Prostate Cancer Prostate Cancer Overview
Prostate cancer is the most prevalent visceral cancer among men in the United States, with approximately 1.3 million men currently living with the condition (American Cancer Society, 2003b). It is estimated that 70% of men who reach the age of 80 will have evidence of histologic or latent prostate cancer (Pienta & Esper, 1993). Histologic prostate cancer, which is often asymptomatic, can eventually progress to clinically evident cancer, leading to a substantial number of diagnoses through intensive screening efforts (Pienta, Goodson, & Esper, 1996).
Screening, particularly with prostate-specific antigen (PSA) tests, has significantly increased the detection of prostate cancer, including many cases that are latent and asymptomatic. This intensive screening has resulted in a noticeable rise in both incidence and prevalence of the disease, doubling in the U.S. from 1984 to 1994 (Newschaffer, 1997; Parkin, Pisani, & Ferlay, 1999).
Pathological Demographics of Prostate Cancer
In 2003, approximately 80% of the 220,900 men diagnosed with prostate cancer were found to have early-stage or locally confined disease (Jemal et al., 2002). Treatment options for early-stage prostate cancer include radical prostatectomy, external beam radiotherapy, brachytherapy, cryosurgery, and observation (watchful waiting). Despite the availability of these treatments, none has shown a definitive survival advantage over observation, although radical prostatectomy may offer a modest reduction in prostate cancer-specific mortality (Harris & Lohr, 2002; Holmberg et al., 2002).
Active treatments often come with significant side effects, including urinary, bowel, and sexual dysfunction, which can profoundly impact a patient’s quality of life. The choice of treatment and its associated side effects are crucial considerations for patients and healthcare providers.
Health Outcomes and Quality of Life in Prostate Cancer
Research into quality of life outcomes for men with early prostate cancer often focuses on the side effects of active treatments, such as urinary, bowel, and sexual dysfunction (Talcott et al., 1998). Studies have indicated that, while generic measures of quality of life may return to baseline levels within 12 months after primary treatment, some men continue to experience persistent issues. These ongoing problems can lead to psychological distress related to changes in masculine identity and feelings of stigmatization or demoralization (Powel, 2002; Clark, Rieker, Propert, & Talcott, 1999; Pirl & Melo, 2002).
Malignancy of Prostate Cancer
Before the PSA era, prostate cancer was often detected at late stages, frequently leading to imminent death (Litwin, 1994). However, the emphasis on early detection has shifted the proportion of late to early-stage diagnoses. Men are now diagnosed at earlier stages, with a significant reduction in the incidence of metastatic disease at diagnosis. This shift has supported the use of local treatments such as radical prostatectomy and external beam radiotherapy, which have high 5-year survival rates (D’Amico et al., 1998).
Despite these advances, the survival curve declines with longer follow-up. Men with low-risk prostate cancer may experience a recurrence rate of 54% within 15 years (D’Amico et al., 1998). Additionally, those with higher Gleason scores face a significantly higher risk of disease progression and clinical metastasis (Pound et al., 1999; Kupelian, Elshaikh, Reddy, Zippe, & Klein, 2002). This highlights the need for ongoing management and monitoring of prostate cancer patients.
Medical Research and Endemics to Prostate Cancer
Medical research continues to address several clinical challenges associated with prostate cancer management. Areas of focus include genetic predisposition, mechanisms of carcinogenesis, advancements in screening techniques, improved imaging methods, and technical aspects of local therapies. Research also explores hormonal treatments, dietary and complementary therapies, and the role of chemotherapy in hormone-refractory prostate cancer (Weinrich et al., 2004).
Despite these advances, some aspects of prostate cancer management remain under-researched. With an expected 380,000 new cases by 2025, there is a pressing need for further research to address both well-studied and emerging clinical concerns.
Prostate Cancer and Nursing Research Topics
A review of nursing research on prostate cancer from 1974 to 2003 revealed 170 articles, with 45 reporting original research on topics such as cancer-related fatigue, complementary/alternative care, coping strategies, couples’ concerns, culturally sensitive care, decision-making, spirituality, men’s concerns, quality of care, quality of life, screening, sexuality, survivors, treatment outcomes, uncertainty, and watchful waiting.
Common themes in nursing research include the need for better patient education and communication. Many studies found that patients often lack sufficient information to make informed decisions about their treatment and are not consistently asked about their experiences related to prostate cancer and its treatment.
Nursing Research on Prostate Cancer
Nursing research on prostate cancer has predominantly focused on screening high-risk individuals, the effects of local therapies, and the impact on quality of life. Key issues identified include the insufficient information provided to patients, the emotional and physical consequences of treatment, and the impact on couples.
Studies have highlighted that men often do not fully understand their condition, treatment options, or postoperative management. Research has explored patient experiences immediately after diagnosis, during treatment, and in the postoperative period. Some studies have included couples to address concerns related to relationships and information sharing (Gray, Fitch, Phillips, Labrecque, & Klotz, 1999; Harden et al., 2002).
Several intervention studies aimed at improving information sharing and reducing psychological distress have shown promising results. These studies emphasize the importance of addressing patients’ needs for information and support (Davidson, Goldenberg, Gleave, & Degner, 2003; Johnson, J., Fieler, Wlasowicz, Mitchell, & Jones, 1997; Johnson, J., 1996).
Subjective Description of Prostate Cancer
In-depth interviews with prostate cancer patients reveal valuable insights into their experiences, though such information is often underutilized. Many patients feel that their concerns are not taken seriously or adequately addressed. Research has shown that exploring patients’ subjective experiences can provide a deeper understanding of the impact of prostate cancer and its treatment on their lives.
Studies focusing on cancer-related fatigue and other distressing symptoms highlight the need for more comprehensive approaches to managing these issues. Investigators recommend a focus on understanding patients’ experiences and the meanings they attach to their symptoms, rather than relying solely on quantitative measures (Weinrich et al., 2004).
Prostate Cancer Screening
Prostate cancer screening remains a critical area of research, particularly for underserved populations such as African American men and those in rural, low-income areas. Researchers have developed targeted interventions to improve screening rates by addressing barriers and motivating individuals to participate (Weinrich et al., 2004).
Given the complexity of treatment decisions and the physical and emotional consequences of primary treatment, ongoing research is needed to help men make informed choices. Studies must address information gaps, particularly regarding the management of postoperative symptoms and the emotional impact of cancer recurrence.
In conclusion, prostate cancer presents significant challenges in diagnosis, treatment, and management. While advances in screening and treatment have improved early detection and survival rates, there remains a need for comprehensive research and nursing care to address the ongoing physical, emotional, and relational impacts of the disease. Continued research and targeted interventions are essential to enhance patient outcomes and quality of life for men with prostate cancer