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A Genetics Perspective
On Prostate Cancer
Mira Lessick
Anne Katz
ohn Walker is a 66-year-old
man who is fit and healthy.
He comes to see the nurse at
the urology clinic because he
recently discovered that his
younger brother, aged 58, has
been diagnosed with prostate
cancer. His brother suggested
that John be tested for pro s t a t e
cancer but he is unsure of what
needs to be done and why. He
had his PSA measured about 10
years ago and recalls that at the
time it was normal and he had
declined further screening until
now. He is anxious, and his wife
is urging him to have any and all
tests as soon as possible. She
wants to know if genetic testing
is available and if all the men in
the family need to be tested.
J
Introduction
P rostate cancer is the most
common cancer diagnosed in
American men and the second
leading cause of cancer mort a l i t y
(American Cancer Society [ACS],
2006). In 2006, an estimated
234,460 new cases will be diagnosed in the United States, and
27,350 men will die from the disease (ACS, 2006). Factors that
i n c rease a man’s risk for pro s t a t e
Mira Lessick, PhD, RN, is Associate
Professor, The University of Toledo,
College of Nursing, Toledo, OH.
Anne Katz, PhD, RN, is Clinical Nurse
Specialist, Manitoba Prostate Center,
CancerCare Manitoba, Winnipeg,
Manitoba, Canada.
454
Prostate cancer is the most common malignancy and the second
leading cause of cancer-related deaths among American men. In a
small percentage of men, prostate cancer occurs as a result of inher iting a mutation in a major gene predisposing to this disease. The
genome-wide search for prostate cancer susceptibility genes holds
the promise of making genetic testing for prostate cancer risk avail able in the future and for ultimately developing better tools for dis ease prevention, diagnosis, and treatment. Nursing practice roles are
increasingly affected by the translation of rapidly expanding genetic
knowledge into the patient care arena. The current advances in the
genetic basis of prostate cancer, including screening and manage ment aspects and risk assessment considerations for urologic nurs ing practice, are addressed.
cancer include increasing age,
race, family history, and
lifestyle/environmental factors.
As strong evidence for a genetic
component in prostate cancer
has accumulated over the past
several decades, recent dramatic
advances in molecular biology
and genomic science have fueled
intense interest in identifying
genes that increase the risk of
p rostate cancer to individuals
and families. The discovery and
characterization of susceptibility
genes that contribute to the
o c c u rrence and/or pro g ression of
p rostate cancer may ultimately
lead to improved approaches for
disease prevention, diagnosis,
and treatment. It is essential that
urology nurses seek genetic
knowledge and have a basic understanding of genetic advances in
prostate cancer, as they prepare to
meet the needs of patients and
family members clinically affected by, or at risk for, this disord e r.
Genetic Basis of Pro s t a t e
Cancer
Like most cancers, prostate
cancer is a complex neoplastic disorder in which interaction between genetic and nongenetic factors contribute to disease initiation
and progression. One of every six
American men will be diagnosed
with prostate cancer in his lifetime. Numerous genetic studies
p rovide evidence of a significant
hereditary component in prostate
cancer susceptibility (Stanford &
Ostrander, 2001; Verhage &
Kiemeney, 2003). Estimates from
two studies suggest that about
42% to 57% of all prostate cancer
risk may be attributed to inherited
genetic factors and 43% to 58% to
lifestyle/environmental influences
(Lichtenstein et al., 2000; Page,
Braun, Partin, Caporaso, & Walsh,
1997). Lifestyle and/or environmental factors (such as dietary fat,
chemical agents) may interact
with underlying genetic suscepti-
UROLOGIC NURSING / December 2006 / Volume 26 Number 6
bility to determine prostate cancer
risk and clinical features of the
disease such as age of onset or
tumor aggressiveness (Hayes,
2001). However, the role environmental risk factors may have in
this disease is not yet well
defined.
