VOL: 98, ISSUE: 28, PAGE NO: 56
Jayne Lewey, RGN, BSc, DNert, Cert Ed, is MacMillan urology nurse specialist, Lister Hospital, Stevenage, Hertfordshire
Although the incidence of prostate cancer appears to be rising, the cause of the disease is not fully understood. Currently no proven preventative measures have been identified. However, a number of risk factors have been established (Mettlin, 1997):
Prostate cancer can grow slowly for several years before it shows any signs and symptoms. Many older men with prostate cancer live to their normal life expectancy without it causing them any problems. The disease is now being diagnosed earlier in asymptomatic younger men. Traditionally, most men presented with clinically significant disease with a variety of symptoms related to bladder outflow obstruction (Table 1), local extension of the tumour (Table 2) or distant metastatic spread (Table 3).
Recommended diagnostic staging investigations may include a digital rectal examination, serum prostate specific antigen (PSA), transrectal ultrasound scan and guided biopsy, CT scan, bone scan and chest X-ray.
Deciding on the best treatment is not straightforward, and a number of important factors have to be considered:
- The stage of the disease - for instance, its extent and spread;
- The grade of the prostate cancer cells - for instance, their aggressiveness;
- Age of the patient;
- General state of health of the patient;
- Side-effects of treatment on the patient's quality of life. Alterations in bladder, bowel and sexual function can be a major deterrent to treatment (Table 4).
- Weak stream;
- Sensation of incomplete emptying;
- Urge incontinence;
- Urinary tract infection.
- Perineal and suprapubic pain;
- Loin pain (obstructed ureters);
- Renal failure;
- Rectal discomfort/symptoms.
- Bone pain;
- Paraplegia secondary to cord compression;
- Lymph node enlargement;
- Loin pain and/or anuria (obstructed ureters);
- Weight loss and cachexia;
- Rectal bleeding.