Prostate cancer is a chronic disease that has caused death among men worldwide after lung cancer. Men with prostate cancer worldwide are estimated to be around 1276106 in 2018, causing death to about 358989 men in that year. The mortality rate and occurrence of prostate cancer globally interrelate with aging, with the average age at the diagnosis being sixty-six years. In the American nation, ethnicity and race are considered crucial factors in the incidence of prostate cancer, and African-Americans are perceived to be significantly diagnosed with the disease. The occurrence of prostate cancer among Black Americans is higher than among white Americans men who appear to be twice as affected as white men. The rationale for this disparity has been assumed to be genetic, environmental, and social differences.
Prostate cancer can be asymptomatic in the initial phases and frequently has a laid-back course and may need no or minimal medication. Yet, prostate cancer has been associated with difficulties in urination, intensified rate, and nocturia. The advanced phases of prostate cancer can lead to back pain and urinary retention. However, physical activity and diet are essential in disease progression and development. Dietary factors are primarily linked with ethnic differences in the occurrence frequency of the disease.
Diagnosis of prostate cancer is performed through screening, but it is associated with various controversies concerning the screening age and the best technique for screening the disease. However, there is still no evidence on how to prevent prostate cancer. Still, numerous ways can be used to reduce the incidence rate by increasing the consumption of fruits and vegetables and reducing high-fat foods. The paper discusses the significance and background of prostate cancer, its reporting, and surveillance and demonstrates the epidemiological analysis screening and guidelines of the disease. Also, it will integrate the evidence of prostate cancer and summarize the work.
Background and Significance
The prostate is a tiny walnut-shaped gland located in men’s pelvis. It is found next to the bladder and may be assessed by having a digital rectal assessment. Prostate cancer is a type of cancer that occurs in the prostate gland. Growths in the prostate gland may be malignant or benign cancer. Benign growths do not spread to other body parts and do not interfere with the body tissues around them, making them less life-threatening. On the contrary, malignant growths, referred to as prostate cancer, spread to other parts of the body, such as bone and lymph nodes and nearby tissues and organs such as the rectum and bladder, and may sometimes cause death (Sung et al., 2021). When the disease occurs, it begins in the prostate glands and eventually spreads to the seminal vesicles.
Prostate cancer does not show any symptoms and signs at its initial stages. When symptoms are evident, they may be similar to those of a BPH or swollen prostate. Besides, prostate cancer may result in other symptoms not associated with BPH. If individual experiences urinary problems, it is significant to seek medical attention. The symptoms of prostate cancer include loss of appetite, painful ejaculation, frequent urinating, pain in the upper thighs, hips, or lower back, weak urine flow or trouble urinating, burning or pain, and dull pain in the lower pelvic region (Sung et al., 2021). Other symptoms include bone pain and loss of weight. However, the cause of prostate cancer is unknown. Still, it is associated with certain risk factors such as ethnicity, smoking, family history, age, and world area, with a considerable incidence experienced in Northern Europe and North America.
The American cancer society performed a study in 2020 and indicated that 1 in every 9 men was detected with prostate cancer in the United States (Miller et al., 2020). The average age for detecting the disease is sixty-six years, and Black Americans are the most susceptible individuals to experience prostate cancer because of their ethnicity. The incidence data of prostate cancer Nationwide and in California is demonstrated below;
National statistics for prostate cancer incidence as of 2013-2017 indicate a total number of 964598 cases of prostate cancer, with an approximation of 191930 cases in 2020. The number of deaths associated with these cases includes 145728 and an approximation of 33330 deaths in 2020 (Siegel et al., 2020). However, based on ethnicity and race, the estimation of prostate cancer from 2013 to 2017 can be categorized as follows: the data presents that based on the case counts by ethnicity and race, the number of new cases among the whites was 95.8 and a death rate of 17.9. However, the estimated number of new cases for White men nationwide in 2020 based on case counts by ethnicity and race per 100 000 population was 102.3 and a death rate of 17.9 (Siegel et al., 2020). Amongst Black Americans, the new cases were 167.8 and a death rate of 37.9 from 2013 to 2017, recording a higher number than white Americans. The estimated new cases among Black Americans in 2020 were 175.2 new cases and a death rate of 37.9.
