NURSING MANAGEMENT DURING TREATMENT
Patient education is at the heart of caring for those undergoing treatment for prostate cancer. Nurses are in a unique position to educate men with prostate cancer and their families, screen for and identify adverse effects of treatment, and provide support throughout the treatment process. Nurses are also central to care coordination within the multidisciplinary team and the provision of both physical care and emotional support for men and their partners along their journey through the healthcare system.
Prostate Needle Biopsy Nursing Care
The diagnosis of prostate cancer can only be confirmed by histological examination of tissue removed surgically. Fine needle aspiration is a quick, generally painless method done either transrectally or transperineally to obtain prostate cells for cytological examination and to determine the stage of disease that may be present. The procedure typically causes a very brief uncomfortable sensation each time the spring-loaded needle takes a sample. Nurses are involved in the diagnostic process when caring for a patient who has undergone prostate biopsy.

Prostate needle biopsy.
(Source: Blausen Medical, 2014.)
The nurse’s role in the process of obtaining a needle biopsy involves:
- Managing procedure setup
- Prepping the patient
- Assisting during the procedure
- Providing emotional support
- Providing pain control measures
The nurse provides discharge instructions to the patient and/or family/caregivers that include:
- Completing any course of prescribed antibiotics
- Avoiding strenuous exercise such as jogging, heavy lifting, golfing, and bike riding for at least 7 days
- Drinking at least six glasses of water a day for the first few days
- Waiting at least 7 days to resume sexual activity
- Notifying the physician promptly in case of:
- Fever of 100 °F or higher, shaking, or chills
- Heavy rectal bleeding or clots, or bleeding that continues longer than 2 to 3 days
- Pure blood stools
- Increased urinary pain, frequency, or burning
- Inability to urinate within 8 hours
- Blood in urine for longer than 2 to 3 days
Prostatectomy Nursing Care
Preoperative nursing care for patients undergoing prostatectomy includes:
- Reducing anxiety by assessing the patient’s understanding of the diagnosis, planned procedure, and expected postoperative outcomes, and addressing any other concerns and questions
- Educating the patient regarding anatomy
- Relieving discomfort with bedrest and analgesics
- If hospitalized, preoperative monitoring of voiding patterns, assessing for bladder distension, and performing catheterization if prescribed
- Preparing the patient for surgery, which may include:
- Prepping the patient
- Administering an enema
- Application of antiembolic stockings
- Administering prophylactic antibiotics
Postoperative nursing care involves:
- Maintaining fluid balance and documenting intake and output, including fluid used to irrigate the catheter
- Assessing for electrolyte imbalance
- Monitoring vital signs
- Observing for signs of confusion or respiratory distress
- Relieving pain by administered analgesics as ordered and evaluating effectiveness
- Increasing mobility beginning with early ambulation
- Assessing for bladder spasms and administering prescribed smooth muscle relaxant medications and/or warm sitz baths
- Monitoring wound drainage and providing wound care as needed
- Monitoring drainage tubing and irrigating the system as prescribed
- Providing aseptic catheter and tubing care
- Preventing constipation
- Providing reassurance and explanations of care to the patient and significant others
(Hinkle & Cheever, 2018)
Ideally, discharge planning begins when the patient is admitted. Discharge education is provided throughout the patient’s hospital stay, and the patient’s understanding is confirmed on the day of discharge. Nurses play a major role in the discharge process by coordinating care and providing timely communication with families and community providers.
