Therapy 2

The therapy that this case study will be conducted over is Xofigo. It is the first Alpha emitting therapy to be approved by the FDA. It is a therapy for the treatment of castration- resistant prostate cancer, symptomatic bone metastases and no known visceral metastatic disease. The procedure and protocol for Xofigo are as follows, obtain patient history and also verify that this is the correct patient for the therapy. Record the date of administration, time of administration, and activity at administration. Have the authorized user verify dose activity and also verify the patient. Administer intravenously over one minute. This slow injection is used to reduce the possibility of negative side-effects. The syringe is then surveyed after to verify how much activity the patient received. Before the patient is discharge the patient is surveyed in the area of patient’s umbilicus and this is recorded. The patient is instructed that he may return to normal life just that when he uses the restroom to flush multiple times. He is also instructed to use a condom if he engages in sex and their female partners to use highly effective contraceptive (Xofigo® - Radium Ra 223 Dichloride Injection). The radiopharmaceutical used is radium- 223 dichloride. This is used because it mimics calcium so it is taken up by new bone growth. It is also an alpha emitter. Since it is an alpha emitter it is idea when combating cancer because it has a high linear energy transfer but it doesn’t travel that far. The standard dosage is 50 kBq(1.35 uCi) per kilogram body weight, this is given over a 4 week interval for a total of 6 injections. The room preparation for this therapy is the same as any other. The room will be completely covered with plastic back paper towels and appropriate aseptic technique should be utilized. There is no scan required because the majority of the radium-223 decays by alpha decay so there is very limited gammas and we are unable to get a valid image.

The patient that the therapy is being performed on is a 63 year old African-American male. He currently lives in Ohio Just outside of Cleveland in Shaker Heights. His father was diagnosed prostate cancer but they were successful in putting it into remission and he lived 9 years after the initial diagnoses. His brother was also recently tested for it; this is what brought him in to get his prostate checked. His diet consists of a steady regimen of red meat and high-fat dairy products. He is currently a firefighter and has been one for 30 years now. When the physician checked his prostate the physician discovered an enlarged prostate. When asked, the patient said that he has had general lower back pain, but he felt that it was due to the amount of strain that he has put on it from working for so long. He also told the physician that he noticed a decreased force when urinating and also that he has been experiencing erectile dysfunction. The nuclear medicine study that should be order is a Prostascint scan to evaluate the prostate for cancer and if possible metastatic sites and if it has spread to the lymph nodes.

When looking at this medical history there are areas to be concerned about. Prostate cancer has been linked to people that have a genetic disposition. This patient father had prostate cancer and that put him at a much greater risk of cancer. The risk is more apparent when a sibling actually has prostate cancer than those who have no history of prostate cancer. Prostate cancer is also more prevalent in patients that are of African-American ethnicity. Studies show that African- Americans are more likely to be diagnosed with an advance stage and are more likely to die from prostate cancer than white men. The question about the patient’s diet is also useful because studies show that there is a correlation between both high intake of red meat and high-fat dairy product. The patient is also a firefighter which is the only occupation that exhibits increased population that is diagnosed with prostate cancer. This could be attributed to the exposure to toxic combustion products (What Are the Risk Factors for Prostate Cancer).

One of the non-nuclear tests that would be ordered for the patient is a PSA blood test. This blood test looks for prostate specific antigen in the blood stream. It’s normal for all men to have this in their system but if it is there in a larger quantity may be indicative of a problem with the prostate but not necessarily prostate cancer. Another test that could be done is a digital rectal examination. This is done to see if the prostate gland has any hard or irregular areas also it is used to estimate the size of the gland itself. The most important test when looking to see of it is prostate cancer is a prostate biopsy. This biopsy medical name is a trans-rectal ultrasound guided prostate biopsy. This biopsy takes a piece of the prostate tissue and is then looked at under a microscope to see if the tissue sample shows any signs of being cancerous. If this scan is normal it cannot completely rule out cancer since only a small sample of tissue is taken.

The results of the therapy for the patient were successful in putting the patient’s prostate cancer into remission. The patient has been instructed to change his diet and to live or more healthy lifestyle to avoid a possible recurrence of cancer. These results confirm the tentative diagnose. It confirms the diagnoses of prostate cancer because this therapy is designed specifically to combat prostate cancer (Testing for Prostate Cancer)

The etiology of prostate cancer is still undetermined but researchers have found multiple risk factors that are related to prostate cancer. It has been found that there is an inherit DNA gene that may cause anywhere from 5 to 10% of all prostate cancer. It is also more of a risk if an individual has multiple ancestors that have had prostate cancer. Also the development of prostate cancer can be attributed to high levels of certain hormones. One group of hormones is androgens, these hormones promote prostate cell growth and this can contribute to an increased risk of prostate cancer in some men. The typical symptoms of prostate cancer include trouble urinating ,decreased force in the stream of urine, blood in the urine, blood in the semen, general pain in the lower back, bone pain, and erectile dysfunction (Prostate Cancer). There are many treatment options. This treatments are all based on the patients situation. The treatments include surgery, radiation therapy, cryosurgery, hormone therapy, chemotherapy and bone directed therapy. The risk for surgery is the same as any major surgery but also may experience problems with controlling urine flow. The benefit is that you are removing the cancer from your body and trying to get as much as possible (What Are the Risk Factors for Prostate Cancer). The prognosis of patients with this disorder is that 5 year survival rate is almost 100% if it is local and regional. But if it spreads and becomes distant that percentage drops down to 28 %.

Works Cited

"Prostate Cancer." Symptoms. N.p., n.d. Web. 22 Apr. 2014.

"Testing for Prostate Cancer." Prostate Cancer UK. N.p., n.d. Web. 22 Apr. 2014.

"What Are the Risk Factors for Prostate Cancer?" What Are the Risk Factors for Prostate Cancer? N.p., n.d. Web. 22 Apr. 2014.

"Xofigo® - Radium Ra 223 Dichloride Injection." Xofigo (radium Ra 223 Dichloride) Injection-Now Approved. N.p., n.d. Web. 22 Apr. 2014.