIS:
Impaired nutrition, less than body requirement related to decreased oral
intake because of anorexia.
PLANNING: Maintain optimal nutritional status.
IMPLEMENTATION:
1. Assess the amount of food eaten.
2. Routinely weigh patient.
3. Elicit patient’s explanation of why he is unable to eat more.
4. Recognize effect of medication or radiation therapy on appetite.
EVALUATION:
1- Responds positively to his favorite foods.
2- Assumes responsibility for his oral hygiene.
3- Reports his absence of nausea and vomiting.
4- Notes increase in weight after improved appetite.

21. 4-NURSING DIAGNOSIS:
Anxiety related to concern and lack of knowledge about the
diagnosis.
PLANNING: Reduced stress and improved ability to cope
IMPLEMENTATION:
1-Obtain health history.
2-Provide education about diagnosis and treatment plan.
3-Assess his psychological reaction to his diagnosis.
EVALUATION:
1-Appears relaxed.
2- States that anxiety has been reduced and relieved.
3-Engages in open communication with others.

22. 5-NURSING DIAGNOSIS:
Sexual dysfunction related to effects of therapy.
PLANNING: Ability to resumeenjoy modified sexual
functioning.
IMPLEMENTATION:
1. Determine from nursing history what effect patients
medical condition is having on his sexual functioning.
2. Inform patient of the effects of prostate surgery,
orchiectomy, chemotherapy, irradiation, and hormonal
therapy on sexual function.
EVALUATION:
1. Describes the reasons for changes in sexual functioning.
2. Discusses with appropriate health care personal
alternative approaches and methods of sexual
expression.

23. References;
1. TEXT BOOK OF MEDICAL SURGICAL
NURSING,BRUNNER&SUDADARTH,ELEVEN
EDITION{PAGE1740-1769}
2. WWW.CANADACA PROSTATE.COM;17-10-2010
3. LAPROSCOPIC UROLOGIC SURGURY IN
MALIGNANCIES,JEAN DE LAROSSETI,{133-176}.
4. CURRENT MEDICAL DIAGNOSIS AND
TREATMENT,2008,STEFEN.J.MACFEE
5. National Prostate Cancer Coalition
www.npcc.org