CNE Objectives and Evaluation Form appear on page 264.
An Overview of Prostate Cancer:
Diagnosis and Treatment
Dawn Mielke Strief
Stages of Prostate Cancer
This review of the state of
the science for prostate can-
P rostate cancer is the most
commonly diagnosed cancer
and the second leading cause of
Localized prostate cancer has
been defined as a cancer confined
cer includes a description of cancer-related death among Amer- to the prostate (Bott, Birtle,
current screening, diagnosis, ican males (Terris & Rhee, 2006). Taylor, & Kirby, 2003). Research to
The incidence of this disease is date has failed to link prostate
and treatment options for highest among Caucasian and cancer to any specific modifiable
localized prostate cancer. African-American males, with re- lifestyle choices, but it has identi-
Educational resources ap- ported incidences of 161/100,000 fied non-modifiable risk factors.
propriate for at-risk patients and 256/100,000, respectively. The These include increasing age, a
estimated overall incidence of family history of the disease, and
are outlined. prostate cancer in the United ethnicity. Higher incidences of
— Linda H. Yoder, PhD, States for 2008 is 186,320, with localized prostate cancer are
MBA, RN, AOCN®, FAAN projected mortality of 28,660 reported among men over age 60,
(Jemal et al., 2008). Despite the especially in African Americans.
high incidence of the disease, pos- Caucasian men have the second
itive outcomes can be achieved highest incidence of prostate can-
through early, effective, and ap- cer, and rates of the disease are
propriate treatment. Many health lowest among men of Asian-
professionals will care for individ- American and Hispanic-American
uals with prostate cancer, or know decent (U.S. Department of Health
individuals at risk for developing and Human Services, 2006). The
the disease. All nurses should be American Cancer Society (ACS)
familiar with the guidelines for (2007) estimates that one in six
screening, treating, and managing men will be diagnosed with
early or localized prostate cancer. prostate cancer during their life-
Dawn Mielke Strief, MS, RN, ANP, GNP, is a Nurse C-Change is a not-for-profit
Practitioner, VA Medical Center, Minneapolis, MN. organization whose mission is to
eliminate cancer as a public
Editor’s Note: This article is reprinted with permission from health problem, at the earliest possible time, by leveraging
Urologic Nursing, 27(6), 475-479. Certain facts and figures have the expertise and resources of our members. C-Change is the
been updated and modified for MEDSURG Nursing readers by only organization that assembles cancer leaders from the
“Cancer: Caring and Conquering” Column Editor Linda H. three sectors – private, public, and not-for-profit – from across
Yoder, PhD, MBA, RN, AOCN®, FAAN. the cancer continuum – prevention, early detection, treat-
ment, and quality of life. C-Change invests in the resolution of
Notes: This column is made possible through an educational problems that cannot be solved by one organization or one
grant from C-Change, a 501(3)c (not-for-profit) organization. sector alone. For more information about C-Change, visit
The purpose of the “Cancer: Caring and Conquering” column is www.c-changetogether.org.
to strengthen the cancer knowledge, skills, and confidence of
The author and all MEDSURG Nursing Editorial Board mem-
medical-surgical nurses who care for patients at risk for or liv-
bers reported no actual or potential conflict of interest in rela-
ing with cancer.
tion to this continuing nursing education article.
258 MEDSURG Nursing—August 2008—Vol. 17/No. 4
An Overview of Prostate Cancer: Diagnosis and Treatment
time, but only 1 in 35 will die of has been speculation that the it may be localized and treatment
this disease. virus interacts with the prostate may cure or control.
