6. Prostate cancer: malignant neoplasm, usually adenocarcinoma; most common cause of cancer in men.
   • Risk factors:
     1. Men > age 50.
     2. Familial history.
     3. Geographic distribution, environmental (e.g., industrial exposure to cadmium).
     4. Hormonal factors (testosterone).
     5. Diet (high fat).
   • Annual incidence: 185,000 new cases; 40,000 estimated deaths.
   • Assessment:
     1. 1. Subjective data:
        • Difficulty in starting urinary stream (hesitancy); urgency.
        • Pain due to metastasis in lower back, hip, legs; perianal or rectal discomfort.
        • Symptoms of cystitis; frequency, urgency.
     2. Objective data:
        • Urinary: smaller, less forceful stream; terminal dribbling; frequency, nocturia; retention (inability to void after ingestion of alcohol or exposure to cold).
        • Diagnostic tests: digital rectal examination (DRE); transrectal ultrasonography (TRUS). Needle biopsy or tissue specimen reveals positive cancer cells.
        • Lab data: increased:
          1. Prostate-specific antigen (PSA) - over 4 ng/mL.
          2. Urine RBCs (hematuria).
          3. Gleason score for prostate cancer grading system (range: 2-10).
   • Analysis/nursing diagnosis:
     1. Altered urinary elimination related to incontinence.
     2. Altered sexuality pattern related to nerve damage and erectile dysfunction.
     3. Anxiety related to diagnosis.
     4. Pain related to metastasis to bone.
   • Nursing care plan/implementation:
     1. Goal: assist patient through decisions about treatment protocol (varies by stage: 0-IV).
        • Radiation - alone or in conjunction with surgery. Types: external beam radiation, 3-D conformal (focal), radioactive seed implants (brachytherapy).
        • Surgery - cryosurgery; radical retropubic prostatectomy.
        • Other options: hormones (luteinizing hormone-releasing hormone agonists [Lupron, Zoladex, Casodex, Nilandron]), antiandrogen (flutamide [Eulexin]); drugs in conjunction with orchiectomy, to limit production of androgens (androgen deprivation therapy).
        • Watchful waiting - recommended with small contained tumor; older men; where surgery is contraindicated for other serious health problems.