To date, the most definitive
risk factors for prostate cancer are
age, race/ethnicity, and family history. The disease affects primarily
older men, with men over the age
of 65 at highest risk (Zwang et al.,
2003). Approximately 32% of all
patients are diagnosed before the
age of 65 (Ostrander, Markianos, &
Stanford, 2004). The incidence of
prostate cancer is highest among
African-American men and lowest
in Asian populations.
Family history is a major risk
factor for developing prostate
cancer. Using family history as a
general guide, prostate cancer can
be categorized into three groups:
sporadic, familial, and hereditary
(Ostrander et al., 2004). A man
with sporadic prostate cancer is
typically the only person in the
family who has been diagnosed
with the disease (the patient
re p o rts no family history of
prostate cancer). Sporadic prostate
cancer accounts for most cases
(approximately 75% to 85%) of
prostate cancer in the general population.
Familial prostate cancer
accounts for about 10% to 20% of
all prostate cancer cases, and represents families in which there are
two first-degree or one first-degree
and two or more second-degree
relatives with prostate cancer
(Ostrander et al., 2004). Hereditary
prostate cancer (HPC) is estimated
to account for about 5% to 10% of
all cases of prostate cancer. Men
with HPC represent families which
meet at least one of the following
three criteria: (a) three or more
affected first-degree relatives with
prostate cancer, (b) prostate cancer
o c c u rring in three generations
through the paternal or maternal
sides of the family, and/or (c) at
least two first-degree relatives diagnosed at an early age (age 55 years
or younger) (Carter et al., 1993;
Ostrander et al., 2004; Verhage &
Kiemeney, 2003).
F i g u re1.
G l o s s a ry of Te rm s
Autosome: A single chromosome from any 1 to 22 pairs of the chro m osomes not involved in sex determination (XX or XY). A disease caused by
a mutation in an autosomal gene or gene pair shows autosomal inheritance.
Autosomal Dominant Inheritance: A type of single gene or Mendelian
inheritance pattern having certain characteristics such as the disease usually seen in several generations (vertical transmission pattern); roughly
equal numbers of affected males and females; male-to-male (father-son)
transmission may be observed; and a 50% risk for each offspring of an
affected individual to inherit the mutant gene.
Autosomal Recessive Inheritance: A type of single gene or Mendelian
inheritance pattern having certain characteristics such as the disease seen
among siblings and usually no earlier generations affected (horizontal
transmission pattern); roughly equal numbers of affected males and
females; and a 25% risk for each offspring of carrier parents to inherit two
copies of the mutant disease-causing gene (one copy of the gene fro m
each parent).
Chromosome: Microscopic stru c t u res in the cell nucleus that contain the
genes. Chromosomes occur in pairs, and humans have 46 chromosomes
(22 pairs of autosomes and 2 sex chromosomes).
Dominant: A genetic trait or disorder that is expressed when a person has
one copy of the mutant gene.
First-Degree Relatives: Parents, siblings, and children.
Gene: A functional unit of inheritance consisting of DNA.
Gene Mapping: Assignment of genes to specific locations on specific
chromosomes.
Genotype: The genetic constitution of an individual.
Linkage Analysis: A method used to map a disease gene. Genetic markers located close to the disease-causing gene are analyzed to observe if
they are transmitted together with the disease in an extended family pedig ree. The closer the marker and the gene in question are located, the more
frequently they will be transmitted together.
Locus: Location of a gene on a chromosome.
Mendelian: D i s o rders that are caused by a single gene and follow certain
p a t t e rns of inheritance. Single-gene disorders and their inheritance are
also known as Mendelian disorders or inheritance, referring to Gregor
Mendel, an Austrian monk, whose genetic principles derived from experiments with garden peas form the foundation of much of modern genetics.
Multifactorial: Traits or disorders that are determined by the interaction
of multiple genetic and environmental factors.
Pedigree: A diagrammatic representation of the family history that traces
health conditions, family relationships, and other attributes in a family.
Recessive: A genetic trait or disorder that is expressed only when an individual has two copies of a mutant gene.
Second-degree Relatives: Grandparents, aunts, and uncles.
S e g regation Analysis: A method used to analyze the mode of inheritance of a particular trait or disease fitting to observed family data.
