Pathophysiology Master of Nursing
The clinical presentation of acute prostatitis, benign prostatic hypertrophy (BPH), and prostate cancer are markedly different. Differentiate between these three diseases by focusing on patient symptoms, findings on clinical examination, and diagnostic testing used to confirm the diagnosis. Discuss a detailed patient education plan that will help the patient maintain proper health. Your plan should address medications that may be prescribed, follow-up plans, and possible referrals to other healthcare providers.
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Benign prostatic hyperplasia is the overgrowth of "smooth muscle and epithelial cells within the prostatic transition zone" (Curran, 2012). In other words, there is an increase in the size of the prostate, which is progressive as the patient ages. This increase in size puts pressure on the urethra and surrounding tissues, resulting in alteration of the process of urination. It is also commonly associated with erectile dysfunction. Common symptoms can be prior to voiding, during the voiding process or post micturation. Some of the more commonly known symptoms are difficulty starting or maintaining stream, polyuria, urinary retention post-void and increased risk of urinary tract infections. Medications used to treat BPH are usually alpha-blocker such as Flomax or doxazosin. These medications work by relaxing the smooth muscle in and around the prostate, resulting in less obstruction of urinary flow. Possible treatments include symptomatic treatment with medications or surgical resection of the prostate. Transurethral resection of the prostate is performed by inserting a resecting tool into the urethra and removing part or all of the prostate without the need for any additional incisions. Bloody urine is an expected side effect of a TURP procedure and will generally subside within a few weeks.
Prostatitis can be chronic or acute in nature. The more common is the chronic form, which is non-bacterial inflammation that is painful and is also known as chronic pelvic pain syndrome. Acute prostatitis is usually bacterial in nature. Although the prostate is the affected gland, there is not a known increase in the risk of prostate cancer from the diagnosis of prostatitis. Common symptoms for both forms is characterized by "persistent pain between the scrotum and rectum" (Pluta, Lynn & Golub, 2012). This pain may be referred pain that affects the genital area as well. Medications for acute bacterial prostatitis are obviously antibiotics for several weeks’ to several months’ duration. Chronic prostatitis is treated with a more individualized approach and consists of pain relievers, alpha-blockers or NSAIDS. Possible treatments are generally lifestyle changes such as increased exercise, avoiding trigger foods or drinks and utilization of cushioned chairs.
Although the prostate is the affected gland, there is not a known increase in the risk of prostate cancer from the diagnosis of prostatitis. Common symptoms for both forms is characterized by "persistent pain between the scrotum and rectum" (Pluta, Lynn & Golub, 2012). This pain may be referred pain that affects the genital area as well.
Prostate cancer is malignancy associate with the prostate gland. Prostate cancer is often asymptomatic in the early stages. As the cancer progresses, it may put pressure on the prostate and mimic the symptoms of BPH such as decreased stream pressure or difficulty starting stream. Medications are either antineoplastic, hormonal such as Lupron, or forms of corticosteroids such as prednisone. The goal is to decrease neoplastic cell formation as well as decreasing the inflammation to the area. Possible treatments include radiation therapy, chemotherapy, radical prostatectomy and cryosurgery. Individual treatment options vary depending upon the stage of cancer formation, patient age and physical condition at the time of diagnosis. Another consideration is the type of specialist the patient is referred to, such as urologists or oncologists. A surgical approach is obviously more common for a surgeon and chemotherapy or radiation is more common for an oncologist.
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Acute prostatitis is an inflammatory disorder of the prostate gland whose etiology is usually bacteria which ascends from the urethra or a ?reflux of infected urine into the prostatic ducts? (Porth & Matfin, 2009, p. 1105). E. Coli is the most common bacteria found with acute prostatitis. Clinical findings include fever, chills, malaise, frequent and urgent urination, dysuria, and urethral discharge. Dull aching pain is also present in the rectum or perineum. The individual?s urine may also be cloudy with a foul odor because of a urinary tract infection, and prostate massage produces a thick discharge with white blood cells that grow large numbers of pathogens on culture. Treatment includes antibiotics for at least four weeks, hydration, NSAIDS including ibuprofen, Tylenol to control fevers, and stool softeners i.e. colace, and senna s, to reduce constipation as a possible side effect with acute prostatitis.
Benign prostatic hyperplasia is a nonmalignant enlargement of the prostate gland and is one of the most common diseases of aging men (Porth & Matfin, 2009). Symptoms include partial or complete urinary obstruction, urinary retention, nocturia, urinary incontinence, urinary tract infections, and renal failure. To diagnose benign prostatic hyperplasia ?The American Urological Association symptom index consists of seven questions about symptoms regarding incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia? (Porth & Matfin, 2009, p. 1107). Each question is rated 0-7 with a max score of 35 indicating severe symptoms. Diagnosis also includes a thorough history and physical, digital rectal exam, urinalysis, serum creatnine and PSA labs. Treatment for mild BPH is to take a watchful waiting stance to see if the condition improves on its own. For more severe cases with obstructions, surgical treatment is often indicated which includes the removal of the prostate gland. Pharmacological agents for treatment of BPH are finasteride which causes prostate atrophy and a1 adrenergic blocking drugs to improve the urine flow rate (Porth & Matfin, 2009).
Prostate cancer is a disease of aging and is the most common non skin cancer in the United States (Porth & Matfin, 2009). African American men have the highest incidence of the disease, with Asians and Native Americans with the lowest cases. Most men are asymptomatic with the early stages of prostate cancer. Symptoms usually suggest advancement of the metastatic disease (Porth & Matfin, 2009). These symptoms include urinary frequency, nocturia, hesitancy, hematuria, or blood in the ejaculate. With digital rectal examinations the prostate can be fixed or nodular on palpation. Metastasis is characterized by the spread of the cancerous cells to other locations of the body and is often characterized by low back pain with prostate cancer (Porth & Matfin, 2009). If metastasis has occurred it is evidenced by anemia, weight loss, and shortness of breath. Diagnosing is based on the history and physical and confirmed through a biopsy of the prostate. Screening measures for prostate cancer include yearly digital rectal exams, PSA testing, and transrectal ultrasonography (Porth & Matfin, 2009). Treatment for prostate cancer includes hormonal manipulations, surgery with radical prostectomy, and radiation therapy which involves the ?external beam radiation or transperineal implantation of radioisotopes? (Porth & Matfin, 2009, p. 1109).
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