The identification of family and the tissue surrounding it to
history as a major risk factor for cause prostate cancer. Further Diagnostic Work-Up
prostate cancer has resulted in a research in this area is targeting Screening. PSA is an enzyme
great deal of research to isolate a development of a vaccine to pre- created only by prostate cells
genetic component (Lessick & vent prostate cancer (Simard et (Stutzman, 2003); it is a normal
Katz, 2006). The first prostate can- al., 2003). product of the prostate gland and
cer susceptibility gene, HPC1 Prostate cancer frequently normal component of the seminal
(Hereditary prostate cancer 1), offers no specific clinical symp- fluid. Minute amounts of this pro-
was discovered in 1996 (Smith et toms. Lower urinary tract symp- tein leach into the blood and are
al., 1996) and mapped to the long toms may be present, but these are detectable quantitatively by sev-
arm of chromosome 1. Since then, neither specific nor sensitive eral chemical assays (Linn, Ball, &
several other prostate cancer sus- enough to diagnose prostate can- Maradiegue, 2007). Catalona and
ceptibility genes have been linked cer. Lower urinary tract symptoms colleagues (1991) first reported
to various regions on other chro- are more specific to another condi- the use of PSA serum levels as a
mosomes (Ostrander, Markianos, tion known as benign prostatic first-line screening tool to detect
& Stanford, 2004; Verhage & hyperplasia (BPH) and should not prostate cancer. They found that a
Kiemeney, 2003). be correlated directly to the pres- single PSA determination was
In addition to the discovery of ence of prostate cancer. However, if more accurate than a DRE, previ-
the HPC1 gene, several other theo- prostate cancer is present, lower ously the standard and only
ries have been developed in an urinary tract symptoms also may method available to detect
attempt to explain the genetic be present, especially if the prostate cancer and to identify
basis of prostate cancer. The prostate enlarges or intrudes into early prostate cancer. Elevated
Mendelian autosomal dominant the urethral space. These symp- levels of PSA have been correlated
inheritance theory is thought to toms may include urgency, hesitan- positively with prostate cancer,
best explain familial clustering of cy, frequency, dysuria, weak but are not specific for prostate
prostate cancer among men with stream, and urine leakage. In a cancer. Elevated levels of PSA also
early-onset disease. Approximate- review article, Hamilton and Sharp are seen in the presence of BPH,
ly 43%-65% of prostate cancer (2004) determined that lower uri- prostatitis, prostate abscess, man-
cases diagnosed in patients before nary tract symptoms are more ipulation of the prostate, prostatic
age 56 have been linked to the prevalent in the presence of pro- infarction, and ejaculation within
presence of a rare autosomal dom- state cancer, yet the high preva- the previous 48 hours (Stutzman,
inant, high-risk susceptibility gene lence of these symptoms among 2003). Thus, screening only by
(Verhage & Kiemeney, 2003). A the general population decreases PSA results has been met with
multifactorial model has been their predictive value. No evidence some controversy.
developed which describes how thus suggests that lower urinary The variability of PSA results
prostate cancer may occur when tract symptoms are associated within an individual further com-
several susceptible genes interact with localized prostate cancer, and plicates testing and contributes to
with environmental factors (Gong their presence is not sensitive or the continuing controversial na-
et al., 2002). specific enough to aid in the diag- ture of the test. Soletormos and
A virus was identified recently nosis of prostate cancer. associates (2005) determined that
which may be an environmental At present, no symptoms are biological variations of total
influence on the development of specific to the diagnosis of prostate-specific antigen (tPSA)
prostate cancer. The HPC1 gene prostate cancer. Rather than rely exist. These researchers deter-
has been implicated in viral on symptoms, patients should mined that while tPSA is increas-
defense, and scientists have found have routine prostate cancer ingly used for screening, diagno-
that men with mutations in their screening, which includes a digital sis, and monitoring of prostate
HPC1 gene harbor this virus 30 rectal examination (DRE) and cancer, serial measurements of
times more than men without the obtaining a blood sample to deter- individual tPSA levels varied by
genetic mutation. The HPC1 gene mine the presence of the prostate- more amplitude than could be
encodes an antiviral protein which specific antigen (PSA). If one or accounted for by the analytical
is activated by viral infection. Any both of these screening examina- variation of the test. This variation
impairment in this gene has been tions are abnormal, further inves- was believed to be caused by
proposed as a susceptibility factor tigation should occur. Interven- intra-individual variation. Further
in the development of prostate tion at this stage allows prostate research must be performed to
cancer (Hampton, 2006). There cancer to be detected early, when determine if the variation of tPSA
MEDSURG Nursing—August 2008—Vol. 17/No. 4 259
An Overview of Prostate Cancer: Diagnosis and Treatment
is greater in men with known Table 1.
