Case Study: Prostate Cancer

 

Case Study: Prostate Cancer

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Part A:

 Written case analysis: Case Scenario Topic 1

The essay will encompass a case study of Garry, fifty-five years old with life-limiting (terminal) prostate cancer, and experiencing intolerable pain. The diagnosis was made five years ago when Garry had a prostatectomy. Nevertheless, treatment was unsuccessful, and his cancer has metastasis in the lungs and spine. Garry’s pain in his lower back is intolerable and needs to be reviewed. According to Leslie et al. (2020), prostate cancer occurs when there are anomalous cells in an uncontrollable way in the prostate gland, which transforms into a malignant tumour. In Australian men, prostate cancer is regarded as the second most diagnosed cancer, and terms of the most prevalent cause of death in the cancer category, it is ranked third. By the age of 85, one in every six men is diagnosed with prostate cancer. In older men, it is a common occurrence, and for men aged over 65years, 63% of prostate cancer cases are in this category (Feletto et al. 2015) Hence, it is no surprise that Garry who is fifty-five years of age is suffering from prostate cancer. Australian Institute of Health and Welfare (2020), the approximated number of new prostate cancer in 2020 is 16,741, which is an estimated 22% of new cancer cases in men. In addition, the estimated deaths in 2020 in men due to prostate cancer are 3,152. According to Leslie et al. (2020), there are two stages of prostate cancer. One the stage is the locally advanced prostate cancer, which has only spread to the neighbouring glands or body to the prostate. The second stage, which is the advanced stage, is the metastatic prostate cancer, which has spread to glands or body parts far away from the prostate (Litwin & Tan, 2017). Therefore, since Garry’s cancer has metastasis in the lungs and spine, he is suffering from metastatic prostate cancer. Garry needs immediate medical attention due to the nature of his cancer, in addition to the intolerable pain in his lower back.

Leslie et al. (2020) have tackled various aspects of prostate cancer. The prostate is approximately three centimetres long and weighs around twenty grams, and its size is that of a walnut. The prostate is tasked with producing around one-third of the seminal fluid. The secretions are a white milky substance of alkaline chemicals, enzymes, and simple sugars.  The sugars give nutrition to the sperm as they are transferred to a woman’s body to fertilize the ova. At the base of the penis in the male pelvis, there is the prostate gland. The prostate surrounds the urethra’s posterior, which can be deceptive (Leslie et al., 2020). The proximal urethra, prostatic urethra, and posterior urethra are meant to describe the same anatomy, and thus, there is no difference between the interior lining of the urethra and the prostate. The prostate is composed of glandular tissue, which is responsible for the production of about 32 percent of the total semen. This part provides the ideal pH and also nourishes the sperm.  For the prostate gland to function optimally, it requires testosterone (androgen) (Leslie et al., 2020). Cancer starts with the normal granular cells of the prostate mutating, and it is profound in the peripheral basal cells. The cancer cells start to grow and multiply and spreading initially in the surrounding tissue of the prostate, which forms a tumour nodule (Leslie et al., 2020). The tumour can spread outside the prostate like in Garry’s case, or remain localized. Commonly, prostate cancer metastasizes to the lymph nodes and bones, which leads to severe pain, such as the pain experienced by Garry. According to Litwin and Tan (2017), the most common symptoms of prostate cancer are in urinating habits. The changes may include a weak urine flow, difficulty in emptying the bladder or starting to urinate, urine dribbling after one finishes to urinate, frequent need to urinate mostly at night, and the inability to hold urine due to the abrupt need to urinate. Other symptoms may include pain or discomfort when sitting, blood in the seminal fluid or urine, and pain when urinating. In advanced cases, cancer breaks out of the prostate and spreads to other body parts; an individual may experience unexplained weight loss, problems keeping or getting an erection and pelvis pain, hip pain, and back pain (Litwin & Tan, 2017). Hence, the back pain experienced by Garry can be linked to the fact that he has advanced prostate cancer.

Garry’s diagnosis was made five years ago, and he underwent a prostatectomy. In Australia, health professionals utilize the Australian clinical guidelines when making the decision on the diagnosis technique they can apply (Roberts, 2018). Therefore, Garry may have undergone the digital rectal examination or the PSA blood test conducted by a general practitioner. When the tests revealed that Garry had an abnormality in his prostate, Garry went for a multi-parametric magnetic resonance imaging (mpMRI) scan, which uses radio and magnetic waves to get clear images inside the prostate. This was when Garry was diagnosed with prostate cancer and underwent a prostatectomy. According to Roberts (2018), prostatectomy refers to a surgical procedure for the complete or partial removal of the prostate. It may either be done using a perineum incision or a suprapubic incision. However, the treatment was unsuccessful, and the prostate cancer is in stage 4 (metastatic). This is the advanced stage of cancer, and it has spread to other parts of the body, such as bone or lymph glands. According to Sivaraman and Bhat (2017), this cancer is still referred to as prostate cancer, despite the tumour being located in another part of the body. Due to the unsuccessful treatment, a bone scan was undertaken to indicate if cancer has spread to the bones. The whole was scanned to detect radioactivity, and it showed large radioactivity in the spine (Sivaraman & Bhat, 2017). A CT scan (computerized tomography) was undertaken, which revealed that his cancer had spread to the lungs. A PET scan (Positron emission tomography) was also used in creating pictures of tissues and organs in the body. Hence, this was how Garry was diagnosed with cancer spreading to the lungs and spine, showcasing the metastasis. Cancer in his spine is the reason why Garry is experiencing lower back pain.

