St.
Michael’s College
Iligan City
COLLEGE OF NURSING
A CASE STUDY ON A 68 YEAR OLD MAN WITH PROSTATE CANCER - STAGE 4
Partial Fulfillment of the Final Requirements in NCM 109.1 2A3
MEMBERS
Clemena, Brent G.
Diacamos, Monielle Jette V.
Dimatinday, Johaira L.
Gimena, Kitchie Juliana A.
Layno, Mickylah Joy L.
Libot, Kathleen Jay F.
Medina, Juana Leazly M.
Minalang, Rayenesa M.
Montebon, Angel Mae G.
Orong, Mikyla Mae P.
Orquillas, Liv Arwen C.
Pangandaman, Sittie Ayessha A.
Sangkula, Chrystina Hershey Meg A.
APRIL 2025
Table of Contents
I. Objectives…………………………………………………………………...1
II. Introduction………………………………………………………………..2
III. Demographic Data………………………………………………...….….3
IV. Physical Assessment and Vital Signs……………………………….….4
V. Anatomy and Physiology……………………….………………………10
VI. Pathophysiology………………..…………………….…………………12
VII. Medical Management………………………………………...………..13
VIII. Diagnostic and Laboratories…………………………………..……..15
IX. Nursing Care Plan…………………………………………...…….……18
X. Drug Study……………………………………………………………….22
XI. Discharge Plan…………………………………………………………..32
XII. Prognosis……………………………………….……………………… 34
OBJECTIVES
General Objectives:
After our case presentation, this case study aims to expand our knowledge as student nurses to
understand the assessment, pathophysiology, and management, as well as promoting a deeper
understanding of the impact on patient outcomes and the importance of early detection and
intervention. This training allows us to appreciate the importance of teamwork and unity to
achieve a good patient outcome.
Specific Objectives:
At the end of the case presentation, the prosecutors aim to:
1. Define Prostate Cancer stage IV;
2. Review the risk factors including the epidemiology of Prostate Cancer stage IV;
3. Analyze signs and symptoms in patient with Prostate Cancer stage IV;
4. Discuss the clinical presentation and staging of Prostate Cancer stage IV;
5. Discuss the nursing interventions in managing symptoms and providing support for
patients with Prostate Cancer stage IV;
6. Emphasizing the importance of patient education and counselling in Prostate Cancer
care, including lifestyle modifications and coping strategies.
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INTRODUCTION
Stage IV Prostate Cancer or also known as Metastatic Prostate Cancer is a cancer that
starts in prostate and spreads to other parts of the body, and the most advanced stage, meaning
cancer cells have spread beyond the prostate and into other areas of the body. Prostate is a small
gland that helps make the fluid part of semen. It is found just below the bladder. The prostate is
a part of the male reproductive system. There are two sub- stages of Stage IV Prostate Cancer to
help guide the treatment option: Stage 4A is cancer cells that have been found nearly lymph
nodes and may have spread into local tissue. Stage 4B is a cancer that has spread to areas farther
away from the prostate, such as distant lymph nodes or bones. This type of cancer doesn’t
always cause symptoms, but as the cancer grows and becomes more advanced. Signs and
symptoms can include feeling very tired, having to urinate more often or feeling pain when
urinating, losing weight without trying, nausea and vomiting, and pain, which might be felt in
the back, hips, pelvic area or in a bone. The pain tends to get worse over time. Shortness of
breath, rapid heartbeat, dizziness, anemia. These signs may also be caused by other medical
conditions besides prostate cancer.
Prostate cancer is the second most common cancer in men worldwide (Trewartha &
Carter, 2013). Prognosis significantly varies depending on the stage at diagnosis. For early-stage
prostate cancer (stage I/III), outcomes are favorable, with over 90% of patients experiencing
progression-free survival at 5 years. However, for patients diagnosed at stage III and IV, the
likelihood of a cure is low. It is often not clear what causes metastatic prostate cancer, but
healthcare professionals found out the cause of this cancer and this includes older age (common
after age 50), race and ethnicity, family history of prostate cancer obesity, family history of DNA
changes, and smoking tobacco. For more advanced cancer, treatment involves reducing male
hormones (androgens), either through surgery or medicine. This can control the cancer for a
while. But over time, the cancer usually becomes resistant to this treatment. Meaning it starts
growing again even when male hormones are blocked. This is called castration-resistant prostate
cancer, and its harder to treat. There are many treatments for metastatic prostate cancer.
