The PCRMP is currently undergoing a review with updated guidance which is expected to be released by the end of 2015. NHS Cancer Screening Programmes. London: Cancer Research UK. Early studies investigating this protein have been encouraging, but further larger scale and longer-term clinical studies are required. A large clinical trial called Procure, looking at EN2 as a potential biomarker for prostate cancer, is aiming to complete and publish by Autumn 2016. Adenocarcinoma is the most common form; only seldom does prostate cancer occur as a sarcoma. A second-degree relative (uncle, nephew, grandfather) diagnosed with the condition increases risk by 90-95% (CRUK, 2013b). Urinary infection should also be ruled out as this can elevate the PSA level for many months, even after treatment. Desired Outcomes. High-dose brachytherapy is delivered in a similar fashion to permanent seed brachytherapy, but the dose is implanted into the prostate contained in tubes. If all affected tissue has been removed, PSA will be undetectable on blood tests. Its incidence has risen by 22% in the past decade (Cancer Research UK, 2012a); in 2010, 40,975 cases were diagnosed (CRUK, 2012b). Prostate cancer diagnosis and screening continues to be one of the most fiercely debated subjects surrounding the disease and gives rise to a number of questions that remain to be answered. Nursing diagnoses and NIC interventions in adult males undergoing radical prostatectomy ... Nearly 1.1. million men received a diagnosis of prostate cancer (Pca) around the world in 2012. Patients avoid the risk of side-effects until necessary, and some never need treatment. Gonadotropin-releasing hormone (GnRH) antagonists (degarelix) prevent the production of LHRH in the hypothalamus, and stimulate the pituitary gland to produce LH. It is found adjacent to the PSA gene and exists in multiple forms in serum and as free and complexed HK2. New England Journal of Medicine; 350: 2239-2246. Nursing Times; 110: 9, 12-15. Hormone therapy, also called androgen deprivation therapy, is given to treat metastatic prostate cancer or in combination with external beam radiotherapy for localised or locally advanced prostate cancer. Citation: Bagnall P (2014) Diagnosis and treatment of prostate cancer. Sign in or Register a new account to join the discussion. London: NICE. Urine testing for prostate cancer may be a possibility; either as a stand alone test or in combination with PSA testing. A raised PSA level, above the ‘normal’ value for a man’s age, can be a sign of a problem with the prostate but not necessarily prostate cancer due to the poor sensitivity and specificity of the test. So not only are we dealing with the fact that the patient has cancer, but with the fact that it can impact their fertility and their sexuality. prostate cancer diagnosis The initial step for diagnosing prostate cancer in men will be a simple physical examination, and the doctor will ask you more about your physical history. Medical organizations don't agree on the issue of screening and whether it delivers benefits.Some medical organizations recommend men consider prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer.Discuss your particular situation and the benefits and risks of screening with your doctor. This is because prostate cancer is an oncology diagnosis. However, the National Institute for Health and Care Excellence (NICE) guideline for Suspected cancer: recognition and referral,1 which was updated in June 2015, recommends that any man presenting with lower urinary tract symptoms (LUTS) (such as nocturia, urinary frequency, hesitancy, urgency or retention), erectile dysfunction (ED) or visible haematuria should be considered for a prostate specific antigen (PSA) blood test and digital rectal examination (DRE) to assess for prostate cancer. Although it is currently only available in a few UK private hospitals and clinics, it is being assessed by NICE as we need more evidence to see how much PCA3 in the urine denotes prostate cancer. Mr. There are more than 150 different types of cancer, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. He will also be unable to have the test if he’s had a prostate biopsy within the previous six weeks or a DRE within the previous week before the test. Symptoms of prostate cancer Symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the … Nurses are often key workers for patients with prostate cancer and are responsible for ensuring men have the support they need throughout their cancer journey. Advances in knowledge about prostate cancer and improvements in imaging techniques mean the patient diagnostic and treatment pathway changed recently (NICE, 2014). To help men make this decision, there is a shared decision tool available that helps men through the process.3. London: Cancer Research UK. prostate cancer 3 diagnosis and interventions the word prostate comes from medieval latin prostate and