Date of Award

5-2020

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Daryl Sieg

Keywords

Prostate Neoplasm; Depression; Anxiety; Radical Prostatectomy; Brachytherapy; Active Surveillance; External Beam Radiotherapy; Psychologic Distress, Low-Grade

Abstract

Prostate cancer (PCa) is the second most common cancer, behind skin cancer, among men, in the United States (Centers for Disease Control and Prevention [CDC], 2019.). PCa is defined as low-grade or low risk if the neoplasm grows slowly or not at all. According to the Institute for Quality and Efficiency in Health Care, (2020), to make the conclusion that a PCa is low-grade, several tests are performed including a prostate specific antigen (PSA) level, a Gleason score, and a TNM score, which refers to tumor size, lymph node involvement, and metastasis outside the prostate. Low-grade PCa is further defined by; lack of metastasis outside the prostate (M0), no lymph node involvement (N0), tumor staging up to T2a, a PSA of less than 10 ng/ml, a Gleason score of less than 6, and no more than two of the 10-12 tissue samples (each composed of less than 50% cancer cells) of the 10-12 samples taken. Four treatment options exist for low-grade PCa patients: active surveillance (AS), external beam radiotherapy (EBRT), brachytherapy, and radical prostatectomy (RP), all of which cause a number of physical and psychological side effects. The purpose of this scholarly project is to determine if there is a statistical significance regarding treatment modality chosen and the psychological distress (PD) experienced by the patient, due to these treatments and their side effects. Additionally, to determine if early education and close follow up would aid in management of PD. Three databases were searched: PubMed, CINAHL, and Cochrane Database of Systematic Reviews. Topics researched included: low-grade prostate cancer, side effects of treatment options and psychologic distress from the adverse effects of treatment. Research was conducted from June 26, 2019 to January 26, 2020. All works were published within the last 10 years. Limitations and strengths were considered with each treatment modality. Radical prostatectomy is the most effective treatment for low grade PCa. It is also the treatment that is most invasive, causes the most physical and psychological side effects and has led the medical community to consider low grade PCa to be over treated. Due to this finding, education regarding an individual’s illness (grading of the cancer), age, comorbidities, patient’s needs, preference and likely side effects of treatment must be thoroughly examined, by not only the patient, but with partners and caregivers.

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