Prostate Cancer Patient Information Session

Marian Waldie RN, BScNSylvie Bellerive RN, BScN

Corrina Arsenault MSW, RSWProstate Diagnostic Unit

Cancer Assessment Clinic7th Floor General Campus

The Ottawa Hospital2009

Prostate Cancer

Picture from the Canadian Prostate Cancer Network Website

Today’s Purpose & Goals

Purpose: To prepare you, and those supporting you, to care for yourselves after your prostate cancer surgery

Goals:• To describe the purpose of the prostate • To explain how prostate cancer is graded and staged• To provide information about getting ready for

surgery• To provide information about caring for yourself after

surgery

Patient Education Materials

The Prostate Gland

Grading & Staging

The grade of your cancer, Gleason score, is based on how different the cancer cells look from normal cells under the microscope.

Before surgery it is based on the slivers of tissue taken during the biopsy.

After surgery it is based on the entire prostate gland that is removed.

The stage of your cancer is based on the digital rectal exam, and gives your physician an idea of how extensive your cancer is.

Before Surgery

More tests needed: Blood work Urine tests Electrocardiogram (as required)

Visits with the team: Your Urologist Nurse in the Pre Admission Unit

(PAU) Anaesthesiologist in PAU

Getting Ready for Surgery

Diet:• Follow a low-fat, high-fibre diet

before surgery

Getting Ready for Surgery

Smoking:

• Avoid all types of tobacco at least 14 days before surgery

• Smoking places you at serious risk for complications from surgery

• Support is available – discuss your plan with your nurse or doctor

Getting Ready for Surgery

Strive for a minimum of 30 minutes of moderate exercise four to five days per week

Benefits of exercise:• Promotes muscle development• Prevents excess weight gain• Improves cardiovascular and immune

system function• Reduces fatigue• Kegel (pelvic floor) exercises can

improve urinary incontinence after treatment for prostate cancer

• Can improve urinary incontinence after treatment for prostate cancer

• Start Kegel exercises before your surgery, and resume these exercises after your catheter is removed

• Exercise in the morning and mid-afternoon when you may be less tired

• After surgery you should notice an improvement in bladder control after 4 to 6 weeks

Kegel Exercises

How to do Kegel Exercises

Finding The Right Muscle:• First, sit down• Now, squeeze the

muscles you would use to stop the flow of urine or a bowel movement

• If you feel your penis pull in slightly toward your body, you are squeezing the right muscle

Kegel Exercises

Doing Your Kegels:• Stand, sit, or lie down

with your knees slightly apart

• Squeeze your pelvic muscles as if you are trying to hold in some urine or gas

• Hold that squeeze for 5 to 10 seconds

• Relax the muscles for about 10 seconds

• Repeat 12 to 20 times• Try working your way

up to doing a set of 12 to 20 contractions, 3 times a day

Bowel Preparation

Day before surgery:Follow the bowel preparation instructions given to you by your urologist

or during your pre-admission appointment (Pico-Salax or Colyte).

Do not take any solid food once you have started your bowel preparation. You may have clear fluids only, such as water, clear juices (apple, cranberry, grape), clear broth soups, plain Jell-o (any flavour, nothing added), coffee, tea (no milk), any clear pop.

Drink plenty of clear fluids, in general, about one cup of water or clear fluid every hour while you feel the effects of Pico-Salax.

If you are using Colyte follow the instructions given to you.

Other Preparations

The night before your surgery: after midnight stop all clear fluids you have been drinking during the day.

You may drink water (2 cups ONLY) up to 3 hours before the time of your surgery. Do not chew gum or suck on hard candy

Medications – The anaesthesiologist or PAU nurse will tell you if you should take your medications prior to surgery

Do not drink any alcohol 7 days before surgery

Other Preparations

Bring in phone numbers of a relative or friend who will be helping you(home, cell, work)

Personal items – pack a bag to be brought to you after your surgery when you are admitted to the surgical unit.

Do not bring valuables (jewellery, money, watch, etc.)

Surgical Day Care Unit (Same Day Admit Unit) - SDCU

• Come to the hospital the day of your surgery: At the General campus, go to the 2nd floor

Critical Care Wing At the Civic Campus: 1st floor E1

• Bring your hospital green card.• For General campus surgery: The hospital will

call you the evening before your surgery between 5pm and 8pm to tell you what time to come in. After 8, if you have not heard, you may call – 613-737-8200;

• For Civic Campus surgery: you must call the day before surgery at 613-761-5252 between 2 and 4pm for your time. If your surgery is scheduled for Monday or after a long weekend, please call the Friday before.

