vinay kumar, M.Sc nursing 1st year, Himalayan college of nursing,Deharadun

1. PRESENTED BY
Mr. Vinay Kumar
M.Sc. Nursing 1st year
HCN, SRHU

2. Definition
Prostate cancer is the most
common cancer among men,
but it can be often related
successfully.
Prostate cancer is the
development of cancer in the
prostate which are the gland of
male reproductive system and
may relate to other area or
organ of body.

4.  progressive BPH
• Inherited gene mutation-RNASEL (HPC-1) the normal function is
tumour suppressor
DNA mismatch repair- MSH2 and MLH1 genes normally help to
mismatch in DNA that are made when a cell preparing to divide
into 2 new cell.
HOXB13- this gene is responsible for development of prostate
cancer.
Inherited mutation of these gene is cause cancer

6. Major risk factor
Age
Ethnicity
Geography
Family history- mutation of gene

7. Less risk factor
Diet- excess use of red meat, dairy product
Obesity
Smoking
Chemical exposure
STD

8. stages of
prostate cancer

9. A staging system is a standard way for the cancer care team
to describe how far a cancer has spread.
The most widely used staging system for prostate cancer is
the AJCC (American Joint Committee on
Cancer) TNM system, which was most recently updated in
January 2018.

10. • The TNM system for prostate cancer is based on 5 key pieces of information:
• Main (primary) tumour (T category)
• Whether spread to nearby lymph nodes (N category)
• Whether spread (metastasized) to other parts of the body (M category)
• Level of PSA
• The Grade Group (based on the Gleason score), which is a measure how likely
the cancer is to grow and spread quickly.
• Determined by the results of the prostate biopsy (or surgery).

11. There are two types of category for prostate cancer
• The clinical t category writer ct is best estimate of the extent of
disease based on
Physical examination (digital physical rectal examination)
• Prostate biopsy

12. If the surgery to remove the prostate then it determine the pathogical
T category written (PT)
• Pathological t is likely to be more accurate that the clinical T.
• Number or letters after t n and m provide more detail about each of
these factors higher number means the cancer is more advanced.
• Once the T, N and M category have been determined this information
is combined called stage grouping

13. • The main stage of prostate cancer is range from 1 to 4 and some
stages are split further (a, b, c, etc)
• Lower no of score mean less spreading of cancer while higher score
means high spread of cancer cell in body.

14. AJCC
Stage
I
Stage grouping
Ct1,no,mo
Grade group 1
Gleason score is 6
PSA>10
Stage description
Tumour is seen by radio imaging test such as
transrectal ultrasound or diagnosed by needle biopsy
done for high PSA(ct1)
Cancer not spread near by lymph node (N)o or
elsewhere in the body(Mo)
PSA level is>10
or

15. Stage Stage grouping
Ct2a no Mo
Grade group 1
Gleason score-6
PSA>10
Pt2,no,mo
Grade group-1
Glsn score-6
PSA>10
Stage description
The tumour can be felt by digital rectal examination or
by imaging it is felt on half or 1 side of the
prostate(ct2a)
No and Mo
PSA>10
or
Prostate removed with surgery and still tumor is in
prostate
No and mo
PSA >10

17. sta
ge
Stage grouping Stage description
IIA
cT1,No,Mo
Grade group-1
Gleason score -6
PSA at least 10 or
<20
cT2b,or cT2c
No, Mo
Grade group-1
Gleason score -6
PSA at least 10 or
<20
tumour see with imaging such as USG or by
biopsy for high PSA level.
(cT1)
No
Mo
Grade 1, PSA at least 10 or less than 20
Or
Tumour find by physical examination (DRE) or by imaging
More than half of one side of prostate(cT2b) both side of
prostate (cT2c).
No
Mo
Grade-1, PSA <20

18. stage Stage grouping Stagedescription
IIB
IIC
T1 or T2
No, Mo
Grade group-2
Gleason score-7
PSA>20
T1 or T2
No, Mo
Grade group-3 or 4
Gleason score-7or
8
PSA>20
Might or might not felt by USG or physical
examination (DRE)- T1or T2
No, Mo
Grade group-2
PSA>20
or
Might or might not felt by USG or physical
examination (DRE)- T1or T2
No, Mo
Grade group-3 or4
PSA>20

20. stage Stage grouping Stage description
iiiA
iiiB
T1 or T2
No, Mo
Grade group 1-4
Gleason score-8 or<
PSA at least 20
T1 or T2
No, Mo
Grade group 1-4
Gleason score-8 or
<
PSA at least 20
Might or might not felt by USG or physical
examination (DRE)- T1or T2
No, Mo
Grade group-2
PSA>20
or
Cancer grown out side the bladder and might have to
spread in to other tissue like semi vesicles(T3) it has
spread in to other tissue like urethral spincter, rectum,
bladder and wall of pelvic .
No, Mo
Grade group 1-4
PSA value