medieval french prostate the ancient greek word prostates means ... prostate cancer nursing management in providing direct care to these patients the nurse has a unique opportunity to initiate a conversation with the patient about concerns. He may also have a greater risk if his mother or sister has been diagnosed with a type of breast cancer that is due to a fault in the genes BRCA1 or BRCA2. Their half-life is 60 days, so men are advised to avoid prolonged contact with children and pregnant women for two months. Prostate cancer is the most common cancer in men. Or, on the other hand, should we disregard the PSA test entirely and concentrate on other biomarkers? Patients often expect doctors to recommend a treatment and can find it distressing to have to make a choice, particularly as there is a great deal of uncertainty about disease progression (NICE, 2014). At present, the PSA blood test is the best method we have of identifying an increased risk of prostate cancer in a man. Treatments include pelvic floor muscle exercises, functional electrical stimulation, biofeedback and extracorporeal magnetic innervation to help patients recover after surgery (e.g. Nursing Care Plans for Prostate Cancer. However, there is current research and clinical trials looking into other ways of testing for prostate cancer and identifying whether the cancer is aggressive or non aggressive. Kirkham APS et al (2013) Prostate MRI: who, when, and how? Prostate cancer is diagnosed using a combination of prostate-specific androgen (PSA) blood testing, digital rectal examination (DRE), biopsy and magnetic resonance imaging (MRI) scan; a bone scan may be used for staging. Once the man has made an informed choice to have the PSA test, it is important to explain to him that he should avoid vigorous exercise and not ejaculate 48 hours prior to the test. Colley W (2014) Incontinence following prostate cancer surgery. London: National Cancer Intelligence Network. About 1% of these will need transurethral resection of the prostate, which will need to be deferred for one year so the seeds treatment can be completed and for any other side-effects to resolve (Kirby and Patel, 2014). Prostate cancer usually affects men over the age of 50, and the risk increases with age. In an essay Abdul-Jabbar wrote for WebMD, the NBA’s all-time leading scorer revealed how he’s had prostate cancer, leukemia and heart bypass surgery to shed light on the health challenges facing Black people. Rosario D J et al (2012) Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within protect study. 3 Nursing Diagnosis and Nursing Interventions for Prostate Cancer 1. A total of 500 men with a PSA between 4 and 20ng/ml and no previous history of prostate cancer will be enrolled from the Surrey area. The transition zone is most commonly affected by benign enlargement, while 70% of prostate cancers are found in the peripheral zone (Dasgupta and Kirby, 2012). Treatments for prostate cancer affect masculinity, as side-effects include erectile dysfunction, testicular shrinkage, breast development and loss of strength. Table 3 describes the staging of prostate cancer. The enlargement of the prostate may cause difficulty urinating, having to urinate more often, especially at night, and a weak urine stream. Together, you can decide whether prostate cancer screening is right for you.… The average age of diagnosis is between 70 and 74 years. Asian men have a lower risk (National Cancer Intelligence Network and CRUK, 2009). Long-term urinary incontinence and erectile dysfunction may be minimised by nerve-sparing techniques during surgery, or treatment with pelvic floor exercises, medication, further surgery or a combination of these (Kirby and Patel, 2014). The stage of the cancer will determine which types of treatments will be necessary. Prognostic biomarkers predict the likely outcome for a man who has no treatment, and predictive biomarkers calculate how well a man will respond to prostate cancer treatment. It can be used to cure localised prostate cancer, to improve disease control for locally advanced prostate cancer and/or for pain control in metastatic prostate cancer (NICE, 2014). Diagnostic biomarkers tell us if a man has prostate cancer or not. Cancer Research UK (2012c) Prostate Cancer Survival Statistics. The blood test, known as a prostate-specific antigen (PSA) test, measures the level of … The prostate health index (PHI) is designed to categorise men (aged 50 and over whose PSA levels are between 2-10ng/ml with negative DRE) into low, moderate and high probabilities of prostate cancer (found on biopsy). Bicalutamide can be given as monotherapy to men with locally advanced high-risk prostate cancer (NICE, 2014); serum testosterone is unaffected by bicalutamide, so fewer patients develop erectile dysfunction than those treated with LHRH and BSO. The benefits of having a PSA test include finding prostate cancer before symptoms