The clustering of pro s t a t e
cancer within families has long
been recognized. Numerous
studies have shown that men
who have a first-degree relative
(father, bro t h e r, son) with
p rostate cancer have a two-fold
to three-fold increased risk of
UROLOGIC NURSING / December 2006 / Volume 26 Number 6
developing prostate cancer, comp a red to men with no family history (Ostrander et al., 2004;
Verhage & Kiemeney, 2003;
Zeegers, Jellema, & Ostre r, 2003).
The risk is higher for men who
have multiple affected relatives,
or an affected relative who was
455
under age 65 when diagnosed.
The increased prostate cancer
risk in men with a family history
has been observed in various ethnically diverse populations,
including
African-American,
Caucasian, Asian-American, and
Hispanic groups (Stanford &
Ostrander, 2001; Stone et al.,
2003; Whittemore et al., 1995).
In addition to family studies,
twin studies are used to help
d e t e rmine whether the familial
a g g regation of prostate cancer is
due to hereditary or enviro n m e ntal influences by comparing conc o rdance rates in monozygotic
and dizygotic twins. The findings from these studies have consistently demonstrated higher
rates of concordance (both twins
a ffected with cancer) in monozygotic twins (19% to 27%) when
c o m p a red to dizygotic twins (4%
to 7%) (Lichtenstein et al., 2000;
Ostrander et al., 2004; Page et al.,
1997).
Based on the available evidence of a genetic component to
p rostate cancer, numerous res e a rch centers have conducted
studies of high-risk HPC families
to elucidate the mode of inheritance of prostate cancer through
s e g regation analysis, and to identify prostate cancer susceptibility
genes using linkage analysis (see
Figure 1). The results of several
studies using segregation analyses suggest that familial clustering of prostate cancer among men
with early-onset disease can be
best explained by Mendelian
autosomal dominant inheritance
(Verhage & Kiemeney, 2003). The
presence of a rare, autosomal
dominant high-risk susceptibility
gene(s) is believed to account for
about 43% to 65% of all cases of
p rostate cancer diagnosed before
age 56 (Verhage & Kiemeney,
2003). Other studies have suggested an autosomal recessive
mode of inheritance with higher
p rostate cancer risk at older ages
of diagnosis (Cui et al., 2001) or a
multifactorial model in which
p rostate cancer risk may be determined by multiple genes interacting with environmental factors (Gong et al., 2002).
Since the mid-1990s linkage
456
Table 1.
Identification of Prostate Cancer Susceptibility Genes
Gene
Chromosome Region
HPC1/RNASEL
1q24-25 (Long arm of chromosome 1)
PCAP
1q42-43 (Long arm of chromosome 1)
CAPB
1p36 (Short arm of chromosome 1)
MSR1
8p22-23 (Short arm of chromosome 8)
HPC2/ELAC2
17p11 (Short arm of chromosome 17)
HPC20
20q13 (Long arm of chromosome 20)
HPCX
Xq27-28 (Long arm of chromosome X)
analysis studies have been carried out with the goal to map
(localize) susceptibility genes for
p rostate cancer. Linkage analysis
provides statistical evidence
re g a rding the likelihood that a
c h romosomal region may harbor
a disease susceptibility locus
(gene location). By comparing
the genotypes between affected
and unaffected individuals in
l a rge high-risk families, the
analysis “links” the disease to
specific markers in known chromosome locations. In 1996, the
first prostate cancer susceptibility gene, designated HPC1 (here ditary prostate cancer 1), was
mapped to the long arm of chromosome 1 (region 1q24-25)
(Smith et al., 1996). Subsequently,
other prostate cancer susceptibility genes have been linked to various regions on chromosomes 1, 8
17, 20, and the X chromosome,
and include PCAP, CAPB, MSR1,
HPC 2/ELAC2, HPC 20, and HPCX
(see Table 1) (Ostrander et al.,
2004; Verhage & Kiemeney, 2003).
