NCLEX Review Guide: Prostate Cancer

Disease Overview

• Prostate cancer is the most common cancer in men, typically developing in the peripheral zone of the prostate gland where digital rectal examination can detect abnormalities.
• Most prostate cancers are adenocarcinomas that grow slowly and may remain localized for years before metastasizing.
• Cancer cells depend on testosterone and dihydrotestosterone (DHT) for growth, making hormone therapy a key treatment approach.

Clinical Manifestations

• Early prostate cancer is often asymptomatic, which is why screening is crucial for early detection in high-risk populations.
• Advanced disease may present with urinary obstruction symptoms: hesitancy, weak stream, frequency, nocturia, and incomplete bladder emptying.
• Metastatic disease commonly spreads to bones, causing bone pain, pathologic fractures, and spinal cord compression.

Diagnostic Procedures

• PSA (Prostate-Specific Antigen) normal is <4 ng/mL, but levels >10 ng/mL are highly suspicious for cancer.
• Digital Rectal Examination (DRE) can detect hard, irregular nodules in the posterior prostate gland.
• Transrectal ultrasound-guided biopsy is the definitive diagnostic test for confirming prostate cancer.

Treatment Options

• Active surveillance is appropriate for low-risk, localized cancer with regular PSA monitoring and repeat biopsies.
• Radical prostatectomy involves complete removal of the prostate gland and is curative for localized disease.
• External beam radiation therapy or brachytherapy (radioactive seed implants) are alternatives to surgery for localized cancer.
• Hormone therapy (androgen deprivation) using GnRH agonists or antiandrogens is used for advanced or metastatic disease.

Post-Surgical Care

1. Monitor continuous bladder irrigation for color, consistency, and clots in urine output.
2. Maintain catheter patency and assess for signs of obstruction or infection.
3. Teach pelvic floor exercises (Kegel) to prevent long-term urinary incontinence.
4. Provide emotional support regarding potential erectile dysfunction and refer to appropriate resources.

Radiation Therapy Care

• Teach skin care: avoid soap, lotions, and sun exposure to irradiated areas.
• Monitor for radiation cystitis symptoms: dysuria, frequency, urgency, and hematuria.
• Assess for fatigue and provide energy conservation strategies throughout treatment course.

Common Complications

• Urinary incontinence affects 5-15% of patients long-term after radical prostatectomy.
• Erectile dysfunction occurs in 25-75% of patients depending on age, technique, and nerve-sparing approach.
• Hormone therapy can cause osteoporosis, hot flashes, gynecomastia, and increased cardiovascular risk.