prostate cancer when compared Age-Specific Reference Ranges for Serum PSA
to those who do not have the dis-
ease. It appears that the biological Age Range Asians African Americans Whites
variation of tPSA is 20% and is 40-49 years 0-2.0 ng/mL 0-2.0 ng/mL 0-2.5 ng/mL
influenced by age. Thus, using this
50-59 years 0-3.0 ng/mL 0-4.0 ng/mL 0-3.5 ng/mL
laboratory value to screen or fol-
low treatment is not a certainty. 60-69 years 0-4.0 ng/mL 0-4.5 ng/mL 0-4.5 ng/mL
See Table 1 for age-specific refer- 70-79 years 0-5.0 ng/mL 0-5.5 ng/mL 0-6.5 ng/mL
ence ranges for serum PSA.
In addition to the biological Source: Richardson & Oesterling, 1997.
variation associated with tPSA lev-
els, the accuracy of the PSA test
should be explored. The Physi-
cians’ Health Study, performed by response that can lead to unneces- ated with and specific for the diag-
Gann and colleagues in 1995 sary and invasive testing. The net nosis of localized prostate cancer
(Harris & Lohr, 2002), used longi- benefit of prostate screening activ- (Berger et al., 2007). If the patient
tudinal follow-up data rather than ities thus remains controversial. is asymptomatic, an elevated PSA
biopsy to determine the sensitivi- However, even in light of these should be correlated with a DRE. If
ty and specificity of the PSA test. facts, the American Urological these results create a suspicion
Analysis of these data determined Association and ACS recommend for prostate cancer, a referral and
that the sensitivity for PSA in offering a screening PSA along prostate biopsy should follow. If
detecting prostate cancer within 2 with a DRE for men age 50 and results are positive, the cancer
years was 73.2%. The specificity of above who are expected to live should be staged using the
the PSA test was 85.4% among longer than 10 years. Men at high- Gleason Scoring System, the
men who did receive a diagnosis er risk, such as African Americans Tumor, Nodes, Metastasis (TNM)
of prostate cancer within 2 years. and men with a family history of classification, or the Whitmore-
These data also determined PCA, should begin testing at age Jewett staging system (Stutzman,
that the specificity of the PSA level 40-45, or 5 years before the age of 2003).
is lower among men with large onset of disease of the affected Gleason Scoring System. The
prostate glands, a population family member. The DRE is consid- Gleason Scoring System separates
which includes men with BPH. The ered an integral part of the screen- the cancer diagnosis into five dif-
researchers concluded that pro- ing protocol and is used in con- ferent histologic grades. Grade 1
state cancer screening using the junction with the PSA. The sensi- tissue is well-differentiated and
PSA test is not appropriate among tivity of diagnosing tumors is provides the best prognosis.
men with BPH because the PSA improved markedly with the use Treatment for individuals with a
level would be decreased falsely. of both modalities (Coley, Barry, Grade 1 tumor may result in a
The results of this study have led Fleming, & Mulley, 1997). See cure. Poorly differentiated cancers
experts to suggest that PSA levels Table 2 for a variety of current are classified as Grade 5 and carry
be adjusted for age, with the screening recommendations for a poor prognosis. Affected individ-
abnormal PSA level decreased prostate cancer. Clearly, further uals require extensive treatment
from 4.0 ng/mL to 2.6 ng/mL research needs to occur with with an appropriate goal being
(Gretzer & Partin, 2003). respect to appropriate screening tumor control. Tissue samples are
Digital rectal examinations also activities, the meaning of the obtained from two different sites,
are used as a screening mechanism results, and necessity and timing with the grade for each tissue
for prostate cancer. In a metaanaly- of further diagnostics and treat- sample defined separately and the
sis, Harris and Lohr (2002) deter- ment. two scores added. The highest
mined that the sensitivity of this Diagnostic examinations. Men Gleason score possible is 10, if
test was 59% and its specificity was with prostate cancer usually have each site obtains a grade of 5.
