The prostate is a small male gland located at the intersection of the urinary and sperm lines, in front of the rectum.
It is thus a passage zone for the bladder channels that allow the passage of urine and the seminal channels that transport semen during ejaculation. An important channel is the prostatic urethra.
Most of the prostate is made up of glands and is surrounded by a fibro-elastic capsule.
The prostate is composed of 3 zones:
• A central zone that surrounds the ejaculatory ducts.
• An intermediate zone crossed by the prostate urethra. Initially it represents only 5% of the prostate then increases from 40 years of age, responsible for benign prostatic hypertrophy.
• A peripheral area that is the most important area that can be felt with A rectal exam. This is the preferred area for malignant tumours.
There are 3 types of cells in the prostate:
Glandular cells (ejaculate secretors), fibrous cells (constitutional) and muscle cells (control urine and ejaculation jets) in the shape of a small inverted chestnut (base at the top and top at the bottom). It weighs 20 grams.
It consists of 3 lobes: 1 central and 2 lateral, right and left.
It is highly vascularized and depends on so-called androgenic male hormones to function properly.
Prostate cancer is the most common cancer in men over 50 years of age. It is the 2nd largest human cancer mortality rate in the world. It is the first of the urogenital cancers.
The highest incidence is in the USA and Canada with African Americans predominating. The lowest incidence is in China, Japan and India. The incidence is intermediate in Europe, with a higher incidence in Sweden than in Spain.
Its incidence increases with age; rare before age 50, it reaches 50% after age 50 and 75% after age 80. Its average age of diagnosis is 70 years.
• Urinary disorders are often the reason for consultation: frequent urination during the day and especially at night, often patients even describe bladder weakness. Also, problems with urine evacuation are reasons for consultation (weakness of the stream, delayed drops, feeling of incomplete urination).
• Erectile dysfunction or ejaculation are also symptoms.
Duration of hospital stay
The time spent abroad depends on the treatment.
Average length of stay
Several long stays may be necessary.
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L’interrogatoire et l’examen clinique sont essentiels. L’interrogatoire permet au médecin de noter l’âge ainsi que les antécédents familiaux et personnels.
The clinical examination looks for neurological disorders, a bladder globe, lumbar pain reflecting the impact of urinary disorders on the kidneys, an inguinal hernia developed by the thrust effort, and inflammatory bone pain associated with bone metastases.
The rectal examination is an essential test. It allows you to feel the prostate to notice an increase in size or volume, determine its consistency and the regularity of its contours.
Standard tests (blood count, sedimentation rate, ionogram, ureatemia and creatinine) are always required.
The specific dosage is the prostate specific antigen or PSA (pathological so high) with measurement of the ratio of free PSA to total PSA (pathological if it is less than 15-20%).
A cytobacteriological examination of the urine is systematically performed.
Mictional flow measurement:
It objectively measures the maximum and average flow rates during urination. The normal maximum flow rate is between 25 and 35ml/sec.
Transrectal vesico-prostatic ultrasound:
It consists of passing an ultrasound probe by rectal way under local anaesthesia after taking antibiotics 48 hours before and a rectal enema the day before in the evening. The ultrasonic waves are transmitted back to the screen thanks to a gel placed on the probe.
This imaging is used to evaluate the volume of the prostate gland, its echostructure. It also allows to see the higher urinary tract and to evaluate the post-micturition residue. During this ultrasound, biopsies are performed.
Echoguided prostate biopsies confirm the diagnosis and assess its prognosis using the Gleason score (degree of tumour differentiation, i. e. the tendency of the tumour to resemble normal prostate tissue. It is a microscopic evaluation rated from 2 to 10, 10 being the maximum degree of aggressiveness).
At the end of this assessment, prostate cancer can be classified according to the D'amico classification based on 3 prognostic factors:
• The clinical stage with the rectal examination
• Gleason's score
• The PSA rate
There are thus 3 categories: low risk, intermediate risk and high risk.
The international cancer classification is based on the TNM classification:
T = tumour
N = nodes
M = metastases
The extension assessment:
It is reserved only for patients considered most at risk according to D'Amico's classification.
• Prostatic MRI in search of capsular crossing and invasion of seminal vesicles or pelvic lymph nodes.
• The thoraco-abdomino-pelvic CT scanner, which looks for pelvic and lumbo-aortic lymph nodes, visceral metastases, invasion of the bladder and its appendages.
• Bone scanning for Bone metastases.
There are 4 different stages of prostate cancer:
This is an active treatment in which patients with prostate cancer and a life expectancy > 10 years are closely monitored and regularly rebiopsied.
This treatment is for patients with low-risk localized prostate cancer with certain criteria:
Chemotherapy is only used in cases of castrate-resistant cancer. A drug that can be combined with oral corticosteroids is injected every 3 weeks as a one-hour infusion. It is carried out in a one-day hospital stay.
Biological and clinical control examinations are systematically carried out. It is associated with hormone therapy by taking oral medication.
Some complex diseases such as cancer can lead some patients to seek a second medical opinion. Almost 50% of patients using the second medical opinion have seen their treatment options evolve. Seeking a second medical opinion is perfectly legitimate when faced with a serious illness.
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