T h ree of these genes —
HPC1/RNASEL, MSR1, and
HPC2/ ELAC2 — have been
cloned and mutations identified
(Verhage & Kiemeney, 2003).
Additional susceptibility genes
associated with hereditary prostate
cancer have yet to be identified.
Research to date has shown that
the inherited predisposition to
prostate cancer is quite complex.
T h e re are no major clinical or
pathologic features that distinguish between hereditary, familial, and sporadic forms of prostate
cancer (Verhage & Kiemeney,
2003). In addition, hereditary
prostate cancer appears to be
anatomic site-specific, and is not
associated with an increased risk
for other cancers. However,
prostate cancer is associated with
previously identified hereditary
cancer syndromes, such as BRCArelated breast/ovarian cancer syndrome. For example, it is well recognized that male relatives in
breast/ovarian cancer families
with BRCA2 mutations have an
elevated risk for prostate cancer
(Ostrander et al., 2004).
A definitive genetic test for
detecting inherited susceptibility
to prostate cancer is not yet clinically available. Curre n t l y, genetic testing is only perf o rmed within the context of re s e a rch studies.
As genetic testing for HPC risk
moves from the re s e a rch setting
to the clinical setting in the
f u t u re, it may become an important tool in cancer prevention or
be useful following a diagnosis of
p rostate cancer in making tre a tment management decisions. In
the absence of clinical genetic
testing, unaffected men with a
s t rong family history of prostate
cancer may opt to initiate scre e ning by prostate-specific antigen
(PSA) and digital rectal examination (DRE).
S c reening and Management
Of Men at High Risk for
P rostate Cancer
The first step in managing
men with a familial or hereditary
risk of prostate cancer is ensuring
that the man understands his
individual risk, since knowledge
of being at high risk for cancer is
associated with anxiety or de-
UROLOGIC NURSING / December 2006 / Volume 26 Number 6
Figure 2.
S c reening Guidelines
Examples of Recommendations for Prostate Cancer Screening
❏ PSA and DRE for men starting at age 40 or, at least 5 years earlier
than the age of the first-degree relative (father/brother) at diagnosis
and at least 10 years earlier than the appearance of metastatic disease in a first-degree relative (Bratt, 2000).
❏ Annual screening with PSA and DRE starting at age 50 for men who
have at least a 10-year life expectancy (ACS, 2006; Smith et al., 2006).
❏ Annual screening with PSA and DRE starting at age 45 for men at
high risk (African-American men and men with a family history of
one or more first-degree relatives diagnosed before age 65 (ACS,
2006; Smith et al., 2006).
❏ PSA and DRE starting at age 40 for men at significantly higher risk
(men with multiple first-degree relatives affected at an early age).
Depending on initial screening results, no further screening may be
needed until age 45 (ACS, 2006; Smith et al., 2006).
p ression (Beebe-Dimmer et al.,
2004). Men at high risk of
p rostate cancer commonly overestimate their lifetime risk
(Beebe-Dimmer et al., 2004).
While studies indicate that most
men with a family history of
p rostate cancer are interested in
screening for the disease (Bratt,
Kristoffersson, Lundgren, &
Olsson, 1997), it is important that
any decision about screening is
made in the context of comprehensive knowledge.
It is recommended that
screening for prostate cancer in
men with a family history include
annual measures of PSA and a
DRE coupled with a detailed discussion of personal cancer risk.
Screening should be initiated in
the 4th decade commencing at
least 5 years earlier than the age at
which the affected relative (father
or brother) was diagnosed and at
least 10 years earlier than the age
at which metastatic prostate cancer appeared in the family (Bratt,
2000) (see Figure 2).
The Netherlands Foundation
for the Detection of Here d i t a ry
Tumours, in association with the
Dutch Urologic Association,
established a protocol for prostate
cancer screening in healthy men
f rom HPC families (Ve rhage &
Kiemeney, 2003). Based on this
protocol, first-degree relatives
should be evaluated by PSA (if
less than 3.0 ng/ml) once every 2
years from age 50, or at an age 5
years younger than the youngest
patient (age 70 or younger) in the
family. If the PSA is greater than
or equal to 3.0 ng/ml, the man
should have a DRE and transrectal
ultrasound with systematic and
random needle biopsies. If no histologic abnormalities are found,
then the man should be re-evaluated after 2 years (Verhage &
Kiemeney, 2003).