Instructions for the patient who is being discharged to home following a prostatectomy includes:
- Caring for the wound
- Urinary catheter care
- Dealing with bladder spasms
- Need for and training in performing Kegel’s exercises
- When to call the physician
- Other self-care, such as:
- Not driving for the first 3 weeks after discharge
- If long car trip is necessary, stopping at least every 2 hours
- Not lifting anything heavier than a 1-gallon milk jug (8.6 pounds) for the first 6 weeks
- Drinking at least 8 glasses of water daily
- Eating lots of fruits and vegetables
- Taking stool softeners to prevent constipation
- Not straining during bowel movements
- Not taking aspirin, ibuprofen, naproxen, or other similar medication for 2 weeks post surgery, as they may restrict the body’s ability to clot blood
Upon discharge, community-based or transitional care may be indicated, depending on the patient’s health status and presence of family or other caregivers. Home visits by the nurse involve assessment of:
- Cardiovascular status
- Respiratory status
- Fluid and nutritional status
- Patency of urinary drainage system
- Wound status
- Catheter care and wound care
During the home visit, the nurse also reinforces previous education, assesses the patient and family’s ability to manage required care, encourages ambulation and perineal muscle exercises as prescribed, answers questions, and provides emotional support (Hinkle & Cheever, 2018).
Radiation Therapy Nursing Care
For patients receiving radiation therapy, the nurse:
- Advises the patient to report a fever over 100 °F and burning or difficulty with urination, excessive bleeding or clots in the urine, or rectal bleeding
- Monitors for adverse skin changes and provides skin care for those receiving external beam radiation therapy, stressing the importance of maintaining skin integrity, including:
- Cleansing the skin with mild soap and water
- Promotion of comfort and pain reduction
- Prevention of additional trauma
- Prevention and management of infection
- Promotion of a moist wound-healing environment
- Avoiding application of lotions, perfumes, or powders to the treatment area
- Protecting the skin in the treatment area from sunlight and extreme cold
- Wearing soft, nonrestrictive cotton clothing directly over the treatment area
Patients who are receiving low-dose-rate brachytherapy with temporary implants must have limited exposure to others. If hospitalized, the patient should be placed in a private room, and visits with others should be limited to 10 to 30 minutes. Patients should be monitored for burning sensations, excessive perspiration, chills and fever, nausea and vomiting, or diarrhea.
For men who are discharged following permanent seed implantation, patient and family education includes:
- Avoid lifting anything heavy for a few days after being discharged.
- Drink plenty of fluids for 2 days following the procedure.
- Expect some blood in the urine for 1 to 2 days following surgery.
- Expect some burning during urination or ejaculation for 1 to 2 days after surgery.
- Observe for lost seeds in linens, and follow instructions about straining urine for lost seeds.
- Do not pick up seeds using fingers; use tweezers or tongs to pick them up and place them in a container of water or wrap them tightly in aluminum foil, or into a special packet, if supplied.
- If any seed is found, return it to a healthcare facility following the radiation safety instructions provided at discharge.
- Avoid close contact with pregnant women and infants for up to 2 months.
- Use a condom during sexual intercourse for 2 weeks after implantation to catch any seeds that pass through the urethra.
(Hinkle & Cheever, 2018)
Patients are also informed that the seeds may set off airport security systems, and they should ask their providers for a card or letter that states one has the seeds in their body in order to show to security personnel.
CASE
George is a 68-year-old man who has recently been diagnosed with low-risk adenocarcinoma of the prostate. The urologist referred George and his wife to Margaret, the urology nurse, who provided them with detailed information about the treatment options that would be appropriate for him, including conservative management, and a discussion of the risks and benefits of each.
George and his wife went home to discuss the options and to make a decision about which one would be the best. The next day George contacted Margaret to inform her that they had decided to proceed with low-dose-rate permanent seed brachytherapy.
Before beginning brachytherapy, George and his wife met with the radiation oncologist, who requested an MRI in order to adapt the dose of radiation to George’s anatomy, accounting for the position of organs at risk.
Under general anesthesia, seed implantation was performed with transrectal ultrasound guidance using 31 needles containing stranded seeds and two needles containing single loose seeds. Following recovery from anesthesia, George was discharged the same day. George returned the following day for a CT of the pelvis, which located all of the seeds within the vicinity of the prostate.
After returning home, George began to experience burning on urination, which he had been told was an expected side effect. Along with the burning he also experienced urinary frequency, both of which gradually subsided. A week later, however, he again began experiencing frequency and pain that he described as “razor-sharp.” The frequency and pain began to seriously disrupt his sleep.
