Helen Forristal MSc (ANP) ; BSc (Hons) Professional Nursing Hormonal Treatment for Prostate Cancer ANP Candidate - Urology 2011

Transcription

1 Helen Forristal MSc (ANP) ; BSc (Hons) Professional Nursing Hormonal Treatment for Prostate Cancer ANP Candidate - Urology 2011

2 What is my Objective? If you see a patient, you may only see someone with prostate cancer. If I see a man, he will have prostate cancer but he will also have a varying set of emotions, maybe a family, a spouse or partner and no matter what his age or social network, he will have a set of opinions, priorities, preferences, experiences, expectations, a history and responsibilities that are individual to him. We and he need to work together in his context to achieve the best outcome for him

3 Epidemiology Prostate cancer is the most commonly diagnosed cancer amongst men in many industralised nations. Ireland was estimated to have the highest Prostate cancer incidence rate in ,100 cases ,600 cases. In the year age group (from ) Largest relative increase in men aged 55 from 10 cases in in In USA 186,000 new cases in 2008 and 28,600 deaths. In UK 35,000 new cases every year and 10,000 deaths. In Ireland 2,600 new cases in 2006 and 520 deaths. Increasingly common to see patients in the earliest stages of their cancer. Although T4 tumours made up a lower fraction of cancers in 2007 than in 1994, the numbers increased from 38 to 55. Drummond et al (2010) The National Cancer Registry, 2010 Sanda and Kaplan (2009)

4 Age adjusted PSA Values Age (yrs) PSA Limit (ng/ml)

5 DRE

6 TRUS guided biopsy Prostate

7 Histological grading: Gleason system Gleason grade Two patterns noted: primary pattern and the secondary, less representative, written in that order Score out of 10 (3+5)

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9 Bone scan Not required if PSA<10µg/ml

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11 Bone Pain Sciatica Lethargy Weight loss and cachexia Distant Metastasis

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13 Prostate cancer continuum High grade PIN Localised prostate cancer Locally advanced Metastatic disease Hormone insensitive T1 2N0M0 T3 4N2MO M1b Time (years) PIN, prostatic intraepithelial neoplasia

14 Treatment for prostate cancer High grade PIN Localised prostate cancer Locally advanced Metastatic disease Hormone insensitive T1 2N0M0 T3 4N2MO M1b D3 Time (years) Treatment options: Radical prostatectomy Radical Radiotherapy Active Surveillance Radical Radiotherapy Hormonal therapy Active Surveillance Hormonal therapy Chemotherapy PIN, prostatic intraepithelial neoplasia

15 John Hunter 1788 Prostate depended upon testicular function for normal growth

16 Prostate cancer is hormone dependent Testosterone Testes Aromatisation Hypothalamus Pituitary Prostate LHRH Prolactin Adrenal Cortisol Adrenal androgens LHRH, luteinising hormone releasing hormone LH, luteinising hormone ACTH, adrenocorticotrophin

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18 Anti androgens

19 LHRH analogues

20 Hot Flashes / Flushes

21 Breast Enlargement, Gynacomastia

22 Loss of Concentration, Low Mood, Depression, Tiredness

23 Loss of Libido, Infertility

24 Erectile Dysfunction

25 Decreased Muscle Mass and Strenght

26 Weight Gain

27 Increased risk of serious heart problems Research lead by cancer epidemiologist Mieke Van Hemelrijck of King s College, London, the researchers looked at 30,642 Swedish men with locally advanced or metastatic prostate cancer who had received hormone therapy as the primary treatment for their disease between 1997 and In all PC patients treated with HT had a 24 % increased risk of non fatal heart attack 19% risk of arrhythmia 31% risk of IHD 26% risk of heart failure 28% risk of fatal heart attack. 21% risk of dying from heart disease 26% risk of heart failure death 5% risk of death from arrhythmia

28 Mood swings

29 Manhood

30 Lower Bone Mineral Content Loss

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32 All about your bones

33 Bone Hardner (Therapy)

34 The Range of Symptoms

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36 Common Symptoms

37 What are my options for feeling better right now? Life Style or Self help Complementry Approaches Medical and Surgical Approaches

38 The Benefits of Regular exercize Walking has no harmful side effects, if done moderately, but it can dramatically improve life for men suffering from side effects from some prostate cancer treatments Dr. Paula Chiplis. A reduced risk of heart disease Lowers the risk of developing diabetes. Maintenance of muscle strength Better bone & joint health Higher levels of good cholesterol Better appetite control & weight Reduced risk of abdominal symptoms Efficient immune system Increases mental health Improves sleep quality

39 Complementry Therapy Sage Ginseng Dong quai Black cohosh Wild yam root Soya Acupuncture Massage/Touch Therapy Aromatherapy Yoga Pilates

40 Closing Thought I believe in self help, support and complementary therapies as an effective way of dealing with problems, stress, hardship and pain mending people, curing them is no longer enough: it is only part of the total healthcare that most people require

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42 Thank You