Screening for Prostate Cancer

by Mikayo Streeter, RN

Should men get screened for Prostate Cancer?

Prostate cancer is the second leading cause of cancer death in U.S. males, with an estimate of over 186,320 new cases and 28,669 deaths in 2008” (Mauk 2010, p. 418) This cancer is known for its unusual behavior because the patients can go asymptomatic for awhile before the cancer has spread throughout the body. “The incidence of disease varies according to race, with Americans black having the highest risk in the world” (Granville 2006, p.53) According to the American Cancer Society, men especially African Americans should get screened at the age of 40. They often go to say that men who have a family history should consider discussing the option with their doctor. “Men with one close relative affected have more than a two-folded increased risk, and men with two close relatives affected have more than an eight-fold increased risk” (Granville 2006, p. 53). Studies have shown that it increases with age for the older population of men. “Over half of men 70 and older show some histologic evidence, though only a percentage die from this disease” (Mauk 2010, p. 418).

According to Mauk, she mentions that it is highly suggested that older men get screened because they are normally asymptomatic. Most men complain if symptoms are present that there is pain in the lower back, difficulty urinating, painful ejaculation, or blood in the urine/semen. There is two ways a screening can be done to detect prostate cancer: digital rectal exam (DRE) and PSA blood test. During the digital rectal exam the doctor inserts a glove fingered thru the rectum to feel for anything unusually hard or enlarged prostate that may exhibit lumps. The PSA test is used to detect a higher level of prostate cells thru the blood stream. “A PSA of less than 4ng/ml is considered normal for ages 60-69 years, whereas 7ng/ml may be normal in the 70-79 age group, because PSA rises with age” (Mauk 2010, p.418).

When the cancer is detected, it depends on the stages and growth of the cancer and the severity of the disease. The doctor discusses several options with the family and patient: surgery (radical prostatectomy), radiation/chemotherapy, or watchful waiting. “Surgery is considered the best option when the cancer is caught early; however, because a radical prostatectomy is major surgery and carries some inherent risks, all options should be considered with the older patient” (Mauk 2010, p. 143). The nurse responsibility after surgery is to explain the potential side effects to the patient: inform the patient they may experience urinary incontinence, loss of interest in sex, hot flashes, and impotence. “Sometimes, radiation is suggested where x-rays are passes through an external machine or through radioactive isotopes inside the body” (Moore 2007, p.1) Watchful waiting is recommended for the elderly men because of the complications after surgery. It is also recommended if they have other medical comorbidities. Older men should take a holistic approach by including a “low fat diet and the addition of vitamin E, selenium, and soy protein” (Mauk 2010, p. 418). The nurse should encourage the patient to consult with doctor before taking a holistic approach.

Prostate cancer is known as a chronic disease. That if it occurs in older men watchful waiting is the best decision for these patients. These patients need frequent monitoring but no treatment is needed. “Most prostate cancers are slow-growing and unlikely to be a cause of significant morbidity and mortality in older men” (Mauk 2010, p. 372). The pro of doing the screening is to early detect prostate cancer before it metastasize to other organs of the body. For older men, it will help to decrease the altered mental status changes if these men frequently develop urinary tract infections, urinary incontinence, or inability to urinate. The con is that majority of the older men that is diagnosed with prostate cancer usually die from the other medical comorbidities. “The greatest controversy regarding screening for prostate cancer is the inability to accurately predict which cancers will be aggressive and require treatment, and which are unlikely to metastasize” (Mauk 2010, p. 372).

References

Ginger, L. (2007). The Importance of cancer screening. Retrieved October 29, 2011, from http://cancerawarenesscenter.com
Granville, L. J. (2006). Prostate disease in later life. Chronic conditions in later life, , 51-56. Mauk, K. L. (2010). Gerontological nursing competencies for care (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers. Moore, K. (2007). Prostate cancer. Retrieved October 29, 2011, from http://cancerawarenesscenter.com

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.