By Kathleen Wiley, RN, MSN, AOCNS®, and Patricia Friend, PhD, APRN-CNS, AOCNS®, AGN-BC
One in nine men will be diagnosed with prostate cancer, the second leading cause of cancer-related death in men in the United States. Survival varies greatly depending on the disease’s severity and extent at diagnosis: five-year survival rates are near 100% for local or regional disease, but they drop to 30% for metastatic prostate cancer.
Prevention and Screening
Screening tests may lead to earlier diagnosis and treatment but do not correlate with improved survival, so the U.S. Preventive Services Task Force recommended that men aged 55–69 decide with their healthcare providers whether they will undergo periodic prostate-specific antigen (PSA) testing. Those at higher risk for prostate cancer (e.g., African Americans) and those with a first-degree relative with prostate cancer may consider earlier screening. Screening is not recommended for men after age 70.
Biomarkers that offer more precision in screening and early detection than PSA testing are in development. However, their value and cost effectiveness in detecting clinically significant prostate cancer or stratifying men who would most benefit from prostate biopsy have not been clearly established. Currently, they’re not recommend for routine use but can be considered if a biopsy’s specificity may be improved with additional biomarker analysis.
Biomarkers can also be used to improve treatment decision making. Genomic tests of urine, blood, or biopsied prostate tissue can help clinicians recommend optimal treatment options by accurately categorizing a man’s risk. The tests may be considered for certain men with low or favorable intermediate disease, but the clinical utility has not been established.
Prostate cancer is typically slow growing, and active surveillance is reasonable in many instances, depending on age, comorbidities, and stage. That involves long-term monitoring such as PSA, prostate biopsies, and other tests until healthcare teams and patients decide that definitive treatment is best.
Treatment usually consists of surgical intervention with adjuvant radiotherapy (e.g., radical prostatectomy, brachytherapy, external-beam radiotherapy) but depends on patients’ life expectancy; whether the disease is low, favorable, or high risk; and the presence of germline mutations. Hormone therapy deprives the body of androgens, most commonly testosterone, that are feeding the tumor cells.
Chemotherapy and immunotherapy are options for more advanced, widespread disease. Sipuleucel-T, a cancer vaccine, and pembrolizumab, a PD-1 inhibitor, are two immunotherapies approved for metastatic microsatellite instability-high prostate cancer.
Side Effects and Management
Sexual dysfunction and changes represent some of the most frequently reported side effects of prostate cancer regardless of treatment method. Nurses must be ready to educate patients and loved ones, provide counseling and referrals, and offer evidence-based strategies for those sensitive side effects. Surgery, radiation, and hormone therapy may increase the risk for erectile dysfunction, infertility, dysorgasmia, and other sexual changes. Urinary incontinence and skeletal changes (most common with hormone therapy) are also reported. Depending on patients’ age at diagnosis and treatment, fertility discussions may be needed prior to treatment initiation.
Prostate cancer is a disease of the aging population, and in many cases patients die from other causes before prostate cancer survivorship occurs. However, during the intra- and post-treatment phases, men should avoid tobacco, limit alcohol, maintain healthy dietary and exercise habits, manage stress, and remain current with other cancer and health screening procedures. Additionally, many sexual side effects can be life-long challenges. Patients and their partners should be assessed for emotional and sexual strains on their relationships. Offering counseling to couples following treatment may improve quality of life by helping relationship intimacy. Late and long-term effects should be continually assessed before they affect quality of life.