• You must arrive on time or your surgery may be cancelled

Different Types of Surgery

Open Approach Laparoscopic Approach

After Surgery

You will have:

Pain medication (as required)

Oxygen (as needed)

Intravenous

TED Stockings

Urinary catheter

Abdominal Dressing and Drain

You will go home with a urinary catheter that will be removed in 7 to 10 days after your surgery

DrainsThe surgeon may use one of two types of drains –

a hemovac or a Jackson-Pratt – and both remove fluid that would collect under the incision

Hemovac Drain Jackson-Pratt Drain

Urinary Catheter Drainage

Catheter Care

Cleaning the Catheter Exit Site:• Wash your hands with soap & water• With a wet facecloth & soap, gently clean the catheter and skin

around the catheter twice a day (use a new facecloth each time, preferably disposable) and then dry with a clean towel

• You may shower with a catheter but soaking in water (bathing, hot tubs, swimming) should be avoided

Ensure that you:• Secure your catheter to your leg using tape or a catheter strap• Make sure your urine bag rests below your bladder• Drink 2-3 litres of fluid each day (water, tea, juice) • Avoid constipation (take stool softeners, drink plenty of water, eat

high fibre foods)

Cleaning Your Drainage Bags

• Wash your hands before and after emptying or changing your drainage bag.

• Empty your catheter bag at least every 8 hours. Empty more often if needed.

• When changing bags wipe the catheter bag connection stem with an alcohol swab.

• Keep the protective cap on the bag that is not in use.• Rinse the used bag twice with water by agitating

vigorously and let drain.• Clean drainage bags daily with either a solution of 1

part vinegar to 3 parts water or 1 part household bleach to 10 parts water (wear protective gloves if using bleach).

• Fill with 150ml of the prepared solution and agitate vigorously. Drain bag and allow to dry.

Going Home• Don’t expect to feel 100%

at 2 months, you will be ~80% recovered

• What are your resources? Friends/family Health care providers

• Make a plan regarding: Meals Household chores Work

After SurgeryWound Care:• Keep the area clean with mild soapy water• Rinse well and pat dry• You may tub bath once the catheter and clips have been

removed• Wear non-restrictive clothing while still tender

Exercise:• Early and frequent walking• Do not lift anything over 7 kg (15 lbs) for 4 weeks• Avoid strenuous exercise, snow shovelling, pushing a lawn

mower • Take frequent rest periods as needed• Use stairs as needed and as tolerated• Resume your regular activities ( sexual relations, regular

exercise, household chores) gradually over eight weeks

After Surgery

Driving:• Do not attempt to drive until your catheter is removed• Avoid driving a vehicle for 2 to 3 weeks

Flying:• You may wish to delay any trips until your catheter is removed• Remember you need to avoid lifting or straining for at least 4 to

6 weeks

Return to Work:• For a non-strenuous job with flexible hours – about 3 to 4 weeks• For work that involves strenuous work – at least 6 to 8 weeks• For heavy manual labour – 12 weeks

After Surgery

• After surgery a diet rich in protein and some fattyacids helps to promote tissue healing

• Sources of protein include lean meat, fish, dairy products (1% or skim), vegetables such as split peas and beans, nuts and seeds

• Fish such as salmon, herring, mackerel, sardines, bass, and white albacore tuna are sources of fatty acids

• Eating foods rich in fibre (wheat bran, beans, broccoli, sweet potatoes, carrots, apricots) helps prevent constipation, as well as drinking plenty of water and exercising

Normal symptoms

At home after your surgery, it is normal to experience: Swelling and discoloration of the skin

over the penis and scrotum are common A “burning” feeling around your incision Some redness along the incision Small amount of drainage from your

incision Feeling tired Most men experience urinary problems

and sexual difficulties, at least temporarily

Tips to Help Bladder Control After Your Surgery

• Empty your bladder regularly during the day, every 3 to 4 hours, and before going to bed.

• Sit to urinate to completely empty your bladder.• Learn to squeeze before you sneeze, and before

you cough, laugh or get out of a chair.• Decrease your consumption of alcohol and caffeine.• Watch your weight. Being overweight makes bladder

control more difficult.• Stop smoking. Smoking is irritating to the bladder.

Recovery of Erectile Function

Erectile Function After Surgery

Depends on:

• Age at time of surgery

• Erectile function before surgery

• “Nerve Sparing” Amount of nerve tissue preserved during surgery

Penile Rehabilitation

• Aim is to optimize the recovery of erectile function

• Includes the use of drugs such as Viagra, Cialis, or Levitra given in low doses daily for several months after surgery

• Penile injections may also be used to stimulate early return of erections

Helpful Things to Consider When you are Ready to Resume Sexual Activity

• Sexual behaviour will not cause recurrence• Expect the unexpected. Be ready to laugh when that

happens. Sex does not have to be “serious business” or a “marathon”. It is okay to stop and rest when tired.

• Sex should not cause pain or discomfort. If it does, do not hesitate to talk with the nurse or physician about this. Fear of pain can cause sexual dysfunction.

• Performance anxiety can occur if you are hyper vigilant about erection.

• Skin is the largest sexual organ and the brain is the most important sexual organ. Use them and the possibilities for sexual activity are limitless.

