Prostate Cancer Patient Information Session Marian Waldie RN, BScN Sylvie Bellerive RN, BScN Corrina Arsenault MSW, RSW Prostate Diagnostic Unit Cancer Assessment Clinic 7th Floor General Campus The Ottawa Hospital 2009

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

Kegel Exercises • 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

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)

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

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

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

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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

Drains The 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 Surgery Wound 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 fatty acids 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 Professionals This 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 Urology Service is contacted and the patient be assessed by Urology. Insertion of a catheter by a non-urologist could result in serious consequences for this patient. The Ottawa Hospital Division of Urology

Psychosocial Support for Oncology Patients

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

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

Cancer and Stress… •

Strong scientifically established link between stress and health:     

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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.

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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   

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Get back to basics so you can feel your best    

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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   

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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

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 Society Contact: 1-888-939-3333  Prostate Cancer Association of Ottawa Contact: (613) 828-0762  Gay Buddies With Prostate Cancer Contact: Bruce Bursey at [email protected]  Ninon Bourque Patient Library  Social Work – Cancer Assessment Centre

Regional Program Sites If 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) 4324851 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!