BENIGN PROSTATIC HYPERTROPHY (BPH)
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o BPH is an age-related enlargement of the prostate gland that constricts the urethra and obstructs
the outflow of urine
o Affects 50% of 50 - 60 year-old men and 90% of men 80 years old or older
o In addition to age-related changes other causes include neoplasms, arteriosclerosis,
inflammation, and metabolic or nutritional disturbances
o BPH does not predispose older men to the development of prostate cancer
o Location of the enlargement is the most important factor to consider with the obstruction present
CLINICAL PRESENTATION OF BPH
o Initially BPH may be asymptomatic; symptoms develop as a result of urinary obstruction
o As the prostate enlarges the client has symptoms of obstruction (hesitancy, decrease in force of
urinary stream, terminal dribbling, sensation of full bladder after voiding, and urinary retention)
o Urethral obstruction may lead to urinary stasis, UTI, renal calculi, and eventually to
hydronephrosis if untreated
MEDICAL MANAGEMENT OF BPH
o The primary methods of diagnosis are a history and physical exam which includes a digital rectal
exam (DRE)
o Other diagnostic tests - labs (BUN, serum creatinine, urinalysis), transrectal ultrasound may be
done
o Treatment is conservative if possible
o Noninvasive treatments (e.g. balloon dilation of prostatic urethra, laser prostatectomy and
indwelling urethral stents) are sometimes done; these are frequently done in urologists’ offices
o Surgical intervention
DRUG THERAPY FOR BPH
o a-Reductase inhibitors
 blocks 5-alpha reductase enzyme that converts testosterone to dihydrotestosterone
 Finasteride (Proscar) is frequently used
o a-Adrenergic receptor blockers
 blocks a1-adrenergic receptors
 Doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax) are examples
o Saw palmetto, used by many older men, is an OTC herbal preparation that is often effective in
improving BPH symptoms and have few side effects
NURSING DIAGNOSES – BPH
o Altered urinary elimination r/t bladder outlet obstruction
o Urinary retention r/t blockage secondary to BPH
o Risk for infection r/t acute prostatitis,urinary stasis
o Potential for sexual dysfunction r/t erectile dysfunction
NURSING INTERVENTION – BPH
o Interventions focus on client education regarding diagnosis and management
o Interventions vary depending on type of treatment regimen being used
o Surgery (TURP, TUIP, Prostatectomy)
 Post op care includes pain management, observing for bleeding, & keeping catheter
patent
o Surgical interventions may result in temporary sexual dysfunction
 Give an opportunity to verbalize concerns and to be referred to appropriate supportive
services (e.g. urologist, certified sex therapist) if needed
PROSTATE CANCER
o Prostate cancer seldom occurs before 50 – the incidence increases substantially with age
o A family history of prostate cancer is a strong risk factor
o African American men are at high risk for prostate cancer
CLINICAL MANIFESTATIONS PROSTATE CANCER
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o Early prostate cancer is typically asymptomatic
o Other s/s may include perineal and rectal discomfort, weakness, nausea, hematuria, and lower
extremity edema
o Skeletal pain and pathologic fractures may indicate advanced disease with metastases
DIAGNOSTIC TESTS
o History and PE, Urinalysis with culture
o Diagnostic tests include digital rectal exam (DRE) and the blood test known as PSA (prostate
specific antigen)
o Neither PSA nor DRE is a definitive diagnostic test for prostate cancer
o Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland
o The PSA is a starting point for the diagnosis of prostate cancer in men
o Various factors (infection, physical activity, rectal stimulation during DRE, and BPH) can cause
PSA levels to fluctuate
o Serum creatine
o Neurologic exam
o Postvoid residual
o Cystoscopy
PROSTATE CANCER SCREENING
o The American Cancer Society (ACS) recommendations:
 Age 50 for men who are at average risk of prostate cancer and are expected to live at
least 10 more years.
 Age 45 for men at high risk of developing prostate cancer. This includes African
Americans and men who have a first-degree relative (father, brother, or son) diagnosed
with prostate cancer at an early age (younger than age 65).
 Age 40 for men at even higher risk (those with more than one first-degree relative who
had prostate cancer at an early age)
 If no prostate cancer is found as a result of screening, the time between future screenings
depends on the results of the PSA blood test:
 Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to
be retested every 2 years.
 Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.
 Because prostate cancer often grows slowly, men without symptoms of prostate cancer
who do not have a 10-year life expectancy should not be offered testing since they are not
likely to benefit. Overall health status, and not age alone, is important when making
decisions about screening.
MEDICAL MANAGEMENT PROSTATE CANCER
o Once prostate cancer is diagnosed, the older man has a variety of treatment options; no one
option seems to have significant benefits over the others for all older men
o A conservative strategy referred to as “watchful waiting” or “active surveillance” is sometimes
used
o Surgical intervention (laparoscopic prostatectomy) may be done
o Radiation is often done – some newer procedures (intensity modulated radiation therapy or
IMRT) can be effective; chemotherapy may or may not be done
o Hormonal therapy (androgen deprivation) may be done to decrease the amount of circulating
androgens
DRUG THERAPY
o Reductase inhibitor
 Finasteride (Proscar)
 Dutasteride (Avodart)
 Jalyn (finasteride plus tamsulosin)
 Goal is to decrease the size of the prostate
o Adrenergic receptor blocker
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 Helps relax the muscles and open the flow (relax urethrea0
 Can be used for men and women
 Silodosin (Rapaflo)
 Tamsulosin (Flomax)
 No impact on size of prostate
PROGNOSIS FOR PROSTATE CANCER
o If detected early prostate cancer can be effectively treated
o With successful treatment men can survive and live many years longer
NURSING DIAGNOSES PROSTATE CANCER
o Altered urinary elimination r/t bladder outlet obstruction
o Anxiety r/t to uncertain prognosis
o Sexual dysfunction r/t treatment measures
o Knowledge deficit: treatment modalities and prognosis r/t lack of exposure
NURSING INTERVENTIONS PROSTATE CANCER
o Interventions should focus on teaching regarding annual screening, diagnostic tests, and
treatment options
o If surgery is done, post-op care includes pain management, suggesting options for sexual
counseling if needed, and teaching about importance of follow up care
GOALS
o Restore bladder drainage
o Relieve symptoms
o Treat complications.
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