undeterminable. Thus, while this a PSA result higher than 10 ng/mL, Prostatic intraepithelial neoplasia
procedure may be useful in detect- while men with BPH rarely have (PIN) also may be identified in the
ing prostate cancer among those such an elevation. Men who have biopsy tissue. PIN is known to be a
with a low PSA, the limited repro- a PSA serial increase in 1 year of premalignant lesion for prostate
ducibility of the examination limits 0.75 ng or more over baseline PSA cancer and these individuals have
its clinical significance. should undergo further screening. an increased risk for prostate
Prostate cancer screening This rate of change is known as cancer in subsequent biopsies
may result in a false-positive PSA velocity, and has been associ- (Stutzman, 2003).
260 MEDSURG Nursing—August 2008—Vol. 17/No. 4
An Overview of Prostate Cancer: Diagnosis and Treatment
Recommendations for Screening
Organization Published Recommendations for Screening
American Urologic The prostate-specific antigen (PSA) test and the digital rectal examination (DRE) should be offered
Association annually, beginning at age 50, to men who have a life expectancy of at least
10 years. Men at high risk should begin testing at age 45.
American Cancer Annual screening: The American Cancer Society believes that doctors should offer the PSA blood
Society test and DRE (digital rectal exam) yearly, beginning at age 50 to men who do not have any major
medical problems and can be expected to live at least 10 more years. Men at high risk should
begin testing at age 45. Men at high risk include African Americans and men who have a close rel-
ative (father, brother, or son) who had prostate cancer before age 65. Men at even higher risk
(because they have several close relatives with prostate cancer at an early age) could begin test-
ing at age 40. Depending on the results of the first tests, they might not need more testing until
United States There is insufficient evidence to support prostate cancer screening.
National Cancer Institute No published standards or guidelines. The National Cancer Institute posts information: “What is
PSA?” “Why is PSA performed?” “For whom is it recommended?” http://www.cancer.gov/cancer-
American College of There is insufficient evidence to support prostate cancer screening.
American College of No published standards or guidelines.
Centers for Disease Although there is good evidence that PSA screening can detect early-stage prostate cancer, evi-
Control dence is mixed and inconclusive about whether early detection improves health outcomes.
Additionally, prostate cancer screening is associated with important harms, which include anxiety
and followup procedures based on test results that sometimes are false positive, as well as the
complications that may result from treating prostate cancers that, if left untreated, might not have
affected the man’s health.
U.S. Department of There is insufficient evidence to support prostate cancer screening.
National Comprehensive Practice Guidelines in Oncology suggest “talking points” to discuss with patients. The pros and
Cancer Network cons of screening are listed within this guideline. Men should make an informed decision about
having a PSA screening test.
Tumor staging classifications. Stage B (T2, N0, M0) is limited of a palpable node and unilateral
Stage A (T1, N0, M0) prostate can- to the prostate gland and usually capsular penetration. Stage T3b
cer is disease that cannot be pal- is found by DRE in which a nodule describes the presence of a palpa-
pated during DRE of the prostate. or hardness may be palpated. ble node which has bilaterally
This stage is further divided into Stage T2a is defined as the pres- extracapsular extension. Stage
T1a and T1b. T1a is well-differenti- ence of a palpable node which T3c involves a palpable node
ated and involves less than 5% of involves up to one-half of one which has invaded the seminal
the prostate gland. T1b also is well lobe. Stage T2b is defined as a pal- vesicles (Stutzman, 2003).
differentiated, yet involves more pable lesion which involves more Stage D (T4, M+) is a cancer
than 5% of the prostate gland. This than half of one lobe, but not both which has invaded adjacent struc-
determination often is made dur- lobes. Stage T2c describes a pal- tures, such as the bladder neck,
ing a surgical procedure for symp- pable node, present in both lobes sphincter, rectum, or pelvic wall.