22. Stage Stage grouping Stagedescription
IVA
IVB
Any T, N1,Mo
Grade group- 5
Gleason score 9-10
Any PSA
Any T, N1,M1
Any grade group
Any PSA
Might or might not be growing into tissue near the
prostate any T
Spread to nearby lymph node (T)
Spread to nearby lymph (N1)
Mo.
Any PSA
or
Might or might not be spread to near lymph node, (N)
Spread to other part of body such as distant lymph,
bones, or other organ(M)
Grade group can be any value
PSA can any value

24. • In early stage there is no any specific sign and symptoms
• When it develop then sign and symptoms is-

25. HEMATURIA

26. • When cancer spread outside the prostrate it will
show –
o pain in back ,hip ,thigh shoulder or other bone
oEdema in legs , feet
oUnexplained weight loss
oFatigue
o changes in bowel function
oBurning urination
oDiscomfort when sitting

28. oHistory collection
present medical and surgical history
past medical and surgical history
o physical examination
oPSA test
oDRE ( digital rectal examination)

29. • Biomarkers -= also called tumour marker.
it is found in blood , urine, or body tissue in cancer
patient.
it is made by body in response to cancer.

30. Conformational diagnosis
• PCA 3 test = prostrate cancer gene assay it is found in
prostrate cancer patient’s urine.
• Transrectal ultrasound = a probe is inserted in rectum and
takes a picture of prostrate by using sound waves , that
bounce prostrate.
It done usually at the time of biopsy.

31. Cont…
• Biopsy = removal of small amount of tissue from prostrate cell
• most patient will have 12 – 14 pieces of tissue removed for
examination
• MRI = it will show tumour size.
• CT-SCAN

33. • Depending on each case, treatment options for men with
prostate cancer might include:
• Watchful waiting or active surveillance
• Surgery
• Radiation therapy
• Cryotherapy (cryosurgery)
• Hormone therapy
• Chemotherapy
• Vaccine treatment

34. Active surveillance-
• closely monitoring the patients sign and symptoms that is
worsening.
• ASCO endorses recommendation from cancer patients which
recommended active surveillance for most patients with a
Gleason score 6 or below , that has not spread beyond the
prostrate.
• Some times active surveillance not require in cancer patients.

35. • ASCO encourages the following testing schedule for active
surveillance-
• a PSA test every 3to 6 months
• DRE at least once every year
• Another prostrate biopsy within 6 to 12 months then biopsy
atleast 2 to 5 years.

36. Watchful waiting
• It may be an option for much older patients and those who
have others serious life threatening and life expectancy less
then five year.
• Watchful waiting include-
• PSA test
• DRE (not usually preferred)
• watch the symptoms of prostate cancer, the treatment may
be recommended.

38. • There are several medicine used for prostrate cancer.
• in general standard chemotherapy begins with docetaxel combine
with steroid called prednisone.

39. Combination of methotrexate, vinblastine, Adriamycin, and
cisplatin, is standard treatment for metastatic bladder cancer.
The new combination regimen shows response rates and
median survival comparable.
Gemcitabine plus cisplatin is now considered a 1st line
treatment for bladder cancer.

40. Fluorouracid (Adrocil)- It is a antimetabolite drugs which
inhibit the RNA synthesis
Methotrexate- it inhibit both RNA or DNA synthesis.
Gemcitabin- it inhibit the DNA replication.
Antineoplastic, vinca alkaloid-it act on the G phase of mitosis,
inhibiting the DNA and RNA synthesis. E.g. vinblastine
Anthracycline- it synthesis by steric obsyruction.
They intercalate between DNA base pairs and triggers DNA
cleavage by topoisomerase 2nd . E.g. doxorubicin, valrubicin

41. Alkelyting agent- these agent inhibit the cell growth and proliferation.
They inhibit the DNA synthesis by proliferation of DNA cross link.
e.g. cisplatin, carboplatin
PD-1/ PD-L1 inhibitors- these is expressed on the surface of activated T
cell under normal condition.PD-L1 interaction inhibit immune
activation and reduce T cell cytotoxic activity when bound. E.g.-
Atezolizumab, Nivolumab

43. • Surgical options include:
• Radical (open) prostatectomy. A radical prostatectomy is the
surgical removal of the entire prostate and the seminal
vesicles. Lymph nodes in the pelvic area may also be
removed.

44. • laparoscopic prostatectomy. This type of surgery is possibly much
less invasive than a radical prostatectomy and may shorten recovery
time. A camera and instruments are inserted through small keyhole
incisions in the patient’s abdomen.
• The surgeon then directs the robotic instruments to remove the
prostate gland and some surrounding healthy tissue.

