The Client with Cancer of the Prostate

The nurse is performing a digital rectal examination. Which of the following findings is a key sign for prostate cancer? 1. A hard prostate, localized or diffuse. 2. Abdominalpain. 3. A boggy, tender prostate. 4. A nonindurated prostate.

1. On digital rectal examination, key signs of prostate cancer are a hard prostate, induration of the prostate, and an irregular, hard nodule. Accompanying symptoms of prostate cancer can include constipation, weight loss, and lymphadenopathy. Abdominal pain usually does not accompany prostate cancer. A boggy, tender prostate is found with infection (eg, acute or chronic prostatitis).

A 65-year-old client has been told by the physician that his prostate cancer was graded at stage IIB. The client inquires if this means he is going to die soon. The best response by the nurse is which of the following? 1. "Prostate cancer at this stage is very slow growing." 2. "Prostate cancer at this stage is very fast growing." 3. "Prostate cancer at this stage has spread to the bone." 4. "Prostate cancer at this stage is difficult to predict."

1. Clients who have stage IA or IIB prostate cancer have an excellent survival rate. Prostate cancer is usually slow growing, and many men who have prostate cancer do not die from it. A stage I or II tumor is confined to the prostate gland and has not spread to the extrapelvic region or bone.

A client with prostate cancer is treated with a luteinizing hormone-releasing hormone agonist and antagonist goserelin. The nurse should instruct the client to expect to have: 1. Tenderness of the scrotum. 2. Flushing. 3. Loss of pubic hair. 4. Decreased blood pressure.

2. Goserelin is used to decrease testosterone production in men to slow or stop the production of cancer cells. A common side effect is flushing or hot flashes. Changes in blood pressure, tenderness of the scrotum, and dramatic changes in secondary sexual characteristics should not occur.

When a client is receiving hormone replacement for prostate cancer, the nurse should do which of the following? Select all that apply. 1. Inform the client that increased libido is expected with hormone therapy. 2. Reassure the client that erectile dysfunction will not occur as a consequence of hormone therapy. 3. Provide the client the opportunity to communicate concerns and needs. 4. Utilize communication strategies that enable the client to gain some feeling of control. 5. Suggest that an appointment be made to see a psychiatrist.

3, 4. Hormone manipulation deprives tumor cells of androgens or their byproducts and, thereby, alleviates symptoms and retards disease progression. Complications of hormonal manipulation include hot flashes, nausea and vomiting, gynecomastia, and sexual dysfunction. As part of supportive care, provide explanations of diagnostic tests and treatment options and help the client gain some feeling of control over his disease and decisions related to it. To help achieve optimal sexual function, give the client the opportunity to communicate his concerns and sexual needs. Inform the client that decreased libido is expected after hormonal manipulation therapy, and that impotence may result from some surgical procedures and radiation. A psychiatrist is not needed.

A client asks the nurse why the prostate-specific antigen (PSA) level is determined before the digital rectal examination. The nurse's best response is which of the following? 1. "It is easier for the client." 2. "A prostate examination can possibly decrease the PSA." 3. "A prostate examination can possibly increase the PSA." 4. "If the PSA is normal, the client will not have to undergo the rectal examination."

3. Manipulation of the prostate during the digital rectal examination may falsely increase the PSA levels. The PSA determination and the digital rectal examination are no longer recommended as screening tools for prostate cancer. Prostate cancer is the most common cancer in men and the second leading killer from cancer among men in the United States and Canada. Incidence increases sharply with age, and the disease is predominant in the 60- to 70-year-old age group.

The nurse is teaching a group of men about prostate cancer. Which of the following points should be included in the instruction? Select all that apply. 1. Prostate cancer is usually multifocal and slow growing. 2. Most prostate cancers are adenocarcinoma. 3. The incidence of prostate cancer is higher in men of African descent, and the onset is earlier. 4. A prostate specific antigen (PSA) lab test greater than 4 ng/mg will need to be monitored. 5. Cancer cells are detectable in the urine.

1, 2, 3, Cancer of the prostate gland is the second-leading cause of cancer death among American and Canadian men and is the most common carcinoma in men older than age 65. Incidence of prostate cancer is higher in men of African descent, and onset is earlier. Most prostate cancers are adenocarcinoma. Prostate cancer is usually multifocal, slow growing, and can spread by local extension, by lymphatics, or through the bloodstream. Prostate-specific antigen (PSA) greater than 4 ng/mg is diagnostic; a free PSA level can help stratify the risk of elevated PSA levels. Metastatic workup may include skeletal x-ray, bone scan, and computed tomography or magnetic resonance imaging to detect local extension, bone, and lymph node involvement. The urine does not have prostate cancer cells.

A client is undergoing a total prostatectomy for prostate cancer. The client asks questions about his sexual function. The bestresponse by the nurse is which of the following? "Loss of the prostate gland means that: 1. You will be impotent." 2. You will be infertile and there will be no ejaculation. You can still experience the sensations of orgasm." 3. You will have no loss of sexual function and drive." 4. Your erectile capability will return immediately after surgery."

2. Loss of the prostate gland interrupts the flow of semen, so there will be no ejaculation fluid. The sensations of orgasm remain intact. The client needs to be advised that return of erectile capability is often disrupted after surgery, but within 1 year 95% of men have returned to normal erectile function with sexual intercourse.

The nurse is developing an educational program about prostate cancer. The nurse should provide information about which of the following topics: 1. The Prostate-Specific Antigen (PSA) test is reliable for detecting the presence of prostate cancer. 2. For all men, age 50 and older, the American and Canadian Cancer Societies recommend an annual rectal examination. 3. Not lifting more than 20 pounds (9.1 kg) aids in prevention of prostate cancer. 4. Regular sexual activity promotes health of the prostate gland to prevent cancer.

2. Most cases of prostate cancer are adenocarcinomas. An adenocarcinoma is palpable on rectal examination because it arises from the posterior portion of the gland. Although the prostate-specific antigen (PSA) is not a perfect screening test, the American Cancer Society and the Canadian Cancer Society recommend an annual rectal examination and blood PSA level for all men age 50 years and older, or starting at age 40 years if the client is of African descent, or if there is family history of prostate cancer. To help achieve optimal sexual function, give the client the opportunity to communicate his concerns and sexual needs. Regular sexual activity does not prevent cancer.

The nurse is caring for a client who will have a bilateral orchiectomy. The client asks what is involved with this procedure. The nurse's most appropriate response would be? "The surgery: 1. Removes the entire prostate gland, prostatic capsule, and seminal vesicles." 2. Tends to cause urinary incontinence and impotence." 3. Freezes prostate tissue, killing cells." 4. Results in reduction of the major circulating androgen, testosterone."

4. Bilateral orchiectomy (removal of testes) results in reduction of the major circulating androgen, testosterone, as a palliative measure to reduce symptoms and progression of prostate cancer. A radical prostatectomy (removal of entire prostate gland, prostatic capsule, and seminal vesicles) may include pelvic lymphadenectomy. Complications include urinary incontinence, impotence, and rectal injury with the radical prostatectomy. Cryosurgery freezes prostate tissue, killing tumor cells without prostatectomy.