California statistics for prostate cancer incidence as of 2013-2017 indicate a total number of 93715 cases of prostate cancer, with an approximation of 20160 cases in the year 2020. The number of deaths associated with these cases includes 19.7/per 100,000 and an approximation of 3890 deaths in 2020 (Siegel et al., 2020). However, based on ethnicity and race, the estimation of prostate cancer from 2013 to 2017 can be categorized as follows in California: the data presented that based on the case counts by ethnicity and race per 100000 populations, the number of new cases among the whites was 89.7 and a death rate of 20.4. However, the estimated new cases for White men in California in 2020 were not applicable (NA). Amongst Black Americans, the new cases were 138.0 and a death rate of 41.3 from 2013 to 2017, recording a higher number than white Americans (Siegel et al., 2020). The estimated new cases among Black Americans in 2020 were not applicable.
The statistics demonstrate that African Americans, both at the state and national level, are most susceptible to having prostate cancer, and their death rates are higher than the other races in the United States. The data for California State does not demonstrate the approximated death rates or approximated new cases per age and race for 2020. The only data provided is based on the county level.
Surveillance and Reporting
Studies have revealed that men are choosing immediate treatment against prostate cancer. Thus, they are operating with their physicians to carefully detect prostate cancer through a process recognized as active surveillance. The active surveillance technique has been implemented to monitor prostate cancer, and the process starts with a prostate biopsy. The primary triggers for prostate biopsy include palpable lesions and elevated PSA levels on modern rectal assessment. The digital standard of care is to acquire a twelve-core biopsy under transrectal ultrasound (TRUS) management, where two samples are developed from the base, the middle, and the apex of the prostate in two areas. The physician then interprets the two samples by applying the Gleason scoring system, which encompasses the major secondary score and histologic Gleason grade scoring system. The secondary scores’ ratings range from 3+3 to 5+5, and the Gleason grade has a range of 3, 4, or 5. Men with a score of 3+4 or 3+3 tumors with a minimal percentage of grades four qualify for active surveillance.
In the American nation, National Cancer Institute (NCI) and CDC are the governmental agencies that maintain the cancer registry countrywide. The prostate cancer data registry may be applied to describe and explain its occurrence at national, state, and even local levels, to determine the cancer treatments, and examine the public awareness of the disease and its control measures which may help to minimize disparities. According to the agencies, it is a must to report the cases of prostate cancer countrywide and statewide (White et al., 2017). Most states in America use the NPCR to gather and report cancer information. Some states use the SEER, while others, such as California, use NPCR and SEER to collect and report information. The statistical data are obtained based on the treatment, diagnosis, and demographic information of an individual detected with the disease. The information is then published on NPCR and CDC websites for the researchers and the public to see.
Epidemiological Analysis
Prostate cancer epidemiology demonstrates that its causes are likely genetic and environmental factors. According to Bray et al. (2018), prostate cancer is among the primary causes of death in the world, and it is ranked number five and number one among men. The disease occurrence rate is more predominant among Black American men than among white Americans and other minority groups in the United States. Also, the death rate among Black Americans is twice that of White Americans. The average age for prostate cancer diagnosis is sixty-six years. The worldwide data statistics collected in 2018 indicated that there were 1276106 new prostate cancer cases worldwide, causing an estimated 358989 deaths to those diagnosed with the disease (Bray et al., 2018).
Prostate cancer does not show any symptoms and signs at its initial stages. When symptoms are evident, they may be similar to those of a BPH or swollen prostate. Besides, prostate cancer may result in other symptoms not associated with BPH. If individual experiences urinary problems, it is significant to seek medical attention. The symptoms of prostate cancer include loss of appetite, painful ejaculation, frequent urinating, pain in the upper thighs, hips, or lower back, weak urine flow or trouble urinating, burning or pain, and dull pain in the lower pelvic region (Rönningås et al., 2022).
The risk factors associated with prostate cancer include ethnicity, family history, age, activity status, diet, and world area, with massive incidences experienced in Northern Europe and North America. The risk of prostate cancer is associated with old age, particularly for men 50 years and above (American Cancer Society, 2018). African Americans in the American nation are the most susceptible peoples to be diagnosed with prostate cancer than other races. Family history can also be a risk factor, especially for a family where the disease runs within the family members, known as familial prostate cancer. Dietary requirements are associated with the risk of having prostate cancer, especially among those with fewer intakes of fruits and vegetables.
Additionally, understanding the relationship between environmental and genetic factors may be essential for recognizing epidemiology and examining risk factors. Genetic factors seem as the main cause of the high rate of prostate cancer among Black Americans compared to other races.