46. • External beam radiation therapy = it is most common type of
radiation therapy
• The radiation is give by using a machine linear accelerator located
outside the body to focus a beam of x-ray on the area with cancer.

47. • Intensity – modulated radiation therapy(IMRT) =it is a type of external
beam radiation therapy that uses CT-Scan to form a 3D picture of
prostrate before treatment

49. Brachytherapy. Brachytherapy, or internal radiation therapy, is the
insertion of radioactive sources directly into the prostate.
• These sources, called seeds, give off radiation just around the area
where they are inserted and may be left for a short time (high-dose
rate) or for a longer time (low-dose rate).
• Low-dose rate seeds are left in the prostate permanently and work for
up to 1 year after they are inserted.

50. • However, how long they work depends on the source of radiation
used.
• High-dose rate brachytherapy is usually left in the body for less than
30 minutes, but may need to be given more than once.
• Brachytherapy may be used with other treatments, such as external-
beam radiation therapy and/or androgen deprivation therapy.

52. • Proton therapy, also called proton beam therapy
• It is a type of external-beam radiation therapy that uses protons
rather than x-rays. At high energy, protons can destroy cancer cells.

53. Focal therapy

54. • Focal therapies are non invasive treatments that destroy
small prostate tumours without treating the rest of the
prostate gland. These treatments use heat, cold, and other
methods to treat cancer.
• cryosurgery, also called cryotherapy or cryoablation.
• It is the freezing of cancer cells with a metal probe inserted
through a small incision in the area between the rectum and
the scrotum, the skin sac that contains the testicles. It is not
an established therapy or standard of care for men newly
diagnosed with prostate cancer.

55. Hormonal therapy

56. • Hormone therapy is also called androgen deprivation
therapy (ADT) or androgen suppression therapy. The goal is
to reduce levels of male hormones, called androgens, in the
body, or to stop them from affecting prostate cancer cells.

57. Androgen deprivation therapy
• The main goal of ADT is lower the level of testosterone.
• Because prostate cancer growth is driven by male sex
hormones called androgens, lowering levels of these
hormones can help slow the growth of the cancer.
• The most common androgen is testosterone. Testosterone
levels in the body can be lowered either by surgically
removing the testicles, known as surgical castration, or by
taking drugs that turn off the function of the testicles, called
medical castration.

58. Types of ADT
• Bilateral orchiectomy. Bilateral orchiectomy is the surgical
removal of both testicles and was the first treatment used
for metastatic prostate cancer more than 70 years ago.
• Even though this is an operation, it is considered an ADT
because it removes the main source of testosterone
production, the testicles.
• The effects of this surgery are permanent and cannot be
reversed.

59. • LHRH agonists. LHRH stands for luteinizing hormone-
releasing hormone. Medications known as LHRH agonists
prevent the testicles from receiving messages sent by the
body to make testosterone. By blocking these signals, LHRH
agonists reduce a man’s testosterone level just as well as
removing his testicles.
• LHRH agonists are injected or placed as small implants under
the skin.

61. • Sipuleucel-T (Provenge) is an immunotherapy.
• Sipuleucel-T is adapted for each patient. Before treatment, blood is
removed from the patient in a process called leukapheresis.
• Special immune cells are separated from the patient’s blood,
modified in the laboratory, and then put back into the patient. At this
point, the patient’s immune system may recognize and destroy
prostate cancer cells.

62. Side effect and complication of treatment
• Erectile dysfunction
• Loss of sexual desire.
• Sweating
• Depression
• Cognitive dysfunction
• Weight gain
• Loss of muscles mass
• Alopecia
• Anaemia
• Osteoporosis

64. Nursing diagnosis
Acute pain related to disease process as evidence by patient
verbalization
Goal- to control pain
Intervention-
• Assess the location, intensity duration of pain.
• Encourage to maintain bed rest.
• Administer the prescribed medication (analgesic)
• Maintain patient comfort.
• Suggest for using relaxation and deep breathing exercise and
diversional activities.

65. 2. Risk for infection related to development of disease
process
Goal = to prevent the risk of infection
Intervention
• Maintain personal hygiene to prevent risk of infection.
• Monitor the CBC with differential WBC count.
• Use aseptic technique while performing any invasive
procedure.
• administer the prescribed medication.
•

66. 3. Risk for impaired skin integrity related to side effects of
chemotherapy and radiation therapy.
Goal = to maintain skin integrity
Intervention
• assess skin frequently for side effects of chemotherapy and
radiation the patient
• Bath with lukewarm water and mild soap
• Turn or reposition frequently

67. 4. Anticipatory grieving related to loss of physiological wellbeing as
evidence by changes in eating, sleeping pattern, and activity level
Goal= to enhance continue normal life activity
Intervention
• Provide open non-judgemental environment.
• Use therapeutic communication skill for active listening of the
patient.
• Review past life experiences