develop and diagnosing the cancer at an early stage when it’s more likely it can be successfully treated. The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy. It usually develops slowly, so there may be no signs for many years. PSA is a protein produced by the prostate. During a DRE, your GP will insert a finger into your rectum (back passage). For example, if most cells are poorly differentiated and the second most widespread are not quite so poorly differentiated the sum score would be 5+4=9; 3+3=6 is the lowest grade diagnosed by needle biopsy (Dasgupta and Kirby, 2012). Due to the fact that most men with early stage prostate cancer will not have any symptoms, being aware of a man’s risk is essential. Another urine test is the prostate cancer gene 3 (PCA3) (Progensa) that detects the amount of PCA3 protein in the urine following prostatic massage. Reg. All patients diagnosed with prostate cancer will have a review of their medical history, histology and any imaging that has been performed, and a risk category will be assigned to their disease (NICE, 2014). Patients suspected to have metastatic prostate cancer - for example those with a PSA >20ng/ml or X-rays that show possible metastases as the cause of bone pain - will probably have a bone scan performed instead of a TRUS. The MRI scan will show if tumours are confined to the prostate or if there is any local or distant spread of disease (Kirkham et al, 2013). National Institute for Health and Care Excellence (2014) Prostate Cancer: Diagnosis and Treatment. Like active surveillance, watchful waiting involves deferring treatment until necessary, although the aim is disease control rather than cure. Below are five (5) nursing care plans (NCP) and nursing diagnosis for benign prostatic hyperplasia: Improving Supportive and Palliative Care for Adults with Cancer. Other factors that should be considered in conjunction with the PSA level are prostate size, DRE findings, age, ethnicity, co-morbidities, history of any previous negative biopsy and any previous PSA history. Risk biomarkers indicate if a man is at a higher than average risk of prostate cancer. Nurses play a vital role in ensuring that all men concerned about prostate cancer are armed with the information they need to make an informed decision about testing. However, it is irreversible and men are often reluctant to agree to BSO as it can harm body image. Key nursing roles are providing information and supporting men in making treatment decision. This article provides an overview of the patient pathway. TRUS (without biopsy) is used to measure prostate volume and shape, and place radioactive seeds in the prostate gland through the perineum. A score of 0-20.9 indicates low risk (8.4%) of cancer; 21-39.9 indicates moderate risk (21%) and greater than 40 indicates high risk (44%). With no national screening programme, diagnosing prostate cancer remains one of the biggest challenges facing health professionals. One of the most important goals of palliative care is easing the physical symptoms of the cancer itself and any side effects from treatment. Although active treatment would be recommended to men with intermediate or high-risk localised prostate cancer, some choose active surveillance. Men whose mother was diagnosed with breast cancer have a 19-24% increased risk of prostate cancer (CRUK, 2013b). Only around 25% of men with a PSA of 4-10ng/ml who have a biopsy will be diagnosed with prostate cancer (Burford et al, 2009), while Thompson et al (2004) found that 15% of those with a PSA less than 4ng/ml had prostate cancer on biopsy. NICE guideline NG12, 2015. (accessed 26 October 2015). Since about 95% of serum testosterone is produced in the testicles, the advantage of BSO is that it is a one-off treatment and reduces serum testosterone within 12 hours (Dasgupta and Kirby, 2012). A bone scan is unlikely to be positive when PSA <10ng/ml (NICE, 2014) and is therefore performed only for men with intermediate or high risk of disease. The prostate gland is divided into four zones (Fig 2). Nurses should be alert to cues and offer patients referral to professionals for help with psychosexual issues (NICE, 2014). Men whose father was diagnosed with prostate cancer have a 112-140% increased risk; those who also have a brother with the disease have a 187-230% greater risk. Permanent seed brachytherapy is a form of radiotherapy. Burford DC et al (2009) Prostate Cancer Risk Management Programme: Information for Primary Care; PSA Testing in Asymptomatic Men. This guideline covers the diagnosis and management of prostate cancer in secondary care, including information on the best way to diagnose and identify different stages of the disease, and how to manage adverse effects of treatment. A biological transition can include the change between a healthy cell and cancer cell, as well as a cancer cell before treatment and a cancer cell after treatment. Does he have