The ACS 2006 guidelines
(Smith, Cokkinides, & Eyre,
2006) recommend annual scre e ning by PSA and DRE beginning at
age 50 for men who have at least
a 10-year life expectancy, and
beginning at age 45 for men at
high risk (African-American men
and men with a family history of
one or more first-degree relatives
diagnosed before age 65). The
ACS also recommends that men
at significantly higher risk (those
with multiple first-degree re l atives affected at an early age)
begin screening at age 40.
Depending on the initial scre e ning results, no further screening
may be necessary until age 45.
It is suggested that starting
PSA screening for men in their
40s who are at high risk allows
for the earlier detection of
p rostate cancer and the potential
for curative therapy (Valeri et al.,
2002). However, this may also
i n c rease anxiety and potentially
d e c rease quality of life for
younger men who have radical
treatment for a cancer that may
have been indolent and not
lethal. There appears to be no dif-
UROLOGIC NURSING / December 2006 / Volume 26 Number 6
f e rence between here d i t a ry and
sporadic prostate cancer in term s
of tumor grade or pathologic
stage (Bratt, 2000).
Risk Perception and
Associated Prostate Cancer
S c reening Behavior in
At-Risk Families
T h e re is some conflicting
evidence related to screening
behavior in men with a family
history of prostate cancer.
Studies of compliance with a
screening program suggest high
past compliance and future
intent to screen (Jacobsen et al.,
2004) among first-degree relatives, particularly if the man is
under age 60 or if there is more
than one first-degree relative
diagnosed with prostate cancer
in the family (Roumier et al.,
2004). Physician support and
knowledge about PSA screening
are
also
associated
with
increased screening uptake in
men at risk (Corm i e r, Reid,
Kwan, & Litwin, 2003). In other
studies, awareness of familial
clustering of disease did not lead
to male relatives seeking early
detection strategies (Arar et al.,
2000; Miller et al., 2001).
Another study of the possible
e ffects of diagnostic methods on
familial risk estimates re p o rt e d
that a diagnosis of prostate cancer in one brother may lead to an
early diagnosis in a second bro t her (Hemminki, Rawal, & Bermejo,
2005). Some men may experience a slight increase in anxiety
during the screening process,
and anxiety is more likely to
occur if they have more than two
relatives with prostate cancer
and are younger (Cormier,
Guillemin et al., 2002).
Attitudes towards screening
and genetic testing among men
with a family history of prostate
cancer have also been explore d .
In one study from Sweden of 69
men with prostate cancer and
their 101 unaffected sons, the
majority (about 90%) of sons
w e re interested in knowing
whether the disease could be
inherited, and 60% claimed they
had worries about having an
i n c reased risk of prostate cancer.
457
Sons were positively inclined to
u n d e rgo prostate cancer scre e ning and genetic testing if there
w e re multiple relatives with
p rostate cancer in the family
(Bratt et al., 1997). A U.S. study
involving a community sample
of 400 healthy non-high-risk men
re p o rted that most men were
receptive to genetic testing for
p rostate cancer risk, despite the
absence of any prior inform a t i o n
about the risks and benefits of
testing. The men in this study
believed that any knowledge is
better than none, even if the
knowledge predicts nothing
about the timing or pro g re s s i o n
of disease (Doukas, Localio, & Li,
2004).
Another U.S. study involving
342 men presenting for routine
p rostate cancer screening found
that interest in learning about
DNA testing for HPC was high,
but 28% of participants had low
knowledge about what constitutes
“inherited
tendency”
(Miesfeldt et al., 2000). The
investigators suggest that their
findings are similar to those fro m
studies of women interested in
DNA testing for breast and ovarian cancer risk. In a study fro m
France of 375 first-degree re l atives of men with prostate cancer,
the level of worry about genetic
susceptibility was low and there
was interest in genetic testing
among the majority of men with
a family history of prostate cancer. Interest in genetic testing
i n c reased with the number of
affected men in the family
(Cormier, Valeri et al., 2002).
