Involve. Supporting you. Supporting your patients with cancer
As a healthcare provider, you participate in every aspect of care for patients facing a cancer diagnosis. Use this section to refresh your knowledge of prostate cancer or share the information with patients who are facing a prostate cancer diagnosis.
- Facts and Statistics
- Risk Factors
- Screening and Early Detection
- Diagnosis and Staging
- Prostate Cancer Treatment Options
Facts and Statistics
According to the American Cancer Society:
- Excluding skin cancer, prostate cancer is the most common cancer diagnosed in men in the US.
- In 2009, approximately 192,280 new cases of prostate cancer are expected to be diagnosed.
- One in 6 men will develop prostate cancer during his lifetime, while 2 million men in the US who have been diagnosed with prostate cancer at some point are still alive today.
- Prostate cancer is the second leading cause of cancer-related death among American men. However, only 1 in 35 men will die of prostate cancer.
Risk Factors
While all men are at risk for developing prostate cancer, some men are at a higher risk than others. Some risk factors, like age, race, and family history, are unavoidable, while other risks can be avoided.
- Age: The risk of prostate cancer increases with age and is particularly high in those over the age of 50. Approximately 67% of prostate cancer cases are diagnosed in men older than age 65.
- Race and Nationality: Black men have an increased risk of prostate cancer. In addition, black men are more likely than men of other races to be diagnosed with advanced prostate cancer. Hispanic men and white men have an equivalent risks of developing prostate cancer, while Asian men are less likely than white men to develop prostate cancer. Prostate cancer occurs more in North America and northwestern Europe than in Asia, Central America, Africa, and South America.
- Family History of Prostate Cancer: A family history of prostate cancer increases prostate cancer risk. Having a brother or father who has been diagnosed with prostate cancer more than doubles the risk of developing prostate cancer. This risk is even higher if multiple relatives have been diagnosed with prostate cancer or if any relatives have developed prostate cancer at an early age.
- Genetic Factors: While certain genetic mutations may increase the risk of prostate cancer, genetic testing is not yet available.
- Eating Habits: A diet high in high-fat dairy products and red meat and low in fruits and vegetables may increase the risk of developing prostate cancer.
- Calcium Intake: Some research studies indicate that men who consume a lot of calcium may have a slightly increased risk of prostate cancer. However, most studies have found this to be untrue, and it is important to consider the health benefits of calcium.
- Vasectomy: Some studies have shown that men who have had a vasectomy may have a slightly increased risk of prostate cancer. However, the link between vasectomies and an increased risk of developing prostate cancer has not been confirmed.
- Obesity: Most studies have found no link between obesity and the risk for prostate cancer. However, some studies have indicated that obese men have a higher probability of developing more aggressive prostate cancer.
Screening and Early Detection
Early prostate cancer rarely produces symptoms, so it is possible for patients to have prostate cancer for some time without being aware of it. However, the earlier prostate cancer is detected, the better the chances are for successful treatment. This is why, as a nurse, it is so important to discuss prostate cancer screening with patients.
While the American Cancer Society (ACS) does not recommend routine testing for prostate cancer at this time, ACS does recommend that healthcare providers discuss the potential benefits and limitations of the following prostate cancer early detection testing with men who are at average risk of prostate cancer and have at least a 10-year life expectancy, beginning at the age of 50 years:
- Prostate-Specific Antigen (PSA) Blood Test: PSA is produced in the prostate gland, and a PSA test measures the amount of PSA in the blood. Normal PSA levels are less than 4 ng/mL. A PSA level of 4ng/mL to 10 ng/mL correlates to an approximately 25% risk of developing prostate cancer. A PSA level greater than 10 ng/mL correlates to a risk of developing prostate cancer of more than 50%. It is important to note that PSA levels are not a direct indicator of prostate cancer risk. Even patients with PSA levels less than 4 ng/mL may be at risk of prostate cancer. In addition, factors other than prostate cancer may cause PSA levels to rise, including certain medications, ejaculation, age and prostate infection or inflamation. Discussion should occur which includes an offer of PSA testing.
- Digital Rectal Exam (DRE): The prostate gland is located in front of the rectum, so signs of prostate cancer often can be found during a rectal exam. During a DRE, a healthcare provider uses a gloved, lubricated finger to feel for signs of prostate cancer. A DRE can be helpful in detecting prostate cancer in men who have normal PSA levels.
The ACS recommends DREs along with PSA blood testing for men age 50 and older. For men who have an increased risk of prostate cancer, the ACS recommends earlier screening.
Diagnosis and Staging
Several options are available for the diagnosis of prostate cancer:
- Biopsy: A tissue sample of the suspected tumor will be removed and sent to a laboratory for further analysis. Not all biopsies confirm the presence of cancer. If a biopsy does not indicate prostate cancer but the presence of cancer is strongly suspected, another biopsy may be needed to determine if cancer is present.