George called the urologist’s office and talked with Margaret, who told him to come in for a urinalysis and culture, both of which were negative for infection. The urologist gave him prescriptions for Pyridium (phenazopyridine), a local analgesic that has a specific effect in the urinary tract, and Flomax (tamsulosin) 0.4 mg twice a day. George obtained no relief from the use of Pyridium or Flomax, however, and after two more weeks with pain and not being able to sleep longer than 45 minutes at a stretch, his urologist performed a cystoscopy that indicated a stricture at the urethral/bladder sphincter. The urologist stretched the stricture and prescribed ibuprofen 800 mg per day.
When George continued to have the same severe burning pain and frequency following this procedure, the urologist placed a Foley catheter into the bladder, where it remained for 3 weeks to allow for healing. During this time, the pain subsided, and George was sleeping well.
Following removal of the catheter, Margaret taught George how to perform clean catheter intermittent self-dilation to prevent the stricture from returning. He was told that the urologist would determine when this was no longer necessary to perform. He was given an appointment for a follow-up visit and instructed to call if he had any difficulties or return of symptoms. On his return to the clinic four weeks later, George was urinating without pain and sleeping through the night.
Cryotherapy Nursing Care
Patients receiving cryotherapy may have the procedure done under general anesthesia and will require routine recovery monitoring, including vital signs and pain management.
When stabilized, ambulation should be initiated, and when the patient is ready for discharge, education is provided to the patient and significant others, including:
- Caring for the needle insertion sites
- Managing and caring for the urinary catheter and tubing and collection device (which may remain in place for about two weeks to allow for healing)
- Complete antibiotic regimen for prevention of infection as prescribed
- Possible bruising and soreness for several days at insertion sites
- Possible blood in the urine for several days
- Problems emptying bladder and bowels (which usually resolves over time)
- Bathing instructions per provider’s protocol
- Probability of sexual dysfunction, including impotence following treatment
- Importance of notifying the healthcare provider in the event of:
- Fever and/or chills
- Redness, swelling, bleeding, or other drainage from any needle insertion sites
- Increase in pain around the insertion sites
Prior to discharge the patient is also given an appointment for follow-up (Hinkle & Cheever, 2018; Mayo Clinic, 2020a).
High-Intensity Focused Ultrasound Nursing Care
Patients undergoing high-intensity focused ultrasound will receive either epidural or general anesthesia and require monitoring during recovery, including assessing for perineal pain.
The patient will be discharged home with an indwelling urethral or suprapubic catheter that will remain in place until swelling subsides. The nurse provides the patient with discharge instructions, including:
- Caring for the catheter, tubing, and collection device
- Completing antibiotics as prescribed and reporting signs and symptoms of urinary tract infection or signs and symptoms of infection in the testicles
An appointment should be made for 7 days following discharge for removal of the catheter and a trial of voiding. For patients with urinary retention or insufficient voiding following catheter removal, clean intermittent catheterization may be indicated, which will require education and training (Bandukwala, 2020; Columbia University, 2020).
Hormone Therapy Nursing Care
Nursing care for those undergoing androgen deprivation therapy (ADT) involves helping patients address the adverse effects caused by hypogonadism. Nurses provide education about the options available for management of these effects as well as the support and care for options chosen.
Patients who experience vasomotor flushing (hot flashes) can be advised to:
- Wear cotton clothes
- Take warm baths or showers instead of hot
- Exercise regularly
- Avoid eating spicy foods
- Avoid alcohol and caffeine
- Avoid nicotine
- Avoid eating large meals
- Use a fan
ADT decreases bone density, which can result in osteoporosis and fractures, and it has been recommended that patients include supplementation with calcium and vitamin D. Patients are also encouraged to exercise in order to reduce loss of muscle mass, weight gain, fatigue, and metabolic syndrome (Hinkle & Cheever, 2018).