Treatments aren’t likely to cure the cancer, but they can slow its growth.
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DEMOGRAPHIC DATA
Patient Initial N.M.M
Age 68 years old
Sex Male
Religion Roman Catholic
Father’s Name M.O
Home Address Purok Santa Teresita, Tubod, Iligan City
Weight 40 kg
Height 142 cm
Insurance PhilHealth
Date of Admission March 4, 2025
Admitting Limsiaco, Darryl Y. MD
Physician
Attending Lomansoc, Jade Kenneth G. MD
Physician
History of Present Few days, PTA, patient experienced hematuria and a noticeable
Illness decreased in urinary output. Additionally, patient reported generalized
weakness and anorexia. Due to worsening symptoms and concern for
potential underlying causes, the patient was brought to the hospital for
further evaluation and management.
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Chief Complaints Decreased Urine Output and Hematuria
Admitting Obstructive Uropathy Secondary to Prostate Adenocarcinoma
Diagnosis
Gross Hematuria Secondary to Bleeding Prostate Adenoma Secondary to
Final Diagnosis: Prostate Cancer Stage IV.
ANATOMY AND PHYSIOLOGY
The male reproductive system includes the external genitals (the penis, testes and the
scrotum) and internal parts, including the prostate gland, vas deferens and urethra. The prostate
is a small gland that’s part of the male reproductive system it is a chestnut-shaped reproductive
organ, located directly beneath the urinary bladder in the male, which adds secretions to the
sperm during the ejaculation of semen. The gland surrounds the urethra, the duct that serves for
the passage of both urine and semen. Rounded at the top, the gland narrows to form a blunt
point at the bottom, or apex. The two ejaculatory ducts, which carry sperm and the fluid secreted
by the seminal vesicles, converge and narrow in the centre of the prostate and unite with the
urethra. The urethra then continues to the lower segment of the prostate and exits near the apex.
Figure 1. Prostate Anatomy Figure 2. Male Reproductive System
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The prostate gland is a conglomerate of tubular or saclike glands that secrete fluids into
the urethra and ejaculatory ducts. The secretory ducts and glands are lined with a moist, folded
mucous membrane. The folds permit the tissue to expand while storing fluids. Beneath this layer
is connective tissue composed of a thick network of elastic fibres and blood vessels. The tissue
that surrounds the secretory ducts and glands is known as interstitial tissue; this contains
muscle, elastic fibres, and collagen fibres that give the prostate gland support and firmness. The
capsule enclosing the prostate is also of interstitial tissue.
In prostate cancer, the growing tumor can press against or invade the urethra (the tube
that carries urine from the bladder out of the body) or the surrounding tissues of the urinary
tract. This obstruction can partially or completely block the normal flow of urine, leading to
decreased urine output. Additionally, prostate cancer may cause inflammation or swelling that
further narrows the urinary passage.
Figure 3. Affected Prostate
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VITAL SIGNS
March 10, 2025
Time Temperature Pulse Rate Respiratory Oxygen Blood
Rate Saturation Pressure
4:00 PM 36.9 61 17 99% 120/70
8:00PM 37. 7 65 20 96% 130/70
March 11, 2025
Time Temperature Pulse Rate Respiratory Oxygen Blood
Rate Saturation Pressure
4:00 PM 36.2 14 99 120/60
DISCHARGED AT 5:30 PM
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DIAGNOSTIC TESTS AND LABORATORIES
LABORATORY RESULTS
HEMATOLOGY
Complete Indication Reference Results Interpretation
Blood Count
Hemoglobin This test can help 138 - 172 100 The patient’s
detect infections, haemoglobin level is
Hematocrit such as when there is 0.41 – 0.50 0.30 100g / L and
an elevated WBC haematocrit is 0.30
RBC Count count. CBC helps 4.00 – 5.00 x 10^12 3.37 L/L, both indicating
diagnose anemia or anemia. The red
WBC Count other blood disorders 4.50 – 10.00 24.50 blood cell (RBC)
by identifying low count is low at 3.37
Lymphocytes haemoglobin or 1.0 – 4.8 x 10 9 0.08 x 10^12/L, further
haematocrit levels. It supporting the
Eosinophils is useful in 0.00 – 0.05 0.01 presence of anemia.