There are various potential complications associated with prostate cancer is metastasizes or the spreading of cancer. In Garry’s case, cancer has already spread from the prostate to other parts of the body like the spine and lungs. Prostate cancer spreads through the lymphatic system or the bloodstream to Garry’s lung and bones (Cuzick et al., 2014). The spread can cause broken bones or severe pain, which is why Garry has intolerable back pain. At this stage, it is highly unlikely that cancer will be cured, but it can be controlled, and it can also respond to treatment. The second complication of prostate cancer is urinary incontinence. According to Singla and Comiter (2017), urinary incontinence refers to unconscious urine leakage. This means that an individual urinates without wanting to urinate. This is caused by the weakened or lost urinary sphincter. The treatment of prostate cancer and cancer itself may cause urinary incontinence, and it can be treated using surgery, catheters, and medication.

When taking care of a patient, there are other factors that should be considered, such as the level of health literacy, cultural aspects, and psychosocial aspects. Garry has his sister (Iris) to take care of him, which raises the question of her health literacy. She is not a health worker, which makes it intricate in taking care of her brother. In addition, Iris cannot monitor Garry’s condition since she has to work and take care of her young family. Based on the transtheoretical theory of behavioural change, it assesses the readiness of a patient to act new healthier behaviour (Glanz et al., 2015). The model is composed of processes of change, stages of change, decisional balance, and self-efficacy. In this case, there is the decision balance of whether Garry should remain in hospital where he is lonely and isolated or whether to go back home where Iris has to go to work and therefore lacks ample time to take care of him and also lacks the health literacy to assist him. According to the psychosocial developmental changes by Erik Erickson, Garry is in the last stage of Ego Integrity vs. Despair (Newman & Newman, 2018). The stage occurs after attaining 65 years of age. In Garry’s case, he is in a state of despair, as he has an incurable illness (metastasis prostate cancer), and he has no one to take care of him apart from his sister, who has to work. He feels isolated in the hospital and very lonely.

Garry is suffering from metastatic prostate cancer, which does not have a cure though it can be managed through palliative care and hospice, chemotherapy, and radiotherapy. According to Miller et al. (2018), chemotherapy is the use of a combination or one of the drugs used to fight cancer. Since Garry’s cancer is in the advanced stages, recurrent, and it did not respond to prostatectomy, it is time for Garry to consider chemotherapy. The treatment will be in cycles, and then a recovery period follows. Depending on the medication used, the treatment may take 3 to 6 months. The second nursing management is radiotherapy. According to Merriel et al. (2018), X-ray therapy (radiation therapy) involves the utilization of high radiation levels to kills cells of prostate cancer while mitigating the damage on healthy cells. Radiation can be undertaken through inputting radioisotopes in the areas affected by cancer. The process is referred to as internal radiation. Radiation can also be done by a machine that directs light to the prostate and other affected parts of the body. Garry’s condition can also be managed using palliative care and hospice. According to Silbermann (2020), palliative care entails treating cancer symptoms and thus leading to improved quality of life. Palliative care will help Garry because it will relieve the severe pain in his lower back and control the symptoms of cancer. Garry has experienced bone metastases, which is very painful, and it can be treated using palliative radiation therapy, radiopharmaceuticals, opioids, rank ligand inhibitors, and bisphosphonates (Miller et al., 2018). Compressions of the spinal cord can be treated using radiation therapy, surgery, or steroids. Garry should also modify his diet, and he should avoid eating high cholesterol and high-fat food. He should also increase the intake of selenium, which is in various foods such as eggs, poultry, meat, fish, and grains (Kaiser et al., 2019. Regular exercising will also help Garry in managing his cholesterol and body fat and thus reduce cancer from spreading.