toms of BPH. Stage T1c indicates (Stutzman, 2003). The inclusion of N or M in the stag-
that the prostate gland was biop- Stage C (T3 and T4, N0, M0) is ing describes a cancer that has
sied as a result of an elevated PSA local-extensive prostate cancer. metastasized to the lymph nodes
level (Stutzman, 2003). This stage is marked by presence or has distant metastases (such as
MEDSURG Nursing—August 2008—Vol. 17/No. 4 261
An Overview of Prostate Cancer: Diagnosis and Treatment
bone), respectively (Stutzman, comes, but the transperineal efficacy and clinical outcomes (El-
2003). approach may be accomplished Hakim & Tewari, 2004).
Whitmore-Jewett Staging. The with less blood loss, no abdominal Robotic prostatectomy appears
Whitmore-Jewett Staging classifi- incision, and decreased pain. This to be slightly more efficient at re-
cation is similar to the TNM classi- approach has two potential disad- ducing complications related to
fication. Stage A is a clinically vantages. First, because lymph impotency, urinary incontinence,
undetectable tumor, usually found node sampling is not possible, an and recovery time (Starnes &
incidentally. Stage A1 is focal and additional procedure will be re- Sims, 2006). Robotic prostatecto-
well-differentiated. Stage A2 is dif- quired. In addition, this approach my is slightly more expensive than
fuse or poorly differentiated. Stage cuts the prostate during removal, other surgical procedures and
B is limited to the prostate upon which may pose a risk of tumor may not be available at all treat-
rectal examination. Stage B1 seeding. ment centers.
implies one solitary nodule, less Potential side effects or com- External beam radiotherapy.
than 1.5 centimeters, and involves plications associated with a radi- External beam radiotherapy treat-
only one lobe. Stage B2 involves cal prostatectomy include tempo- ment (EBRT) has similar efficacy
one whole lobe or both lobes. rary urinary incontinence and to surgery with some differing
Stage C extends locally outside the impotence. Urinary dysfunction complications. EBRT usually is
prostatic capsule or into the semi- subsides within the first year after performed every weekday for 4-6
nal vesicles. Stage D implies surgery, and potency is regained weeks. This procedure affects nor-
metastatic disease; Stage D1 for approximately 80% of patients mal tissue, resulting in temporary
involves pelvic lymph node metas- (Bott et al., 2003). Return of these adverse effects that include diar-
tases, while Stage D2 involves dis- physical functions is dependent rhea, tenesmus, proctitis, dysuria,
tant metastases (Stutzman, 2003). on patient age, the disease stage, frequency, and lethargy. Long-
and if nerve bundles are intact term effects of EBRT include impo-
Treatment Options postoperatively. tence in 10%-30% of men. In addi-
Watchful waiting. Watchful Many men who do not regain tion, chronic proctitis may lead to
waiting, or active surveillance, in- potency can benefit from an oral bleeding and fibrosis. Incontin-
volves routine observation of a phosphodiesterase type 5 inhibit- ence usually is not a side effect
patient’s prostate cancer clinically or such as sildenafil (Viagra®) from this treatment. Disturbances
with routine PSA testing. Ac- (Bott et al., 2003). Sildenafil has in stool frequency are reported
cording to Bott and associates the best results for patients less among fewer than 20% of men
(2003), a link exists between than age 60 who had a bilateral (Bott et al., 2003).