Screening and Guidelines
Prostate cancer screening implies observing whether an individual has cancer before any signs are identified. Prostate cancer screening aims to determine whether there are cancers that can lead to high risks of spreading if medical attention is not taken. There are no standard tests for screening for prostate cancer, but two tests are mainly applied. Digital Rectal examination (DRE) and Prostate Specific Antigen (PSA) are the most commonly applied screening test (Carroll, 2018). DRE involves a physician inserting a gloved, oiled finger into a male’s rectum to determine whether there is any abnormality with the prostate. However, the DRE screening test is not recommendable since there is inadequate evidence of its significance.
On the other hand, PSA involves a blood examination to determine the PSA level in the blood. The prostate usually makes a substance known as PSA. The PSA levels in the blood may be higher in males with the disease. This means that the higher the PSA levels in the blood, the more likely a person may have the condition. However, it is the work of the physician to determine the actual cause of PSA levels increase because it is affected by other factors such as race, age, medical processes, and medications (Vane, 2019).
There are no national guidelines on when the PSA or DRE are required. The purpose of active surveillance is to offer treatment for prostate cancer if detected. When there is any prostate cancer development detection, the disease treatment may be implemented with active surveillance and intensive care. Some factors such as economic effect, morbidity caused by recurrent biopsy sampling, and biopsy sampling mistakes may impact the results of active surveillance (Vane, 2019). Besides, patients’ and healthcare providers’ anxiety may be experienced if medications are held back.
It is recommendable to perform prostate cancer screening at the age of fifty years because men at this age are the most susceptible to the disease. However, the American Cancer Society (2016) indicated that individuals at high risk of prostate cancer should have a screening test at age forty to forty-five years old. Also, PSA tests should be done every two years for those with over 2.5ng/ml and annually for those with less than 2.5ng/ml. It is also expected that individualized screening with PSA testing should be performed at fifty-five to sixty-nine years old. For men above seventy years, it is not recommendable.
Brown et al. (2018) conducted a study to determine the MRI among men with prostate cancer. The study involved 576 men who underwent tests such as transrectal ultrasound (TRUS). The TRUS specificity was 96%, with a sensitivity of 48%. A negative predictive value (NPV) of 74% and a positive predictive value of 90% were observed.
Screening of prostate cancer among men may be impacted by the cost needed. Unemployed and low socioeconomic class men may find it challenging to go for screening because of a lack of finances to incur the required expenses to have the screening (Vane, 2019). However, using mpMRI for the first diagnosis of prostate cancer may minimize insignificant biopsies and costs associated with it.
Plan: Integrating Evidence
Detecting and managing prostate cancer at its early stages is essential in ensuring the patient’s safety. Advanced practice registered nurses (APRNs) require being aware of the initial symptoms and signs of the disease by examining them for timely treatment as primary intervention measures (Cadet et al., 2019). APRN examination must observe any PSA abnormalities, age, genetic history, family history, and ethnicity or race.
APRNs need to consider the potential diagnosis with the same indications and signs as prostate cancer, such as BPH, during a secondary intervention. This means that advanced registered nurses require assessing symptoms associated with BPH, such as nocturia, frequency of urination, and painful urination (Cadet et al., 2019). This will help them to detect any chances of prostate cancer among men. Also, APRNs should develop a strategy of caring that involves informed consent from the patients to assist in the decision-making process. Informed consent about the diagnosis process and treatment plan with the patient and the team members can play a pivotal role in shared-decision making. Thus, diagnostic tests like DRE and PSA can be performed, and the Gleason score may be used to measure the prostate cancer grade.
Additionally, the nurses may address the racial prostate cancer disparities by offering training and education programs to the most affected population, such as Black Americans. This will help implement and develop evidence-based practices to minimize the morbidity and mortality rate.
Conclusion
Prostate cancer is a chronic disease that has caused death among men worldwide after lung cancer. The symptoms of prostate cancer include loss of appetite, painful ejaculation, frequent urinating, pain in the upper thighs, hips, or lower back, weak urine flow or trouble urinating, burning or pain, and dull pain in the lower pelvic region. The risk factors associated with prostate cancer include ethnicity, family history, age, activity status, dietary. However, prostate cancer screening implies observing whether an individual has cancer before any signs are identified. Men should be advised to undergo clinical screening such as DRE and PSA for cancer screening. Besides, APRNs can play a pivotal role in enhancing various interventions, such as addressing racial cancer disparities to help those populations that are most susceptible.
References
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