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| Audience |
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Nursing:
Deprecated Courses
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| Authors |
Jennifer Guy, BS, RN, OCNŽ
Jennifer L. Guy, BS, RN, OCNŽ
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| Hours |
3.00 contact hours |
| Expires |
EXPIRED |
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| Passing Grade |
70% |
| Test Retries |
Unlimited
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After completion of this course the participant should be able to:
- Identify the incidence, prevalence, age, and racial distribution of prostate cancer in the United States.
- Differentiate between patients at high risk and normal risk for the development of prostate cancer.
- Identify two common tests used to detect prostate cancer.
- Define prostatic intraepithelial neoplasia and its significance.
- Discuss the two staging systems used in this disease and the relationship of stage and pathological differentiation to prognosis.
- Delineate the most common complications of surgery and radiation therapy in the primary treatment of localized prostate cancer; identify the incidence of these complications.
- Identify two types of hormonal therapy used in the management of prostate cancer.
- Explain the role of chemotherapy in hormone-refractory disease.
- List palliative interventions for the patients with advanced disease.
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To take just this course, test, and evaluation and get your certificate online, the cost is only $ 45.00!
| Hours |
Price |
p/Hour |
Discount |
| 10 |
$ 142 |
$ 14.20 |
5% off! |
| 15 |
$ 203 |
$ 13.53 |
10% off! |
| 20 |
$ 257 |
$ 12.85 |
14% off! |
| 25 |
$ 302 |
$ 12.08 |
19% off! |
| 30 |
$ 339 |
$ 11.30 |
25% off! |
| 35 |
$ 367 |
$ 10.49 |
30% off! |
| 40 |
$ 386 |
$ 9.65 |
36% off! |
| 45 |
$ 405 |
$ 9.00 |
40% off! |
Hours purchased are good for an unlimited time, but only within the discipline they were purchased in.
(If located in Ohio state taxes will be applied before purchase)
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No Commercial Support or Sponsorship is accepted by CEU4U, Inc.
Products, drugs, and/or therapies discussed within this educational offering do NOT imply endorsement by CEU4U, Inc. or American Nurses Credentialing Center.
No off label use of product(s) are discussed in this educational offering.
The author(s) and planning committee of this content declare that they have no real or perceived conflict of interest related to this presentation.
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Course Sample:
1.0 Introduction
Excluding skin cancers, prostate cancer is the most common malignancy among American males. It will account for an estimated 33% of all newly diagnosed cancers in men in 2003, but will account for only 10% of cancer deaths1. This malignancy is age-related; autopsy data identifies prostate cancer in 60-70% of men at age 809. It is hypothesized that all men will develop this disease if they live long enough. Despite the existence of the relatively sensitive prostate specific antigen (PSA) blood test, screening for prostate cancer is controversial, based in part on the variability in the biologic behavior of this malignancy. Prostatic carcinomas range from very slow growing to exhibiting moderately rapid growth. Most prostate cancers are responsive to treatment, and a majority of patients die of other causes. Thus, the variable biologic behavior and the often 'benign' clinical course of the disease present many challenges in identifying which individual patients will peacefully co-exist with their prostate cancer even without treatment versus those with rapidly advancing tumors who require aggressive intervention. Nurses face the challenge of explaining the controversies in screening, the implications of various prognostic factors, and the characteristics each patient's individual situation that result in treatment choices, or specific treatment recommendations. Because the course of this malignancy can span more than a decade, the challenges of integrating new information and advances in management faces not only oncology and urology nurses, but also those practicing in nursing roles that deal with chronic disease affecting the geriatric population.
DEMOGRAPHICS
As a man ages, his risk of developing prostate cancer increases exponentially after age fifty; over 90% of cases are diagnosed in men over 65 years of age3. The median age at diagnosis is 72. Rarely does this malignancy occur in men less than 50 years old, but when it does, it is often exhibits more aggressive biologic behavior, and thus, has a worse prognosis than those occurring later in life. An American man has a 1 in 6 life-time risk of developing prostate cancer. Prostate cancer occurs fifty per cent more frequently in blacks than in Caucasians probably due to differences in androgen levels. Prostate cancer is most common in the United States and Western Europe, and uncommon in Asia. However, those moving from a area of lower incidence to one of higher incidence ( i.e., Asia to the U. S.) assume the risk of their new homeland over time.
A familial pattern has been noted in prostate cancer, with an estimated two to five fold increased risk in relatives of prostate cancer patients. A father, brother, or son with prostate cancer is a significant risk factor. One first-degree relative affected increases the risk to two to three fold; this rises to a ten-fold increase in risk when more than two first-degree relatives have prostate cancer2. Currently, it is estimated that 9 % of prostate cancer have a hereditary genetic component; it is anticipated that the gene or genes responsible in these cases will be identified in the next several years.
Androgens are required for the development of prostate cancer. The higher the cumulative exposure to androgens, the higher the risk of prostate cancer. Levels of testosterone and its metabolic product dihydrotestosterone (DHT) seem to correlate with prostate cancer risk in various populations. For example, the highest levels of these hormones occur in blacks, who have the highest incidence of the disease; conversely, the Japanese exhibit the lowest incidence and have the lowest levels of these androgens. Historically, risk factors for prostate cancer include industrial exposures to chemicals, especially cadmium which is found in batteries and dioxin found in herbicides. More recent data does not confirm this association. Dietary factors may play a role in the development of prostate cancer: high fat diets are associated with a higher incidence of prostate cancer. However, data is incomplete as to the kind of dietary fat responsible, definition of the level of intake of fats that increases the risk, or the exact mechanism of action that fosters the development of prostate cancer. Diets high in fruits and vegetables have been associated with a decreased incidence of prostate cancer. Benign prostatic hyperplasia (BPH), alcohol consumption, cigarette smoking, and previous vasectomy have not been conclusively linked to the development of prostate cancer. Recent data suggest that cigarette smokers tend to present with more advanced disease than non-smokers, and may be more likely to die of prostate cancer10. Table I summarizes risk data.
TABLE I
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Risk Factors for Prostate Cancer |
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Factor |
Level
of Evidence |
| Age |
Definitive:
increases with age, especially > 50 y.o. |
| Race |
Definitive:
Blacks > Whites > Asians |
| Geography |
Definitive:
but assume the risk of new country |
| Family
History |
Increasing
# of lst degree relatives increases risk |
| Hormones |
Definitive:
androgen specific |
| Diet |
Probable:
increase with increased fat intake
Possible:
decrease with fruits & vegetables |
| Chemicals |
Conflicting
data |
| Cigarettes |
Negative:
but may have prognostic importance |
| Vasectomy |
Negative |
| Alcohol |
Negative |
| Obesity |
Negative |
| BPH |
Negative |
Annual mortality from prostate cancer has ranged from 30,520 in l989 to 34,902 in 1994. Since then mortality has slowly decreased to 31,078 in 2000; 28,900 men are projected to die from prostate cancer in 2003. The discrepancy in the incidence of prostate cancer and mortality from it in absolute numbers is due to its increasing incidence with increasing age as well as its biologic behavior. Many afflicted with prostate cancer, by virtue of age, have other life-threatening illnesses, such as heart disease, renal disease, and pulmonary disease, which are more likely to be fatal than a slow growing prostate cancer. Deaths from prostate cancer increase with increasing age. (Table II) for reasons unrelated to socioeconomic status or education, blacks have uniformly worse survivals by stage compared with non-blacks9.
TABLE
II
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Age Distribution of Mortality from Prostate
Cancer |
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Age |
% of total prostate cancer deaths |
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<
55 |
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