Gleason scores and PSA levels at nerve-spare procedure and had Brachytherapy. Brachytherapy
time of diagnosis to rate of pro- some spontaneous return of erec- involves the insertion of a radioac-
gression. Higher grades of pro- tile function after surgery. The tive source directly into the
state cancer increase the risk of effect of sildenafil increased over prostate gland. This procedure
metastases and death. The risk of time, generally requiring 12-24 provides a high dose of radiation
having a known prostate cancer months following surgery for max- delivered locally, which spares
progress, other health care con- imum results; 35%-75% of patients surrounding normal tissue. Brachy-
cerns, and co-morbidities, along regained potency after a nerve- therapy may be performed using
with other demographic data that sparing surgery, compared to 0- either iodine-125 seeds or iridium-
may place this person at risk for 15% of those who underwent non- 192 rods. Iodine-125 seeds are
disease progression, should be nerve-sparing surgery (Briganti et placed permanently and recom-
included when treatment is al., 2007). mended for patients with a life
selected. Robotic prostatectomy. Robotic expectancy of at least 10 years, a
Radical prostatectomy. This sur- prostatectomy is a laparoscopic Gleason score of 6 or less, a
gical procedure requires removal prostatectomy aided by a surgeon- prostate volume of less than 50
of the entire prostate gland, along assisted robot. This procedure milliliters, and no previous
with the seminal vesicles and usu- increases visualization of delicate prostate surgery. Potential compli-
ally the obturator lymph nodes. structures that surround the cations associated with this proce-
These nodes are obtained for can- prostate, adds dexterity to the sur- dure include irritation to the ure-
cer staging purposes. Surgical gical removal, and eliminates sur- thra, which results in inconti-
approaches can include a trans- geon-dependent hand movements. nence and impotence.
perineal route, a laparoscopic ap- Data on the effectiveness of robot- Iridium-192 rods are placed
proach, or a transurethral resec- ic prostatectomy are reported to temporarily and recommended for
tion of the prostate. Each ap- be comparable to open and laparo- patients with PSA results greater
proach has obtained similar out- scopic prostatectomy in terms of than 10 or a Gleason score of 8-10.
262 MEDSURG Nursing—August 2008—Vol. 17/No. 4
An Overview of Prostate Cancer: Diagnosis and Treatment
Along with iridium-192 rod place- recurrent prostate cancer. If can- Berger, A., Deibl, M., Strasak, A., Bektic, J.,
ment, EBRT is delivered over 4 cer recurs, additional treatment Pelzer, A., Klocker, H., et al. (2007).
Large-scale study of clinical impact of
weeks. Potential complications may be recommended. PSA velocity: Long-term PSA kinetics
associated with this procedure as method of differentiating men with
include incontinence and impo- Patient and Family Education from those without prostate cancer.
tence. Education, knowledge, and un- Urology, 69(1), 134-138.
Bott, S., Birtle, A., Taylor, C., & Kirby, R.
Radiation damage to the ure- derstanding are critical factors in (2003). Prostate cancer management:
thra can result in both irritating making an informed decision with An update on localized disease. Post-
and obstructive urinary symp- respect to treatment decision graduate Medical Journal, 79, 575-580.
toms. These symptoms may last making (Lepore, Helgeson, Eton, & Briganti, A., Salonia, A., Gallina, A., Chun,
up to 60 days, which is the half-life Schulz, 2003). Education should F., Karakiewicz, P., Graefen, M., et al.
(2007). Management of erectile dys-
of the iodine rods. Approximately include accurate information, function after radical prostatectomy in
10%-15% of men who undergo pathophysiology, grading and 2007. World Journal of Urology, 25(2),
brachytherapy experience erectile staging, treatment options, and 143-148.
dysfunction. Use of phosphodi- potential short-term and long- Catalona, W., Smith, D., Ratliff, T., Dodds, K.,
Coplen, D., Yaun, J., et al. (1991).
esterase type 5 inhibitors may term side effects and adverse Measurement of prostate specific anti-
help them regain sexual function effects (Held-Warmkessel, 2002). gen in serum as a screening test for
(Bott et al., 2003). Fagerlin and associates (2004) per- prostate cancer. New England Journal
Hormonal manipulation. Pa- formed a critical review of existing of Medicine, 324, 1156-1161.
tients with a Gleason score of 8-10 patient education materials for Coley, C., Barry, M., Fleming, C., & Mulley, A.
