Congress Abstracts 2004

96

INTERPRETATION OF PSA LAB VALUES IN SEXUALLY ACTIVE MEN WITH PROSTATE CANCER: THE ROLE OF NURSING ASSESSMENT. Janet Cogswell, RN, CNS, AOCN^®, Erma Morales, RN, MSN, Lourdes Duque RN, MSN, and Casaundra Davis, RN, MSN, Veterans Administration New Jersey Healthcare System, East Orange, NJ.

The purpose of this analysis is to identify the unique role of nursing assessment in interpreting prostate surface antigen (PSA) values in men with prostate cancer (PC).

Changes in PSA values in men diagnosed with PC are important in disease assessment. Much is known about PSA changes in disease detection and progression. Other variables effecting PSA that would permit a holistic interpretation are less known. Utilizing holistic theory the effect of activities such as ejaculation, bicycle riding, marathon running, and clinical prostate manipulation via digital rectal exam, colonoscopy, biopsy, and Foley catheter placement on PSA was reviewed. Observations on patients at a VA medical center linked sexual activity and PSA increases. The following representative case study illustrates the role of nursing assessment.

A 53-year-old male with a PSA value of 5.3 ng/ml found during a routine physical exam was diagnosed with adenocarcinoma of the prostate Gleason 3 + 4 = 7. He elected to explore treatment options of radical prostatectomy and external beam radiation therapy while obtaining a second opinion. In six weeks his PSA was 20.6 ng/ml. The initial clinical interpretation based on disease theory alone was the need for urgent intervention based on accelerating PSA reducing his window of opportunity to learn about PC treatment options. The patient was contacted for a detailed nursing assessment regarding exercise, prostate manipulation, and sexual activity. The night prior to his PSA draw, he confirmed sexual activity leading to orgasm. Utilizing holistic theory, a nursing intervention of sexual abstinence was prescribed. The patient was to avoid ejaculation for 7 days.

The repeat PSA was 8.4 ng/ml. The importance of holistic assessment was in giving the patient adequate time to learn about PC and allowing him to make an informed decision about his treatment.

Clinical decisions made on the basis of PSA changes are based on the assumption that the values reflect the disease status. Good nursing assessment of a patient’s sexual history permits the use of a nursing intervention resulting in accurate PSA values. Based on this observation a prospective trial was designed.