Gynecomastia is common in those undergoing ADT, and the patient is educated about options for prevention. Pretreatment with radiation or taking tamoxifen along with antiandrogen therapy are two options for preventing breast tissue growth. Treating the breasts with radiation before antiandrogen treatment can prevent gynecomastia in approximately 30% of men. Gynecomastia that has already developed can be treated with higher radiation doses and may improve mastodynia. Additional nursing care and management is the same as for patients receiving radiation therapy (discussed earlier in this course) and includes education about the importance of taking tamoxifen as prescribed for the duration of antiandrogen therapy (Braunstain & Anawalt, 2019).
Orchiectomy Nursing Care
Patients who have undergone orchiectomy may be discharged the same day or may be hospitalized overnight. They will have received general anesthesia, requiring routine postoperative recovery nursing care and monitoring, including vital signs, fluid administration, and pain management. Ambulation is encouraged following recovery from anesthesia.
At discharge, the nurse provides discharge instructions that include:
- Drink 6 to 8 glasses of fluids each day, if not contraindicated.
- Take pain medications as prescribed.
- Gradually return to a normal diet.
- Avoid straining to have a bowel movement.
- Eat a diet with foods high in fiber, and use laxatives, stool softeners, or enema only as directed by the provider.
- Wait to shower until the day after surgery; do not swim or use a bathtub or hot tub until after a follow-up appointment.
- Keep the incision clean and dry and covered in gauze for the first few days; wash the incision gently with mild soap and warm water when necessary.
- Wear an athletic supporter (jockstrap) for the first few days, and then wear supportive briefs rather than boxer shorts.
- Complete the antibiotic regimen as prescribed.
- Apply ice to the scrotum or around the incision to control bruising or swelling for 10 to 20 minutes every 1 to 2 hours while awake for 2 or 3 days post surgery.
- Avoid strenuous activities and lifting 10 or more pounds for 2 to 3 weeks.
- Return gradually to normal activities.
- Do not drive until free of pain and no longer taking narcotic pain medicines, which may take from 2 to 4 weeks.
- Avoid sexual activity for 2 to 4 weeks.
- Contact the provider if any of these occur:
- Pus in the wound or purulent drainage or bleeding from the incision
- Bad smell coming from the wound
- Redness and swelling that does not improve
- Pain that is not controlled or does not improve
- Stitches that come apart
- Fever of 100 °F or higher
Following orchiectomy, a man may choose to have testicular prostheses implants, either solid silicone or saline-filled. The benefits of implants include:
- A similar appearance to that prior to surgery
- Improved self-image
- Relatively easy to remove if there are any problems
- Can be inserted immediately following surgery
Factors to consider following implantation include:
- Infection
- Shifting of the implant
- Possible hardening of the capsule around the implant
(UCLA Health, 2021)
Immunotherapy Nursing Care
Immunotherapy may be administered in a provider’s office, clinic, or hospital outpatient department. Treatments may be given every day, week, or month. Some types are given in cycles of treatment followed by a period of rest. The nurse’s role when caring for a person receiving immunotherapy includes:
- Monitoring laboratory indicators for acute alterations in renal, cardiac, liver, or gastrointestinal functioning
- Evaluating the response to therapy by conducting a thorough evaluation of the patient’s symptoms
- Assessing the patient’s coping behaviors and teaching new strategies as needed
- Managing fatigue and depression
- Encouraging self-care and participation in decision-making
- Providing close supervision for patients with altered mental functioning
- Caring for a central line, if indicated, and assessing for signs of infection
- Monitoring peripheral intravenous site for extravasation
- During administration of sipuleucel-T, closely monitoring patients with cardiac or pulmonary conditions
The nurse also provides patient and family education, which includes:
- Ways to minimize flulike symptoms, including fever
- Managing back and joint pain
- Managing fatigue
- Seeking assistance for serious problems not managed by usual means, such as dehydration from diarrhea
- Notifying the provider if any of the following occur:
- Light-headedness