(1997). Early detection of prostate can-
can benefit from at least 2 years of localized prostate cancer. They cer: Part 1: Prior probability and effective-
adjuvant luteinizing hormone- concluded that few materials were ness of tests. Annals of Internal Medi-
releasing hormone agonist thera- available which provided assis- cine, 126, 394-406.
py following EBRT, according to a tance in making treatment deci- El-Hakim, A., & Tewari, A. (2004). Robotic
prostatectomy – A review. Medscape
review by Bott and associates sions. Most of the reviewed docu- General Medicine, 6(4), 20.
(2003). Significant increases have ments failed to describe all treat- Fagerlin, A., Rovner, D., Stableford, S.,
been documented in disease-spe- ment options, did not contain Jentoft, C., Wei, J., & Holmes-Rovner,
cific survival and overall survival complete information with respect M. (2004). Patient education materials
with a median follow up of over 5 to potential adverse effects of about the treatment of early-stage
prostate cancer: A critical review.
years. The use of adjuvant hor- treatment, and required a high Annals of Internal Medicine, 140, 721-
monal therapy in conjunction with school reading ability to compre- 728.
standard treatments is being hend. Regarding Internet sources Gong, G., Oakley-Girvan, I., Wu, A., Kolonel,
researched. The results at this for health information, patients L., John, E., West, D., et al. (2002).
Segregation analysis of prostate can-
time seem promising, but further and their families should be cer in 1,719 white, African-American,
research is needed to determine encouraged to visit nationally rec- and Asian-American families in the
the long-term effects on bone den- ognized sites to receive accurate United States and Canada. Cancer
sity and endocrine metabolism. information. The five highest-rated Causes and Control, 13, 471-482.
The disease-specific survival fig- patient education Web sites are the Gretzer, M., & Partin, A. (2003). Campbell’s
urology updates: PSA and PSA molec-
ures also must be known before an ACS (www.cancer.org), AstraZeneca ular derivatives, 1(2), 1-12.
approach such as this can be con- (www.prostateinfo.com), Memorial Hamilton, W., & Sharp, D. (2004). Symptom-
sidered standard. Sloan-Kettering Cancer Center (www. atic diagnosis of prostate cancer in pri-
Follow-up care. Serum PSA is mskcc.org), Cancer Care, Inc. (www. mary care: A structured review. British
Journal of General Practice, 54, 617-
synthesized almost exclusively by cancercare.org), and University of 621.
the prostate gland, making its Toronto (www.prostatecentre.ca) Hampton, T. (2006). New virus linked to
assessment an excellent method (Fagerlin et al., 2004). These sites prostate cancer. JAMA, 295(13), 1503.
to determine treatment response. may provide education, guide Harris, R., & Lohr, K. (2002). Screening for
The PSA level should be decreas- treatment decision making, and prostate cancer: An update of the evi-
dence for the U.S. Preventive Services
ed after treatment, and be close to assist diagnosed patients to cope Task Force. Annals of Internal Medi-
zero after surgery. Routine screen- with their disease and treatment. cine, 137, 917-929.
ing using the PSA should continue Held-Warmkessel, J. (2002). What your
to occur after treatment. A rising References patient needs to know about prostate
American Cancer Society (ACS). (2007). De- cancer. Nursing2002, 32(12), 36-42.
or elevated PSA level may indicate Jemal, A., Siegel, R., Ward, E., Haoe, Y., Xu,
tailed guide: Prostate cancer. What are
either residual prostate cancer or the key statistics about prostate can- J., Murray, T., et al. (2008). Cancer sta-
recurrence and should be further cer? Retrieved June 18, 2008, from tistics, 2008. CA: A Cancer Journal for
investigated (Naito, 2005). Radio- http://www.cancer.org/docroot/CRI/ Clinicians, 58(2), 71-96.
graphic and nuclear medicine content/CRI_2_4_1X_What_are_the_
examinations can aid in detecting key_statistics_for_prostate_canc er_ continued on page 269
MEDSURG Nursing—August 2008—Vol. 17/No. 4 263