CHAPTER 9 Genitourinary System^385
- Urinary frequency—need to urinate frequently due to pressure on bladder
- Urinary urgency—need to get to bathroom quickly to urinate due to pressure
on bladder - Nocturia—need to get up at night to urinate due to pressure on bladder
- Decrease in force of urinary stream
- Intermittent stream of urination
- Hematuria
- Palpable nodule on digital rectal examination
- Urinary retention due to enlargement of the tumor, blocking flow of urine
- Back pain due to metastasis
INTERPRETING TEST RESULTS
- PSA elevates as tumor size increases.
- Digital rectal exam may reveal nodule.
- Transrectal ultrasound used to identify prostate cancer and determine the stage.
- MRI to identify prostate lesions and involvement of surrounding tissue or
lymph nodes. - Biopsy to identify cell type.
- Alkaline phosphatase elevates with metastasis to bone.
TREATMENT
- Radiation therapy:
- External beam.
- Brachytherapy—insertion of radioactive substance into prostate.
- Surgery—radical prostatectomy.
- Chemotherapy.
- Cryosurgery—freezing of tissue with ultrasound guidance.
- Watchful waiting—monitoring PSA and ultrasound depending on patient’s
age and cell type of cancer and any comorbidities. - Hormonal treatment to suppress natural androgen production:
- leuprolide
- goserelin
- estrogen
- Orchiectomy to reduce natural androgen production.