Nursing Considerations in
Risk Assessment for Pro s t a t e
Cancer
Expanding knowledge about
the genetics of prostate cancer
provides opportunities for nurses
to incorporate this knowledge
into practical patient care applications. Urology nurses in all settings will be expected to provide
support, education, and resources
for individuals and families who
have questions or concerns about
inherited risk of prostate cancer.
The nurse is often the first
health professional to assess a
458
F i g u re 3.
Examples of Common
Symbols Used For Pedigre e
Construction
Female
Male
Gender
Not Specified
Deceased
A ffected Male
No Off s p r i n g
Adopted
Mating line
Line of Descent
Sibship line
Proband
patient’s risk of prostate cancer
when obtaining a family and personal medical history. Obtaining
a thorough family health history
is an essential component to a
nursing health assessment. When
assessing for the risk of prostate
cancer, family history should
include the following inform ation:
• History of cancer for at least
first and second-degree re l atives on both maternal and
p a t e rnal sides of the family.
• Diagnosis of all primary
p rostate cancers and other
cancers inre l a t i v e s .
• Age at cancer diagnosis.
• Other medical and health
problems (such as benign
p rostatic hypert rophy).
• Ethnic backgrounds of re l atives on both sides of the
family.
• Health information about
both affected and unaffected
individuals.
• Cause and age at time of
death for relatives diagnosed
with cancer.
The family history should be
documented by the construction
of a pedigree, using standard i z e d
symbols. A sampling of common
symbols used in pedigree cons t ruction is provided in F i g u re 3.
A common problem that may
arise in recording a family history is that patients may have
incomplete or inaccurate information about the health status
and cancer history of living and
nonliving relatives. Examples of
other potential problems in gathering family history data may
include loss of parents and other
relatives who can provide family
health information, individuals
adopted at an early age, loss of
contact with family members,
family beliefs that cancer is a
taboo topic for discussion, and
perception that disclosure of
health information would not be
of value to other relatives.
Several studies have examined
the accuracy of self-re p o rted family history of prostate cancer and
emphasized the importance of
verifying re p o rted information in
trying to determine if a patient has
a significant family history (Gaff et
al., 2004; Weinrich, Faison-Smith,
Hudson-Priest, Royal, & Powell,
2002). The nurse also asks dire c t
questions and obtains inform ation about the patient’s personal
health and risk factor history
such as age, ethnic background,
and current and past diet, use of
d rugs or dietary supplements,
and medical problems.
Identifying psychosocial issues
is another central aspect of a risk
assessment. The nurse should
focus particular attention on the
patient’s level of psychological
d i s t ress, his perceived risk of
p rostate cancer, and a history of
d e p ression, anxiety, or other mental illness. Psychological distress
UROLOGIC NURSING / December 2006 / Volume 26 Number 6
Table 2.
Resources
Organization
genetic basis of hereditary
p rostate cancer may be explored.
Web Site
International Society of Nurses in Genetics (ISONG)
www.isong.org
National Society of Genetic Counselors (NSGC)
www.nsgc.org
Oncology Nursing Society (ONS)
www. o n s . o rg
National Cancer Institute (NCI)
www.cancer.gov
The American Prostate Society
www.ameripro s . o rg
Us TOO International, Inc.
www.ustoo.com
American Cancer Society (ACS)
www.cancer. o rg
American Society of Clinical Oncology (ASCO)
National Human Genome Research Institute (NHGRI)
and increased risk perception may
influence men’s decisions about
screening or adherence to risk
management strategies. The nurse
should provide ample time for
patients to ask questions, vent feelings, and address any issues or
concerns.
