Prostate cancer incidence and screening in Canadian men

Prostate Cancer

OLDER MEN'S DREAD

Prostate Cancer

Incidence in Canada

Prostate cancer is the most common type of cancer that afflicts older Canadian men (Canadian Cancer Society, 2012). In the present year, about 26,500 men will likely be diagnosed with it and 4,000 of them will succumb to it. Every day, 73 will be diagnosed with it on the average. From these numbers, 11 will die of the cancer every day on the average. The probability is that one in 7 will develop it in his lifetime and one in 28 will die of it. Incidence is 121 per 100,000 and death rate is 19 per 100,000 with a current number of deaths at 4,000. Prostate cancer accounts for 27% of all estimated new cancer cases in the current year (Canadian Cancer Society, 2012). It accounts for 10% of all estimated cancer deaths also in the current year (Canadian Cancer Society).

An overall upward trend in incidence has been observed since 1980 very likely because of early detection (Canadian Cancer Society, 2012). The slowing down of death rates from the cancer in the same period suggests the same finding. The overall 5-year relative survival rate was 96% from 2004-2006 (Canadian Cancer Society).

Erectile Dysfunction

A number of approaches towards penile rehabilitation have been proposed and have proved efficacious (Jamal & Engel, 2011). The nerve-sparing radical prostatectomy is only one of the approaches in restoring erectile function. The patient's and his partner's goal and motivation must be clearly understood along with expectations to avoid frustration. A frank discussion on the realistic time table of the return of function and the their level of motivation is needed. The use of PDE-5 inhibitors alone is not reliable in the first year after surgery. If they are motivated, they can perform self-injection 1 to 3 months after surgery. A PDE-5 inhibitor should be taken as frequently as possible after surgery. They should be re-assessed at 12-18 months after surgery to measure their level of function, overall satisfaction and future management of erectile function. Different approaches are recommended for different patients. Honesty and allowing the partners to participate in their regimen are the best components to a successful and most satisfying approach (Jamal & Engel).

Informed Consent

Prostate cancer patients often have only short hospitals and hence lack the chance to receive important information and support for their treatment on which to base sound judgment and consent (Bjornes, 2011). A survey was conducted to find out and get insight on possible consequences of the lack of information and the level of awareness on prostatectomy and its consequences. Results of the survey showed that the patients often undergo the surgery without prior and sufficient information about it, dialogue, or individualized support needed. This lack of needed information and support creates feelings of uncertainty and insecurity and a loss of control. They turn to the internet to supply the lack, maintain a sense of control and responsibility for their own course of treatment. The survey concluded that prostate cancer patients lack the sense of security and certainty that individualized information, dialogue, and support alone can provide. Healthcare professionals should have time to be accessible to these patients and to provide them with the full basis for an adequately informed consent to the treatment. As a practice implication, health professionals can lead patients to use Web 2.0 technologies for dialogue-based contacts with other prostate cancers and healthcare professionals (Bjornes).

Another study aimed at establishing the roles played by the urologist, the GP and the nurse as perceived by patients with prostate cancer receiving hormone therapy (Lebret and Bouregba, 2008). It also sought to evaluate patient satisfaction, especially in meeting their management and need for information. A representative sample of 58 French urologists recruited 350 representative patients receiving the hormone therapy as participants. More than 90% of the participants expressed satisfaction over the information provided by the urologist during diagnosis and at the start of their treatment. Their major contact during their treatment was, however, the nurse. She gave the injection to 84% of them. She was also the main source of clarification to 6-% of the respondent-patients, guidance to 35%, and family support to 28%. Fewer patients discussed their disease stage and progression with the nurse at 29%, 63% with the urologist and 61% with the GP at 61%. Only 33% discussed their general health and fatigue with the nurse and 26% with the urologist. The need for consultation and contact was stronger in the early stages of treatment than later. The study concluded that while patients usually consult the urologist for needed and reliable information on disease and treatment and the GP for further support, the nurse played a connecting role. She comes face-to-face with them on a regular basis for injections three times every month. This presence enhances their coping and lifts their quality of life (Lebret & Bouregba).

Surgery

Prostate cancer patients who undergo radical prostatectomy or RP usually confront serious side effects, such as urinary incontinence (Toren et al., 2009). While most are able to recover at least partially, the rest must contend with irreversible incontinence for the rest of their lives. Determining the still-unclear effects of nerve-sparing surgery techniques on continence was the purpose of this review of the database of the University Health Network Prostate Centre database on patients who underwent RP and responded to the Patient-Oriented Prostate Utility Scale. Nerve-sparing surgery techniques were used on 191 of the 253 eligible patients on record from 2003 to 2007. .Of the 191, 44% were incontinent for a year (Toren et al.).

Nurse's Role

A study, which determined the health-related quality of life or HRQL of patients with prostate cancer, showed that they encountered frequent, varying and severe health problems (Bryant-Lukosius et al., 2010). It also found that they can rely from the episodic supportive care extended by an advanced practice nurse for these health problems during the different stages of their treatment. The study identified these most frequent and severe health problems and patients' perception of priority health problems. Respondents were divided into 5 patient groups and surveyed. The majority of those in the early-stage and advanced hormone-sensitive groups can look forward to a good quality of life for many years after diagnosis. These groups' shared priority needs were to improve health conditions relating to sexual function, urinary frequency, urinary incontinence, and physical activity. Patients with advanced hormone refractory prostate cancer but with poorer HRQL encountered severe health problems. Their priority needs differed from the two groups as these related to pain, fatigue and reduced physical activity. The focus for their care can come from an advanced practice nurse who can provide ongoing supportive care aimed at dealing with the many, new and deteriorating health problems of a progressive disease (Bryant-Lukosius et al.).

Impact on Marital Intimacy

The authors Mooney (2011) are a young couple who documented their own unique travails surrounding their bout with radical prostatectomy. Despite their professional background, they were completely unprepared for what could occur to their relationship while learning how to deal with the loss of sexual intimacy since the surgery. They recalled in hindsight that their expectation of recovery was not identical with the assurance of success made to them by the treatment team. The husband's physical recovery did not indicate the life changes they must contend with. These changes included grief over the loss of intimacy between them, the changes in the nature of their relationship, misguided individual expectations, a lack of interpersonal communication and the lack of professional information to help and enlighten them. The process of trying to recover sexual function led them to seek out many treatment modes. Most of them yielded poor results. Their frustration stole almost all hope for intimacy. Reflecting on the situation led us to realize that we actually lacked individual coping skills, which could restore our relationship to normal (Mooney & Mooney).

Their experience led them to see the importance of family physicians (Mooney & Mooney, 2011). They are a family's most valuable resource before and after surgery on sexual dysfunction and intimacy problems and appropriate interventions. As health practitioners themselves, the authors recommend that family physicians extend more support to this particular group of patients. They should seek out a local or regional referral for psychological and sexual counseling. All prostatectomy patients should be evaluated before and after surgery whether they present problems. They should be familiar with treatment for erectile dysfunction besides oral medications. Then they should look for a referral provider specializing in advanced treatment of this dysfunction. Individual and couple counseling may be more effective in helping other couples who develop long-term intimacy problems. Centers, which provide a multidisciplinary approach, should be considered. All providers should be extremely upfront with prostatectomy patients and their spouses about surgical outcomes and a desired return to sexual intimacy (Mooney & Mooney). #