Case scenario:
Mr Joffrey Baratheon is a 65-year-old man admitted to the ward for a prostate biopsy. Joffrey is a retired wheat farmer His PSA was noted to be increased by his GP two months ago after Joffrey went to complained of difficulty urinating, but he reports no other concerns. His admission notes state ‘suspected carcinoma of the prostate’.
His past medical history is notable for Type 2 diabetes, hypertension and a myocardial infarction (MI) at the age of 58.
Both Joffrey’s father and uncle were diagnosed with prostate cancer in their 60’s and his mother and sister were diagnosed with breast cancer in their 50’s.
Joffrey’s current medications are:
- Verapamil 240mg before breakfast
He states he is in pretty good health for his age and is fairly active He smoked up until his MI, but has not smoked since. He states he is not a big drinker of alcohol, but ‘doesn’t mind a beer or two’ when he goes fishing on weekends. He describes himself as ‘a typical meat and three veg type of bloke – none of that fancy stuff’. He denies bowel problems, but does mention that he occasionally finds it difficult to pass a bowel motion.
Part 1
1.Describe the pathophysiology of prostate cancer with links to Joffrey’s case. Include in your answer risk factors, possible complications and discuss the three stages of prostate cancer and associated treatment options.
2. Differentiate between Benign Prostatic Hyperplasia (BPH) is and prostate cancer (at least 5 differences).
3. Identify why Joffrey is experiencing difficulty urinating and discuss the symptoms he may be experiencing with this. Include in your discussion how prostate cancer affects bladder function.
Part 2
Joffrey’s biopsy goes well, however it is confirmed that he has prostate cancer with a Gleason score of 9. He was commenced on anti androgen therapy by the urologists in clinic post biopsy and is scheduled to have radiotherapy in the coming months. His treatment schedule is charted as follows:
- Leuprorelin injection 7.5mg monthly
- External beam radiation therapy (EBRT) daily for 2 months
1 Discuss the three treatments that Joffrey has been prescribed. Include in your answer the action, complications/side effects and nursing considerations linked to Joffrey’s situation.
2 What stage of cancer is Joffery most likely to have given these treatments and his symptoms? Include in your discussion the rationale for hormone treatment in combination with radiotherapy.
Part 3
It is now five (5) years later and Joffrey has returned to his GP after hurting his arm on a camping weekend. X-ray imaging shows that Joffrey has sustained a non-displaced distal fracture to his right radius. The x-ray image also identified the presence of a suspicious bony lesion. Joffrey was sent for further imaging and has now been diagnosed with bone metastases.
1 Explain the complications associated with bone metastasis and the advice that should be provided to Joffrey regarding these.
2.What appropriate treatment should be available to Joffrey? Explain his treatment options with rationale
Add a conclusion in your own words (no new reference should be added in the conclusion)