 

References

Australian Institute of Health and Welfare (2020). Prostate cancer. Retrieved on August 28, 2020, from https://www.canceraustralia.gov.au/affected-cancer/cancer-types/prostate-cancer/diagnosis

Cuzick, J., Thorat, M. A., Andriole, G., Brawley, O. W., Brown, P. H., Culig, Z., Eeles, R. A., Ford, L. G., Hamdy, F. C., Holmberg, L., Ilic, D., Key, T. J., La Vecchia, C., Lilja, H., Marberger, M., Meyskens, F. L., Minasian, L. M., Parker, C., Parnes, H. L., Perner, S., … Wolk, A. (2014). Prevention and early detection of prostate cancer. The Lancet. Oncology, 15(11), e484–e492. https://doi.org/10.1016/S1470-2045(14)70211-6

Feletto, E., Bang, A., Cole-Clark, D., Chalasani, V., Rasiah, K., & Smith, D. P. (2015). An examination of prostate cancer trends in Australia, England, Canada, and the USA: Is the Australian death rate too high?. World journal of urology, 33(11), 1677–1687. https://doi.org/10.1007/s00345-015-1514-7

Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health behavior: Theory, research, and practice. San Francisco, CA: Jossey-Bass

Kaiser, A., Haskins, C., Siddiqui, M. M., Hussain, A., & D’Adamo, C. (2019). The evolving role of diet in prostate cancer risk and progression. Current opinion in oncology, 31(3), 222–229. https://doi.org/10.1097/CCO.0000000000000519             

Leslie, S. W., Soon-Sutton, T. L., & Sajjad, H. (2020). Prostate Cancer. Treasure Island (FL): StatPearls Publishing.

Litwin, M. S., & Tan, H. (2017). The Diagnosis and Treatment of Prostate Cancer: A Review. JAMA, 317(24):2532–2542. doi:10.1001/jama.2017.7248

Merriel, S., Funston, G., & Hamilton, W. (2018). Prostate Cancer in Primary Care. Advances in therapy, 35(9), 1285–1294. https://doi.org/10.1007/s12325-018-0766-1

Miller, K., Steger, G, G., Niepel, D., & Lüftner, D. (2018). Harnessing the potential of therapeutic agents to safeguard bone health in prostate cancer. Prostate Cancer Prostatic Dis. 21(4):461-472. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283859/

Newman, B. M., & Newman, P. R. (2018). Development through life: A psychosocial approach. Boston, MA: Cengage

Roberts, M. J. (2018). Prostate Cancer Detection. South Dartmouth (MA): MDText.com, Inc.

Silbermann, M. (2020). Top of Form

Palliative Care For Chronic Cancer Patients In The Community: Global. S.l.: Springer Nature.

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Singla, A., & Comiter, C. (2017). Post-Prostatectomy Incontinence: Evaluation and Management. Cham: Springer.

Sivaraman, A., & Bhat K. R. S. (2017). Screening and Detection of Prostate Cancer-Review of Literature and Current Perspective. Indian J Surg Oncol., 8(2):160-168 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427029/

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Part B: A resource for patients, families, and carers

Prostate Cancer 

https://www.prostate.org.au/awareness/general-information/what-you-need-to-know-about-prostate-cancer/

Definition

Prostate cancer is an ailment where abnormal cells form in the prostate, which can change into a malignant tumour

What causes prostate cancer? 

The exact causes of prostate cancer are not known, but there are factors that influence the risk of getting aggressive prostate cancer. The factors are obesity, old age (above 65 years), and ethnicity.

What are the signs and symptoms?

The initial symptoms are changes in the urine. The changes may include

• a weak urine flow
• difficulty in emptying the bladder or starting to urinate,
• urine dribbling after one finishes urinating,
• frequent need to urinate mostly at night
• the inability to hold urine due to the abrupt need to urinate

In advanced stages, an individual may experience

• unexplained weight loss
• problems keeping or getting an erection
• Pelvis pain, hip pain, and back pain.

Outline the potential tests

The initial tests for prostate cancer are digital rectal examination or the PSA blood test conducted by a general practitioner. When an abnormality is seen in the prostate, a multi-parametric magnetic resonance imaging (mpMRI) scan is done. In the event that the prostate cancer has spread to other parts of the body, a bone scan, CT scan (computerized tomography), or a PET scan (Positron emission tomography) can be used to determine in which parts of the body that cancer has spread.

Treatments and medications for Prostate Cancer

The various treatments include:

Prostatectomy: This refers to a surgical procedure for the complete or partial removal of the prostate

Radioactive seed implants: the process involves the planting of radioactive seeds to kill the cancerous cells

Radiation therapy: it is done with a machine that directs light to the prostate and other affected parts of the body

Hormone Therapy: it involves the blocking of prostate cancer cells from responding to hormones.

Cryotherapy: It entails the freezing of cancer cells to kill prostate cancer cells.

Chemotherapy: it is the use of a combination or one of the drugs used to fight cancer.

Watchful waiting: because prostate cancer grows slowly in most occasions, some old men and their practitioner may stop treatment to see how cancer behaves (whether it grows)     

Management strategies

The management strategies can involve palliative care and hospice, which entails treating cancer symptoms and thus leading to improved quality of life.

Patients should also modify their diet, and they should avoid eating high cholesterol and high-fat food. Patients should also increase the intake of selenium, which is in various foods such as eggs, poultry, meat, fish, and grains. Exercise is also imperative in reducing body fat.

Additional online resource:

https://www.healthdirect.gov.au/prostate-cancer