Once prostate cancer is diagnosed, the disease is staged:
| Prostate Cancer Stages | ||||
|---|---|---|---|---|
| Stage | Primary Tumor (T) |
Lymph Nodes (N) | Metastasis (M) | Histological Grade (G) |
| I | T1a | N0 | M0 | G1 |
| II | T1a | N0 | M0 | G2, 3-4 |
| T1b | N0 | M0 | Any G | |
| T1c | N0 | M0 | Any G | |
| T1 | N0 | M0 | Any G | |
| T2 | N0 | M0 | Any G | |
| III | T3 | N0 | M0 | Any G |
| IV | T4 | N0 | M0 | Any G |
| Any T | N1 | M0 | Any G | |
| Any T | Any N | M1 | Any G | |
| Prostate Cancer TNM Staging Guide | |
|---|---|
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| T1 | Clinically inapparent tumor neither palpable nor visible by imaging |
| T1a | Tumor incidental histologic finding in ≤5% of tissue resected |
| T1b | Tumor incidental histologic finding in >5% of tissue resected |
| T1c | Tumor identified by needle biopsy (eg, because of elevated PSA). (Tumor found in 1 or both lobes by needle biopsy, but not palpable or reliably visible by imaging is classified as T1c.) |
| T2 | Tumor confined within prostate that involves:
|
| T3 | Tumor extends through the prostate capsule. (Invasion into the prostatic apex or into [but not beyond] the prostatic capsule is classified not as T3, but as T2.) Extracapsular extension (unilateral or bilateral). Tumor invades seminal vesicle(s) |
| T4 | Tumor is fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall |
| Prostate Cancer TNM Staging Guide | |
|---|---|
| Regional Lymph Nodes (N) | |
| NX | Regional lymph node metastases cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in regional lymph node(s) |
| Prostate Cancer TNM Staging Guide | |
|---|---|
| Distant Metastasis (M)* | |
| MX | Distant metastasis cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis present |
| *When more than 1 site of metastasis is present, the most advanced category is used. pM1c is most advanced. | |
| Prostate Cancer TNM Staging Guide | |
|---|---|
| Histologic Grade (G) | |
| G1 | Well differentiated (slight anaplasia) (Gleason 2-4) |
| G2 | Moderately differentiated (moderate anaplasia) (Gleason 5-6) |
| G3-4 | Poorly differentiated/undifferentiated (marked anaplasia) (Gleason 7-10) |
| Gleason score is considered to be the optimal method of grading because this method takes into account the inherent heterogeneity of prostate cancer and because it has been clearly shown that this method is of great prognostic value. | |
Prostate Cancer Treatment Options
As a healthcare provider, you may find yourself educating patients about their treatment options. The following is a brief summary of common therapies used to treat prostate cancer that may be helpful to you and your patients.
- Watchful Waiting: Prostate cancer tends to grow slowly, and therefore close monitoring without treatment is an option. Watchful waiting may be appropriate for patients with small tumors that are not causing symptoms and are expected to grow slowly. Men who choose to undergo watchful waiting should have PSAs and DREs completed every 3 to 6 months and need to be re-biopsied at some point to make sure the grade has not become less favorable.
- Surgery: Surgery is a common treatment for tumors that have not spread outside of the prostate gland. For early prostate cancer, surgery attempts to cure the cancer by removing the entire prostate gland.
- Radiation Therapy: Radiation is a common treatment for prostate cancer that uses high-energy rays to kill or shrink cancer cells. The radiation may be administered externally or internally by having radioactive materials placed inside the prostate.
- Cryosurgery: Cryosurgery destroys the prostate gland through freezing. Probes or needles are inserted through the area between the scrotum and anus and then into the prostate. These probes contain liquid nitrogen that freezes the tissue and destroys the prostate gland. Cryosurgery is a somewhat experimental approach, is not considered as effective as radiation and surgery in treating prostate cancer, and is associated with a variety of side effects.
- Hormonal Therapy: Hormonal therapy helps to lower levels of androgens, mainly testosterone. Since androgens stimulate the growth of prostate cells, including cancer cells, lowering androgen levels with hormonal therapy may help shrink the prostate cancer or slow its growth. There are several methods for lowering hormone levels, including removal of the testicles (orchiectomy), administration of agents that block the production of androgens (LHRH agonists), administration of agents that block androgen receptors (anti-androgens), and administration of estrogens.
- Chemotherapy: A number of chemotherapeutic agents are available to help kill prostate cancer cells. Chemotherapy may be administered orally or intravenously. Chemotherapy may be chosen if the prostate cancer has spread or if it is no longer responding to hormonal therapy.
- Clinical Trials: Clinical trials give patients access to investigational approaches and treatments that often are not otherwise available. There are both benefits and drawbacks to participation in clinical trials that patients and healthcare providers should discuss.
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