Abstract and Introduction
New therapies and evolving scientific concepts are significantly improving outcomes for patients with prostate cancer. A greater emphasis on delivering state-of-the-art nursing care and personalization of treatments is needed. Nurses often spend significant time with patients, caregivers, and their families, and develop personal relationships that present opportunities for enhanced education of treatment options that may reflect patients' lifestyles and personal preferences. Newer drugs are costly, and their use should be discussed with the patient in regard to choice of treatment, potential survival benefits, and overall quality-of-life outcomes.
Prostate cancer (PCa) is the second most common cancer diagnosis for men in the United States (Scher, Solo, Valant, Todd, & Mehra, 2015). In 2020, the projected incidence for non-metastatic castration-resistant prostate cancer (CRPC) is over 112,000 cases, and for metastatic CRPC is over 43,000 cases (Scher et al., 2015). With recent innovations in the treatment of advanced PCa, patients are living longer, with 98% of patients surviving 10 years, and 96% surviving 15 or more years (American Cancer Society [ACS], 2016). Due to this improved survival rate, long-term disease management has become the new standard, and will require increased education, support, and cancer care team collaboration from nurses in clinics and hospitals. Nurses who work with men diagnosed with prostate cancer will be expected to be familiar with all PCa medications, including their potential side effects and administration methods. Medication use should be considered in the context of each patient's medical history and their disease management plan to effectively communicate patient information to the healthcare team, ultimately resulting in the delivery of improved medical care.
Patients with PCa are usually older; 60% are age 65 years or older at diagnosis (ACS, 2016), and the risk of developing PCa rapidly increases after age 50 (ACS, 2016). Due to advancing age and development of co-morbidities, many patients may be less ambulatory, have low muscle mass, and in some cases, require a wheelchair. As concurrent illness, medical history, and other personal details may be considered relevant factors for healthcare providers to be aware of when determining treatment options, it is important for nurses to document this information for their review (Chamie et al., 2012).
Systemic therapies for PCa have been available for many years, beginning with the elimination of testosterone production by the testes via bilateral orchiectomy in the late 1930s. However, the range of treatments has increased dramatically in recent years. Table 1 presents a summary of currently available therapeutic options and their mechanisms of action. At present, urologic and oncologic guideline committees have not issued recommendations for the timing of initiation or sequencing of therapies; this provides flexibility for the medical team to determine appropriate treatment options for patients. It is necessary for nurses to be aware of all available therapeutic options because they have an important role in preparing and/or administering treatments; educating patients and their families about potential therapies, many with diverse pharmacological mechanisms or delivery routes; and updating physicians on potential changes in treatments based on the information provided by patients. Correct mixing and administration of these drugs is also crucial for optimizing outcomes and preventing errors that may compromise the delivery of effective doses.
In addition to the administration of treatments and assessment of efficacy and adverse events (AEs), it is important that nurses monitor the overall impact of therapy on patients. Nurses spend significant time with patients, caregivers, and their families, and often develop strong personal relationships. This enables opportunities for education and improved understanding of treatment options that are more reflective of patients' lifestyles and personal preferences in addition to important clinical factors.
This article reviews current therapeutic approaches for PCa, including mechanisms of action, routes of administration, delivery technologies, and the potential role of clinic nurses in ensuring correct preparation and administration of drugs. The spectra of efficacy and adverse event profiles of these drugs are also reviewed, along with protocols for monitoring disease progression and treatment effectiveness, pharmacoeconomics, and quality of life considerations.
Urol Nurs. 2019;39(2):83-99. © 2019 Society of Urologic Nurses and Associates