When the patient’s family
history and health assessment
suggest an increased risk of
prostate cancer, referral to a cancer genetics specialist or cancer
genetics specialty clinic may be
warranted. Cancer genetics clinics are typically located in major
medical centers and staffed by a
multidisciplinary team consisting of oncologists, oncology
nurses, genetics nurses, genetic
counselors, psychologists, or
clinical social workers (Middelton & Lessick, 2003). Referrals to
cancer genetics specialists or
clinics come from a broad range
of health care providers such as
urologists, primary care physicians, nurses, and genetic counselors. Cancer genetics specialists evaluate whether a particular cancer in a family is consistent with a known hereditary
cancer, provide counseling
about an individual’s cancer risk
and options for risk management, and identify appropriate
genetic testing and research
studies.
The urology nurse may contact a nearby academic medical
center for information about
cancer genetics services. Resources such as the International
www.asco.org
www.genome.gov
Society of Nurses in Genetics,
National Society of Genetic
Counselors, and the Oncology
Nursing Society can also provide a listing of cancer genetic
professionals in a particular geographic region. A sampling of
additional resources relevant to
prostate cancer is provided in
Table 2.
After evaluation at a cancer
genetics clinic, the patient usually returns to the referring uro l ogist for followup management.
L e a rning of an increased risk for
p rostate cancer that has potential
family implications may place
b u rden on patients. Ongoing psychosocial support and understanding by the urology nurse is
essential. Examples of other
i m p o rtant nursing responsibilities in followup may include verifying the individual’s understanding of information and clarifying any misunderstandings;
p a rticipating in education about
c u rrent prostate cancer screening
methods and the possibility of
f u t u re genetic testing; assessing
the patient’s attitude, motivation
level, perceptions, and knowledge about screening; encouraging health promotion behaviors
and healthy adaptive responses
of the person; and assisting
patients to gain access to community re s o u rces and support
groups. For individuals suspected of having an inherited susceptibility to prostate cancer, part i c ipation in ongoing re s e a rch studies that are investigating the
UROLOGIC NURSING / December 2006 / Volume 26 Number 6
S u m m a ry
Advances in genomic science and technology hold gre a t
p romise for increasing recognition and understanding of the
molecular mechanisms underlying prostatic carcinogenesis.
While significant pro g ress has
been made towards identifying
prostate cancer susceptibility
loci, much work remains to be
accomplished in unraveling the
complexities associated with this
common disease. The discovery
of prostate cancer susceptibility
genes will make it possible to
o ffer genetic testing to high-risk
men and their families in the
f u t u re. Expanding genetic knowledge may also provide insight and
new opportunities for improving
cancer control through the development of better tools for prevention, diagnosis, and treatment.
It is important to remember
that members of families with an
i n c reased risk of prostate cancer
are individuals with diff e rent
levels of perceived vulnerability
and knowledge and diff e re n t
motivations for screening. Each
man must be treated as an individual with a unique set of experiences, beliefs, and knowledge
when it comes to information,
i n f o rmed consent, and screening
behavior. Each man must be
encouraged to make an individual decision re g a rding curre n t l y
available prostate cancer scre e ning, and any genetic testing that
may be off e red in the future, and
what to do with the subsequent
i n f o rmation. With time, genetic
testing to assess here d i t a ry risk
for prostate cancer may become
clinically available. Knowledge
of genetic susceptibility to
p rostate cancer will assist uro l ogy nurses in managing individuals clinically affected with, or at
risk for, this disease. Networking
with genetic specialists and seeking genetic knowledge are important ways by which urology nurses can pre p a re to meet the needs
of families with hereditary
p rostate cancer. •
459
References
American Cancer Society (ACS). (2006).
Cancer facts & figures 2006. Atlanta,
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Arar, N., Thompson, I., Saro d s y, M.,
Harris, M., Shepherd, D., Troyer, D.,
et al. (2000). Risk perceptions among
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Society of Urologic Nurses and Associates is a professional org a n icommitted to excellence in clinical practice and research
Tt h rohezation
ugh education of its members, patients, family, and community. Our
vision is to be the nursing authority in the management of persons with
u rological healthcare concerns.
UROLOGIC NURSING / December 2006 / Volume 26 Number 6