a family history of prostate cancer? This site is intended for health professionals only, Read the latest issue onlineThe hidden front line, Prostate cancer is the most common cancer in men. However, a side-effect of bicalutamide monotherapy is gynaecomastia (breast development) and men prescribed the treatment for six months or more should be offered radiotherapy to their breast buds to prevent this (NICE, 2014). Clinical Radiology; 68: 10, 1016-1023. This rise is due to the increasing age of the population and improvement in diagnostic tests. Goal: Reduced stress and improved ability to cope Expected Outcomes Rationale Nursing Interventions Appears relaxed . Patients should be asked regularly whether their side-effects are troubling, as their views and quality of life may change over the years. Due to a risk of seeds being discharged in semen, they are advised to wear a condom for the first three ejaculations (Colley, 2014; Kirby and Patel, 2014). Of the 4127 men involved in the study, 97 had prostate cancer. This can be done by your GP. According to the American Cancer Society, more than two million men in the United States are prostate cancer survivors. Prostate cancer is one of the most common forms of cancer diagnosed in men, second to skin cancer. Signs and symptoms In 2011, there were 10,793 deaths in the UK due to prostate cancer. External-beam radiotherapy may be offered at any stage of disease. Between 2008 and 2010, only 1% of diagnoses were in men aged 50 years or under, and 75% of men were over 65 years of age (CRUK, 2012a). These findings are significant as the rate of prostate cancer diagnosis is more than 50% higher in African American men, who also have a higher risk of prostate cancer death and disease progression. However, swelling of the prostate caused by the procedure means around 5% of men develop urine retention requiring catheterisation. Prostate cancer is the most common neoplasm in males older than age 50; it’s a leading cause of male cancer death. Italian nurses are responsible for perioperative nursing and are involved in pain assessment and rehabilitation following prostate cancer therapies. Nursing care for patients with benign prostatic hyperplasia includes preparation for surgery (if possible) administration of medications for pain, and relieving urinary retention. Chichester: Wiley. The advantage of permanent seed brachytherapy is the radiation dose is confined to the prostate, reducing the risk of damage to other organs. GnRH antagonist injections result in a rapid reduction of serum testosterone without any initial flare (Dasgupta and Kirby, 2012). If histology or PSA surveillance demonstrates that there is disease progression following prostatectomy, salvage radiotherapy may be possible. A common condition in the aging cycle of men that causes enlargement of the prostate gland that surrounds the urethra. A transperineal biopsy. Symptoms vary depending on the type. It is often diagnosed incidentally, following investigation of lower urinary tract symptoms, which include: Men with locally advanced disease may present with symptoms of: haematuria; haemospermia (blood in semen); erectile dysfunction; difficulty passing urine; retention of urine or anuria; and pain in the penis, perineum or suprapubically. There is currently no national screening for prostate cancer as there is no clear evidence that screening using current tests brings more benefit than harm. Nurses play a vital role in ensuring that all men concerned about prostate cancer are armed with the information they need to make an informed decision about testing. Shields are used to protect surrounding healthy tissues and reduce the risk of damaging nearby organs including the bladder and bowel (Colley, 2014; Dasgupta and Kirby, 2012). It is recommended to men with prostate cancer that is unlikely to affect their life expectancy. Hormone therapy and radiotherapy in combination increase the time before disease progresses and overall length of survival, compared with radiotherapy or hormone therapy alone (NICE, 2014). Analysis of 20 studies selected according to these criteria revealed four important aspects of specialized nursing care: care provided 1) at the time of prostate cancer diagnosis; in the 2) pretreatment and 3) posttreatment periods; and 4) in the assistance of partners and family members of … British Medical Journal; 344: d7894.Thompson IM et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0ng per milliliter. It is similar in size and shape to a walnut, and positioned at the base of the bladder, surrounding the urethra between the rectum and symphisis pubis (Fig 1). For men with intermediate or high-risk prostate cancer, high-dose brachytherapy in combination with external beam radiotherapy should be considered, as research suggests this combination may improve overall survival (NICE, 2014). Cancer Research UK (2013a) Prostate Cancer Mortality. States that