Prostate cancer: Nursing pathophysiology

Prostate cancer is a malignant growth that originates in the prostate gland. The prostate is a small walnut shaped gland that sits under the bladder in front of the rectum.

It secretes an alkaline milky liquid called prostatic fluid, which contains nutrients to nourish. The sperm support its movement and help it survive in the acidic environment of the vagina.

Now, the urethra travels through the prostate before reaching the penis. During ejaculation, smooth muscles in the prostate contract and push prostatic fluid into the urethra where it joins the sperm along with the semen.

The prostate can be divided into distinct zones based on their histological differences, including the peripheral central transitional and fibromuscular zones.

The peripheral zone is the outermost posterior section and is the largest of the zones containing most of the prostate's glandular tissue.

It's also the most common site for development of prostate cancers and is the part of the prostate thats palpated during a prostate exam called a digital rectal examination or dre moving inward.

There's the central zone followed by the transitional zone. The site that undergoes hyperplasia in a condition called benign prostatic hyperplasia, which is considered a normal part of aging part of the transitional zone that surrounds the urethra is sometimes called the periurethral gland region.

Lastly, a fibromuscular zone covers the anterior portion of the prostate. Ok.

So the development and normal function of prostate cells depend on androgens or sex hormones like testosterone. Although most of the body's testosterone is produced by the testes.

A portion of testosterone is made in the prostate in the prostate. Testosterone is converted by the enzyme five alpha reductase into highly potent dihydrotestosterone or DHT which happens when dehydroepiandrosterone or DHEA, produced by the adrenal glands enters the prostate and is converted into testosterone.

Now, although the cause of prostate cancer is unknown, it's linked to a genetic mutation in a prostate cell such as the BRCA one and BRCA two genes.

Epigenetic factors also play a role by altering the expression of tumor suppressor genes that regulate cell division and supporting the formation of oncogenes which are mutated genes that have the potential to cause cancer.

There are several risk factors for prostate cancer including nonmodifiable ones like advanced age, having a family history of prostate cancer and black race modifiable risk factors include obesity and a diet high in animal fat or low in fiber, chronic inflammation, stemming from infection exposure to chemicals or toxins, physical trauma and hormonal changes can also increase risk.

Now, most prostate cancers are adenocarcinomas, meaning they originate from glandular tissue. After mutation and transformation into a cancerous cell, the cell will continue to divide uncontrollably forming a tumor.

The growth and development of cancer depends on activation of androgen receptors on prostate cells by testosterone and DHT early on prostate cancer cells depend heavily on these androgens for survival.

However, eventually the cancer cells mutate and find a way to keep multiplying without relying on androgens. Most prostate cancer cells grow slowly over time as the tumor grows, it can invade neighboring organs and lymph nodes as well as metastasize to lymph nodes, bones and organs like the liver and lungs.

Ok. So, in the early stages, prostate cancer typically causes no symptoms because most cases arise from the prostate's posterior peripheral zone which is far away from the urethra.

However, as the tumor grows, it leads to enlargement of the prostate gland and constriction of the prostatic urethra. This can cause urinary symptoms like urinary hesitancy, urinary frequency, weakened urine stream and dysuria.

Additionally, the tumor might be palpated as a hard nodule during a routine dre and a blood test for prostate specific antigen or psa might be elevated eventually if metastasis occurs.

Other manifestations arise depending on the area affected such as pathological fractures or bone pain. Typically in the pelvis, spine, femur and ribs, gi manifestations like bowel obstruction or liver enlargement.

All right. As a quick recap, prostate cancer is a malignant growth that originates in the prostate gland.

Although the exact cause is unknown, prostate cancer can be related to genetic mutations with nonmodifiable and modifiable factors.

Increasing risk. Initially, prostate cancer may not cause any symptoms.

But as the disease progresses, patients may develop urinary symptoms and other manifestations if metastasis occurs.