• A diagnosis of cancer or its treatment do not dictate what a patient can or cannot do. Use creativity and a sense of play to explore new ways to help maintain intimacy.

Abnormal signs & When to call

Go to the Emergency Room if you:• Experience lower leg swelling, pain, redness• Difficulty breathing • pain not relieved by pain medications

Call your Urologist if you experience any of the following:• Chills or fever (temperature greater than 38.5 degrees C) • Increased discomfort, redness, incision separation, swelling or drainage

around your incision• Increase in mucous and/or sediment, cloudy urine• Little or no urine drainage from your catheter• Pain over kidney (flank) area, lower back pain

Civic Campus: Before surgery: 613-798-5555, ext 12799, After surgery: 613-798-5555, ext 14500

General Campus: 613-737-8146

Emergency Visit Instructions

Important Information for Health ProfessionalsThis patient has recently undergone a Radical Prostatectomy. This patient may present to you with or without an indwelling urinary catheter. The catheter is usually removed as early as 7 days or within 2-3 weeks after surgery. Do not remove or change the catheter if one is currently in place. Under no circumstances should a urinary catheter be reinserted. It is imperative that the UrologyService is contacted and the patient be assessed by Urology.Insertion of a catheter by a non-urologist could result in seriousconsequences for this patient.

The Ottawa HospitalDivision of Urology

Psychosocial Support for Oncology Patients

• Provides social, psychological, emotional, and physical support to patients and their loved ones

• Objective is to optimize health outcomes through stress reduction and promoting wellness

Cancer and Stress…

• Strong scientifically established link between stress and health: Heart Diabetes Immunity Depression Anxiety

• Negative impact on quality of life Relationships Nutrition Sleep Disturbances Fatigue Pain Sense of Wellbeing

Common Stressors for Cancer Patients

Stress is commonly related to…

• Entering unfamiliar territory• Information overload!• Loss of income• Keeping track of appointments, medications, forms…• Impact on household routines, social life…• Impact on relationships with others• Thinking about mortality

Community Information and Resources

Many Patients Have Questions About…

• Transportation• Parking Passes• Income Support• Medication Coverage• Home Help Services• Meals on Wheels• Respite• Childcare• Etc., etc., etc.

• Peer Support• Support Groups• Caregiver Support• Power of Attorney and Living

Wills• Mental Health Resources• Disclosing to Loved Ones• Complementary Therapies• Sexuality

Coping with Cancer • Give yourself time

There is a lot of education materials to go through and won’t get through them all in one day!

You will probably have some questions so it is a good strategy to write them down (so you don’t forget) and bring them to appointments

To recuperate after surgery…your body needs time to heal• Get back to basics so you can feel your best

Eat well Plenty of sleep Do things you enjoy and things which help you relax Socialize

• Accept help from others – they are wanting to be supportive Practical support Emotional support Don’t be shy about delegating tasks when you have too much to do already

• Give others your time and attention as well It is common for those close to you to need some TLC as well Keep lines of communication open Address issues when they arise

Coping with Cancer

Take advantage of the resources available to you!

Canadian Cancer SocietyContact: 1-888-939-3333

Prostate Cancer Association of OttawaContact: (613) 828-0762

Gay Buddies With Prostate Cancer Contact: Bruce Bursey at bruce@bursey.ca

Ninon Bourque Patient Library

Social Work – Cancer Assessment Centre

Regional Program SitesIf you have questions about what practical resources may be available to you when you are discharged from hospital after your surgery….

Cornwall Community Hospital: Ask to speak with a Discharge Planning Nurse (McConnell Ave (613) 938-4240; Second St (613) 932-3300).

Hawkesbury and District General Hospital: CCAC case managers are responsible for discharge planning if you are going home after discharge. There is also a Discharge Planner (Monique Leduc (613) 632-1111 ext 355) on site for patients needing convalescence /retirement home /long-term care after discharge.

Montfort Hospital: Ask to speak with a Discharge Planner (Discharge Management Services (613) 746-4621).

Pembroke Regional Hospital: Ask to speak with a Discharge Resource Nurse (Main Switchboard (613) 732-2811).

Queensway-Carleton Hospital: Ask to speak with a Social Worker/Discharge Planner (Discharge Planning Office (613) 721-4723).

Renfrew Victoria Hospital: Ask to speak with a Discharge Planner (Contact number – (613) 432-4851 ext. 765)

Winchester District Memorial Hospital: Ask to speak with the Discharge Planning Coordinator (Contact number – (613) 774-2422 ext. 5220)

Champlain Community Care Access Centre

1-800-538-0520

Alexandria (613) 525-1213 Carleton Place (613) 253-9000

Casselman (613) 764-0557 Cornwall (613) 936-1171

Hawkesbury (613) 632-4861 Ottawa (613) 745-5525

Pembroke (613) 732-7007 Winchester (613) 774-2800

Any Questions!