anxiety has been reduced or relieved It is normal for men to have a small amount of PSA in their blood, and as men get older this amount can rise. Black men living in the UK are at three times the risk of prostate cancer as Caucasian men (Ben-Shlomo et al, 2007); they are diagnosed an average of three to five years earlier than white men. Unfortunately the downside to tests that measure proteins in urine is that the amount of protein found varies depending on an individual’s urine concentration so this needs to be taken into account when analysing the results. The aim of hormone therapy is to block the production of androgens, including testosterone, upon which most prostate cancers depend for growth. Ben-Shlomo Y et al (2007) The Risk of Prostate Cancer Amongst Black Men in the United Kingdom: The PROCESS Cohort Study. Radioisotope bone scans are performed to look for bone metastases. Having a biopsy to diagnose prostate cancer. Biomarkers – the future of prostate cancer testing? Prostate Cancer Risk Management Programme. National Institute for Health and Care Excellence (2005) Referral Guidelines for Suspected Cancer. The disadvantages of surgery include potential complications such as pulmonary embolism. It also includes recommendations on follow-up in primary care for people diagnosed with prostate cancer. Public Health England’s Prostate Cancer Risk Management Programme (PCRMP) provides information to primary healthcare professionals and men to enable them to decide whether to have the PSA blood test or not.2 After considering the pros and cons and discussing with their GP, men over the age of 50 are entitled to a PSA test if they want one. Urinary frequency, particularly at night; National guidance on the diagnosis and treatment of prostate cancer has been updated, Nurses have an important role in supporting patients to make treatment choices, Prostate cancer treatments can affect men’s masculinity and wellbeing, There have been recent improvements in prostate cancer knowledge and diagnostic technology, The PSA result is not an accurate diagnostic test for prostate cancer. Before new tests can be introduced they need to be tested thoroughly. The Manual. National Collaborating Centre for Cancer (2014) Prostate Cancer Diagnosis and Treatment. It can be anything that changes in response to a biological transition (eg a gene, protein, part of a cell). Prostate cancer is the most common cancer in men in the UK. Although the death rate has fallen by 20% over the last 30 years, it remains the second most common cause of death from cancer among men, accounting for 13% of all male cancer deaths (CRUK, 2013a). Removal of the prostate gland and seminal vesicles aims to cure prostate cancer. Cancer Research UK (2012a) Cancer Incidence for Common Cancers. Prostate cancer is the most common cancer in men – one in eight will develop it at some time Prostate cancer Picture: iStock Essential facts Prostate cancer starts in the prostate gland, at the base of the bladder in men. Prostate cancer is the most common cancer in men in the UK. With no national screening programme, diagnosing prostate cancer remains one of the biggest challenges facing health professionals. Using a decision aid, such as the Localised Prostate Cancer Decision Aid (NHS, 2012), can be help guide them through the process while ensuring their own beliefs and values are considered; for example, remaining potent might be a key factor. It is only available privately and ProstateHealth UK – who hold the licence – believes that when incorporated with the PSA test it can provide a more accurate method of detecting prostate cancer. • Bureaucracy is stopping retired clinicians helping with Covid vaccinations, • Social care workforce: finding solutions to recruitment and retention, • Insomnia: providing support during the pandemic, © Cogora 2021Cogora Limited, 140 London Wall, London EC2Y 5DN Registered in the United Kingdom. TRUS allows prostate volume to be assessed accurately and any abnormal areas seen in the peripheral zone can be targeted for biopsy. Also the PSA test does not differentiate between slow and fast growing cancers, which can lead to unnecessary treatment and side effects for a cancer that would never cause the man any harm within his lifetime. The PCRMP recommends that age-related PSA referral values are used: 3ng/ml and above for men aged 50-59, 4ng/ml and above for men aged 60-69 and above 5ng/ml for men aged 70 and over. n=226 of 320 patients. This guideline covers the diagnosis and management of prostate cancer in secondary care, including information on the best way to diagnose and identify different stages of the disease, and how to manage adverse effects of treatment. It is more than 20,000 times more potent than PSA and some evidence suggests it activates and regulates PSA. This is so we can be sure that they work and that they are safe. 2147432,,,,, Research: breast screening barriers and dementia patient recall, Almost half of women do not regularly check for breast cancer, Gut bacteria could affect prostate cancer treatments. The prostate gland develops after puberty due to the testosterone surge. The identified risks of prostate cancer are age, family history and ethnic origin; there is no evidence that lifestyle changes reduce risk (CRUK, 2013b). Luteinising hormone-releasing hormone agonists (LHRH), such as goserelin acetate or leuprorelin injections, work by stopping the production of luteinising hormone (LH), which stimulates the testicles to produce testosterone; these can be given monthly or every three months. 