PREFERRED PRACTICE PATTERNS3
A 73-year-old male presents with intermittent urinary leakage that is worse with activity. He is retired but stays active in his home doing repairs and renovations. He uses a Kotex sized protective pad which he changes once a day. He gets up an average of 2×/night for urination and does not need pad protection with sleep. He complains that Viagra does not help as much with his erection as it did when he first started taking it. He avoids acidic drinks and drinks water throughout the day. He is pending C-pap for his recently diagnosed sleep apnea. He denies any signs or symptoms of infection and has no bowel issues. PMH includes prostate cancer, external beam radiation (XRT) to prostate, erectile dysfunction (uses penile pump and Viagra), urinary leakage s/p XRT, O/A, dyslipidemia, pneumonia, sleep apnea.
Flow cytometry with WNL for fluid retention. Sensation/neurological: patient is able to sense leakage (can have pudendal nerve damage secondary to XRT). MMT: is able to maintain pelvic floor contraction (verbal cue—to engage muscles as if attempting to stop urine flow or draw the testicles inward). First trial: 25 seconds, second: 38 seconds, third: 55 seconds. Quick flicks (engaging and releasing using aforementioned cueing) in 10 seconds. First trial: 3×, second: 3×, third: 5×.
Cancer begins in prostate gland
Wraps around the urethra
98% of prostatic tumors are adenocarcinomas1
Aggressive and slow-growing forms
Prostate-specific antigen (PSA) screens
Gleason grade to assess risk of cancer spreading
The Gleason scale assigns cancer cells a score from 1 to 10, by combining the two most common patterns of cells to give a total score (i.e., 3 + 4 = grade 7). These scores are broken down into three main levels.
Gleason score of 4 or less = Low-grade (well differentiated)
Gleason score between 4 and 7 = Intermediate grade (moderately differentiated)
Gleason score between 8 and 10 = High-grade (poorly differentiated)
ABCD stages of prostate cancer
Stage A: Cancer found when not suspected or due to a high PSA level
Stage B: Cancer found due to abnormal digital rectal examination and is held in the prostate
Stage C: Cancer that has spread to the tissues outside of the prostate
Stage D: Cancer that has spread to the lymph nodes or bone
Organization of the prostate gland. (From Mescher AL. Junqueira’s Basic Histology: Text and Atlas. 12th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All ...
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