- Racing or irregular heartbeats
- Signs of infection
- Signs of stroke
- Signs of blood clot deep in the body or lungs
Education for patients who are receiving pembrolizumab include:
- Using condoms during treatment and for at least 4 months following treatment to avoid conceiving a child
- Taking no other medications, including over-the-counter and herbal preparations, without discussing first with one’s healthcare provider
- Notifying the healthcare provider immediately, day or night, if any of the following occur:
- Fever of 100.4 °F or higher
- Signs of reaction to the drug
- New or worsening cough, chest pain, or shortness of breath
- Diarrhea or severe abdominal pain, especially right-side
- Blood in stools or dark stools
- Jaundice of the eyes
- Persistent or unusual headache, extreme weakness, dizziness, fainting, or vision changes
Chemotherapy Nursing Care
The nurse recognizes that chemotherapy agents affect both normal and malignant cells; therefore, effects are often widespread, impacting many body systems. Laboratory and physical assessments of metabolic indices and the dermatologic, hematologic, hepatic, renal, cardiovascular, neurologic, and pulmonary systems are therefore critical in evaluating the body’s response to chemotherapy. These assessments are performed prior to, during, and after a course of chemotherapy to determine optimal treatment options, evaluate the patient’s response, and monitor toxicity.
Nurses also have the responsibilities to:
- Administer chemotherapy safely, including taking measures for the prevention of extravasation.
- Assess fluid and electrolyte status and identify creative ways to encourage adequate fluid and dietary intake. Risk factors for nutritional and fluid and electrolyte disturbance may include anorexia, nausea, vomiting, alteration in taste, mucositis, and diarrhea.
- Assess for pain. Chemotherapy-induced peripheral neuropathy (CIPN) may result from damage caused to nerves by certain types of chemotherapy agents. Associated pain can then result in a patient stopping treatment if it is not well managed. Management of CIPN may include steroids, lidocaine patches, capsaicin cream, antidepressants, anticonvulsants, or opioids/narcotics.
- Assess for cancer treatment–related cognitive impairment, mental clouding, or fogginess (“chemo brain”). Chemotherapy can cause both short- and long-term cognitive problems, most noticeable during and after chemotherapy, especially with high doses. Encouraging regular aerobic exercise is helpful for alleviating the symptoms, as is using memory aids such as calendars or note taking. Certain medications may also be recommended and prescribed.
- Assess for emotional and spiritual issues. Patients who are in distress can be helped by different kinds of emotional, social, and spiritual support such as relaxation training, mental health counseling, spiritual counseling, and support groups.
- Assess for signs and symptoms of infection. Lowered white blood cell count increases the risk for infection.
- Educate the patient to use a condom when having intercourse for the first 48 hours after treatment to protect the partner. Depending on the type of chemotherapy agent, it may also be recommended that the patient avoid sexual activity until white blood cell counts rise to safe levels.
- Teach safe handling of chemotherapy drugs by family caregivers. Educate patients and caregivers about oral chemotherapy safety in the home setting, stressing health risks for caregivers with unintended exposure to oral chemotherapy medications and the critical importance of strictly following administration instructions.
(ACS, 2021f; Becze, 2020; Giridhar, 2021)
Radiopharmaceutical Nursing Care
Nursing care for the patient receiving radium-223 (Xofigo) therapy centers on education. Patients are provided the following information:
- Take radiation protection precautions because there are potential risks to others from radiation or contamination from spills of body fluids such as urine, feces, or vomit.
- Practice good hygiene; excretion is predominantly through the feces, and smaller amounts are excreted through the urine.
- Remain compliant with lab appointments one week prior to treatment for hematologic evaluations.
- Use a condom if sexually active; female partners of reproductive age should use a highly effective birth control method during and 6 months following completion of treatment.
- Stay well-hydrated and report any signs of dehydration, hypovolemia, urinary retention, or renal failure to the physician.
(Stancel & Searfoss, 2019)