112 with breast cancer and 114 with prostate cancer. Treatment will depend on risk category and stage of disease. GnRH antagonists are only licensed for men with advanced prostate cancer; their disadvantage is injections need to be administered monthly. At the end of nursing interventions, the patient and/or significant other is expected to: Verbalize feelings about changes in family processes; Participate in interventions to help resolve issues; Percussion / palpation of the suprapubic area. Diagnosis and treatment. 37. For example, if a man suffers from health anxiety, would knowing his PSA level create more or less concern? After his PSA is found to be ele- vated,he is referred to a urolog ist,who diagnoses prostate cancer. Symptoms of metastatic disease include bone pain, pathological fracture, spinal cord compression, anaemia, leg lymphoedema, and hypercalcaemia (Dasgupta and Kirby, 2012). Therefore, it is imperative to ensure that the man takes into account these pros and cons in the context of his own risk of prostate cancer, and his personal circumstances. Nursing Times; 110: 9, 18-19.Dasgupta P, Kirby R (2012) ABC of Prostate Cancer. London: Cancer Research UK. However, black men are more likely to be diagnosed at a younger age than white men, therefore should start to think about their risk from the age of 45. London: NICE. Tests that doctors are looking at include new types of MRI scans and breath tests. The next step to confirming a diagnosis of prostate cancer is a digital rectal examination (DRE). Although it may reduce the number of deaths from the disease, on a population-wide level this is outweighed by the harm it can cause – diagnosing many more men whose cancer is indolent, subjecting them to unnecessary treatment that can impact on their quality of life. Biopsies of the prostate, guided by an ultrasound probe inserted into the rectum, are performed for men with raised age-specific PSA and/or abnormal DRE. The seeds remain radioactive for up to 10 months. These men should be referred using a suspected cancer pathway referral (to recieve an appointment within two weeks) for prostate cancer if their PSA levels are above the age‑specific reference range or their prostate feels malignant on DRE.1. Although causative factors are still being studied and explored, prostate cancer is thought to be dependent upon hormones, with links found between advanced age and androgens. Although there is no national programme to screen for prostate cancer, men aged over 50 who request screening, after considering the consequences, should be given a PSA test (Burford et al, 2009). Though BPH does not cause prostate cancer, men with the former diagnosis are also at risk for the latter. It can produce false positive and false negative results – approximately 76% of men with a raised PSA level do not have prostate cancer on biopsy (false positive), and around 15% of men with prostate cancer on biopsy (and 2% with a fast growing prostate cancer) do not have a raised PSA (false negative). Nurses are often the key workers for patients with prostate cancer, and are responsible for maintaining continuity of care (NICE, 2004). Survival trends from 2005-09 indicate that 93.5% of men diagnosed with prostate cancer are expected to survive for at least one year, and 81.4% for five years or more (CRUK, 2012c). The current first step to diagnosis is the PSA blood test via an informed choice programme, but it is not a definitive test and can only indicate a problem with the prostate. 116 patients in the control group (56 with breast cancer and 60 with prostate cancer), 110 patients in the experimental group (56 with breast cancer and 54 with prostate cancer) The experimental group had a 31% reduction in disruption in home management after 4 weeks. Trauma, for example from catheterisation, can also raise the PSA result. So let’s do our nursing concepts for a patient with prostate cancer. Prostate-specific antigen is a protein produced by cells in the prostate; its role is to liquefy ejaculated semen, increasing sperm motility. Mutation of the BRCA2 gene, which is most commonly associated with breast cancer risk, causes a fivefold increased risk of prostate cancer; this risk can be more than sevenfold higher in men under 65 years (CRUK, 2013b).