Med-Surg · chapter 20 · Genitourinary and Reproductive Systems
Disorders of the Prostate
The 13 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
BPH prevalence and aging
Benign prostatic hyperplasia is quite common, affecting over half of men between the ages of 51 and 60 years and 70% of men older than 60 years (National Institute of Diabetes and Digestive and Kidney Diseases, 2014). This condition is benign and results when the prostate becomes enlarged as a normal side effect of aging.
BPH urethral obstruction
As the prostate gland grows larger, it eventually presses against the urethra, resulting in urinary dysfunction and difficulty with the stream of urine flow.
Prostate cancer prevalence
Prostate cancer is the most common type of cancer in males, with about 288,300 new cases diagnosed in 2023 in the United States (American Cancer Society, 2023a). Approximately one of every eight men will be diagnosed with prostate cancer in their lifetime, highlighting its significant prevalence.
DRE abnormal findings
During this assessment, the provider inserts a gloved, lubricated finger into the rectum to feel the prostate gland and determine if it is enlarged or has any other abnormalities, such as nodules. Enlargement of the prostate gland often indicates BPH, whereas the palpation of a hard nodule on the prostate may indicate prostate cancer.
PSA elevation meaning
This blood test checks for the presence of PSA which is a protein made by the prostate gland. If this value is elevated, it can be indicative of either BPH or prostate cancer.
PSA retesting intervals
Current screening guidelines recommend prostate cancer retesting every two years for men with a PSA level less than 2.5 ng/mL and annual testing for men with a PSA level greater than 2.5 ng/mL.
Ultrasound and biopsy
During this procedure, the provider will insert a small ultrasound probe into the rectum to look at the prostate gland and determine if there are any nodules present that are indicative of cancer. If a nodule is noted at this time, a biopsy specimen is usually taken and sent to the laboratory for further analysis.
BPH fluid timing
Patients with BPH should drink enough fluids to maintain adequate hydration but refrain from drinking too much, especially within four hours of bedtime, which can contribute to worsening urinary frequency and retention, and nocturia.
Voiding schedule
A voiding schedule, whereby the patient is instructed to void every two hours, is another helpful intervention to avoid urinary dribbling.
Observation approach
Because prostate cancer grows slowly and often does not affect men until later in life, treatment is not always required. In these situations, the provider may choose a “wait and see” approach.
Radiation treatment types
Radiation therapy is usually the first treatment option for patients with prostate cancer that is in an early stage and localized to the prostate gland. The two main types of radiation used for treatment of prostate cancer are external beam radiation therapy (EBRT) and brachytherapy (internal radiation).
Radiation adverse effects
With radiation therapy, adverse side effects may include ED, urinary incontinence, fatigue, and radiation proctitis, or inflammation of the rectum lining, which can result in diarrhea and rectal leakage.
Postoperative bladder irrigation
Occasionally, these patients will also be receiving continuous bladder irrigation (CBI), a procedure in which a three-way urinary catheter is used to constantly irrigate the bladder and allow for adequate urinary drainage. The nurse will need to adjust the flow of the bladder irrigation solution to maintain patency and monitor for complications such as severe bleeding.
Terms to know
- digital rectal examination (DRE)
- The best way to physically assess the size and shape of the prostate gland is by performing a digital rectal examination (DRE).
- PSA
- This blood test checks for the presence of PSA which is a protein made by the prostate gland.
- brachytherapy
- An approach called brachytherapy involves placement of radioactive seeds inside the prostate tissue that are left in place and give off radiation to kill excess prostate tissue over several weeks to months.
- radiation proctitis
- With radiation therapy, adverse side effects may include ED, urinary incontinence, fatigue, and radiation proctitis, or inflammation of the rectum lining, which can result in diarrhea and rectal leakage.
- androgen deprivation therapy
- Antiandrogens, also known as androgen deprivation therapy, prevent the body from being able to use the male sex hormones, and this can also assist in slowing cancer growth.
- continuous bladder irrigation (CBI)
- Occasionally, these patients will also be receiving continuous bladder irrigation (CBI), a procedure in which a three-way urinary catheter is used to constantly irrigate the bladder and allow for adequate urinary drainage.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
At 0900, a nurse reviews an elevated PSA result after the provider documented prostate enlargement on digital rectal examination. Further diagnostic testing is pending. Which entry best reflects the available findings?
- Prostate enlargement and elevated PSA indicate BPH rather than prostate cancer.
- Prostate enlargement and elevated PSA noted; findings may indicate either BPH or prostate cancer.
- Prostate enlargement and elevated PSA indicate a urinary tract infection associated with BPH.
- Prostate enlargement and elevated PSA establish prostate cancer; further testing will determine its extent.
Answer: Prostate enlargement and elevated PSA noted; findings may indicate either BPH or prostate cancer.
An elevated PSA can indicate either BPH or prostate cancer, so the entry should preserve that uncertainty. Prostate enlargement does not establish BPH rather than cancer, and elevated PSA does not confirm cancer. These findings also do not establish a urinary tract infection.
At 1600, a patient with BPH reports frequent nighttime urination and asks whether drinking less would help. Which instructions should the nurse include in the documented teaching plan? Select all that apply.
- Reduce fluid intake as much as possible throughout the day to minimize urine production.
- Avoid excessive fluid intake during the four hours before bedtime.
- Keep evening fluid intake unchanged and rely on scheduled voiding alone to address nighttime frequency.
- Drink enough fluids to maintain adequate hydration.
- Use caffeinated drinks before bedtime so their diuretic effect helps empty the bladder.
Answer: Avoid excessive fluid intake during the four hours before bedtime., Drink enough fluids to maintain adequate hydration.
The section recommends balancing adequate hydration with avoiding excessive fluid intake, especially within four hours of bedtime. Reducing intake as much as possible does not preserve that balance, and scheduled voiding does not replace the fluid-intake recommendations. Caffeine is something to limit, not use as a bedtime bladder-emptying strategy.
At 1400, a patient receiving continuous bladder irrigation after TURP has pink-tinged urine with no clots, and the catheter is draining. Which evaluation should the nurse document based on these observations?
- Pink-tinged urine without clots; the desired response has not been achieved because the urine is not clear.
- Pink-tinged urine without clots; urine appearance is consistent with the ideal response to continuous bladder irrigation.
- Pink-tinged urine without clots; the irrigation rate needs to be increased to eliminate the remaining discoloration.
- Pink-tinged urine without clots; urine appearance establishes that irrigation is ready for discontinuation.
Answer: Pink-tinged urine without clots; urine appearance is consistent with the ideal response to continuous bladder irrigation.
The section identifies pink-tinged urine with few to no clots as the ideal response to continuous bladder irrigation. Clear urine is not the stated target, and the observations do not support increasing irrigation solely to eliminate the pink color. The section also does not establish these findings as criteria for discontinuing irrigation.
Where every quote comes from
Section 20.4 Disorders of the Prostate of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.