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. 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.
7. Bladder cancer: bladder is most common site of urinary tract cancer.
   • Risk factors:
     1. Contact with certain dyes.
     2. Cigarette smoking.
     3. Excessive coffee intake.
     4. Prolonged use of analgesics with phenacetin.
     5. Three times more common in men.
   • Annual incidence: 54,500 new cases; 12,100 estimated deaths.
   • Assessment:
     1. Subjective data:
        • Frequency, urgency.
        • Pain: flank, pelvic; dysuria.
     2. Objective data:
        • Painless hematuria (initially).
        • Diagnostic tests:
          1. Cystoscopy, intravenous pyelogram (IVP) - mass or obstruction.
          2. Bladder biopsy, urine cytology - malignant cells.
        • Lab data: urinalysis - increased RBC (>4.8/μL - men, >4.3/μL - women); erythrocytes (>30 mg/dL)
   • Analysis/nursing diagnosis:
     1. Risk for injury related to surgical intervention.
     2. Altered urinary elimination related to surgery.
   • Nursing care plan/implementation:
     1. Goal: assist patient through treatment protocol.
        • Radiation: cobalt, radioisotopes, radon seeds; often before surgery to slow tumor growth.
        • Chemotherapy:
          1. Antitumor antibiotics: doxorubicin hydrochloride (Adriamycin), mitomycin.
          2. Antimetabolites: 5-fluorouracil (5-FU).
          3. Alkylating agents: thiotepa.
          4. Sedatives, antispasmodics.
     2. Goal: prepare patient for surgery - types:
        • Transurethral figuration or excision: used for small tumors with minimal tissue involvement.
        • Segmental resection: up to half the bladder may be resected.
        • Cystectomy with urinary diversion: complete removal of the bladder; performed when disease appears curable.
     3. Goal: assist with acceptance of diagnosis and treatment.
     4. Goal: prevent complication during postoperative period.
        • Transurethral figuration or excision:
          1. Monitor for clots, bleeding, spasms.
          2. Maintain patency of Foley catheter.
        • Urinary diversion with stoma:
          1. Protect skin, ensure proper fit of appliance - because constantly wet with urine.
          2. Prevent infection by increasing acidity of urine and increasing fluid intake.
          3. Health teaching.
             • Self-care of stoma and appliance.
             • Expected and side effects of medications.
             • Importance of follow-up visits for early detection of metastasis.
   • Evaluation/outcome criteria:
     1. Accepts treatment plan.
     2. Uses prescribed measures to decrease side effects of surgery, radiation, chemotherapy.
     3. Plans follow-up visits for further evaluation.
     4. Maintains dignity.