monitoring The white blood cell
Platelet Chronic 150.00 – 400.00 180 (WBC) count is
Count conditions like significantly
leukemia and elevated at 24.50 x
autoimmune 10^9/L, which may
diseases. suggest an ongoing
Additionally, infection or
CBC is performed inflammation. The
to assess bone lymphocyte count is
marrow function and low at 0.08 and
to evaluate bleeding eosinophils are also
or clotting disorders. decreased at 0.01,
It is also commonly which may reflect
required before immune
surgeries or specific suppression or a
medical treatments stress response.
such as Meanwhile, the
chemotherapy. platelet count is
within normal range
at 180 x 10^9/L,
indicating adequate
clotting ability.
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HBA1C: 5.2%
HBSAG: NON – REACTIVE
CT SCAN: Upon reviewing the chart, the patient’s prostate is enlarged and lobulated with
heterogens attenuation density.
ROUTINE URINALYSIS
Physical:
Color: dark yellow with red
discoloration Transparency: turbid
pH: 6.0
Specific Gravity: 1.025
Chemical:
Albumin +1
Glucose Negative
BLOOD CHRMISTRY
Test Reference
Creatinine: 120 71.00 – 115.00 umol / L
Microscopic
Cast Result
Hyaline Present
Coarse Granular Present
Fine Granular Present
Cells Results
RBC Abundant
Pus Cells (WBC) Abundant
Bacteria Abundant
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DISCHARGE PLAN
MEDICATION Instruct the patient on the proper use of medications,
including dosage, frequency, and potential side effects.
1. Cefixime – 1 tab, BID
2. Trammadol + Paracetamol – 1 tab, TID
3. Biculatamide – 1 tab, TID
4. Lactulose, 30mL BID at bed time
5. Atorvastatin – 2 tabs, QD, at bed time
6. Trimetazidine – 1 tab, BID
ENVIRONMENT, EXERCISE, Educate the patient and caregivers on infection control
AND SLEEP measures and proper hygiene practices to minimize
the risk of complications.
Encourage patient to collaborate with a physical
therapist to develop an individualized exercise plan
focusing on maintaining mobility, strength, and
overall physical well- being.
Encourage the patient to maintain a regular sleep
schedule and practice good sleep hygiene to support
overall well- being and recovery.
TREATMENT AND THERAPY Provide clear instructions for all prescribed
medications, including dosage, frequency, and
potential side effects.
HEALTH TEACHING AND Educate the patient and caregivers on the importance
HYGIENE of maintaining proper hygiene to prevent infections,
especially related to urinary and wound care.
Provide guidance on dietary considerations to
support overall health and minimize symptoms
related to prostate cancer and its treatments.
OBSERVABLE SIGNS AND Instruct the patient and caregivers to monitor for signs
SYMPTOMS of infection, including fever, urinary changes, or any
unusual pain, and to promptly report any concerning
symptoms to the healthcare provider.
Provide a clear understanding of when to seek
immediate medical attention in the event of severe
symptoms or complications.
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DIET AND NUTRITION Educate the patient on the importance of maintaining
a healthy lifestyle to support overall well- being and
manage prostate cancer IV effectively.
Emphasize the importance of consuming a balanced
diet rich in fruits, vegetables, whole grains, lean
proteins, and healthy fats to optimize nutritional
intake and support overall health.
10
PROGNOSIS
Patient X male patient shows a POOR PROGNOSIS. The patient presents with stage IV prostate
cancer, which has metastasized beyond the prostate to distant organs, indicating an advanced
and aggressive disease. Given the poor prognosis, the cancer is likely resistant to standard
hormone therapies and may exhibit rapid progression despite treatment. The patient is
experiencing significant symptoms such as bone pain, fatigue, weight loss, and declining
functional status. Treatment options at this stage are typically palliative, focusing on symptom
management and quality of life rather than curative intent.
A patient’s overall survival is restricted and frequently ranges from months to a few years,
depending on the degree of metastases, response to treatment, and general health.
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