Prostate cancer


Prostate cancer
Prostate cancer is a common cancer affecting the prostate and therefore only humans.

The cancer develops from the tissues of the prostate, a gland in the male reproductive system when cells to mutate to multiply uncontrollably.
These can spread (metastasize) to migrant prostate to other parts of the body (especially the bones and lymph nodes).
Prostate cancer occurs regardless of benign prostatic hypertrophy (or prostate adenoma). It is in the vast majority of cases an adenocarcinoma.
Prostate cancer can cause pain, difficulty urinating, erectile dysfunction and other symptoms.

The processing is done by surgery, radiotherapy, hormone therapy and sometimes chemotherapy, or a combination of these methods.

The rate of this cancer vary widely throughout the world. It is less common in South Asia and Far East, more common in Europe and even the USA. According to the American Cancer Society, cancer is more rare among Asians and more prevalent among blacks (high rates may also be influenced by the increased effort of detection).

Prostate cancer develops most often in men over fifty years. This is the type of cancer most common in men, where he is responsible for more deaths than any other cancer (excluding lung cancer). However, a large number of men who develop prostate cancer never symptoms do not undergo any therapy and ultimately died for other reasons. Many factors are genetic in origin, toxicology and food seem involved in the development of this cancer.

Outbreaks of cancer cells are found in 30 to 70% of cases in studies conducted autopsiques in men 70 to 80 years; prostate cancer remains the most often asymptomatic: a man of 50 years was that a 10% probability of experiencing a diagnosis of prostate cancer, and 3% to die.

Geography of Cancer of the prostate
There are significant geographical differences in the expression of this cancer, which seems more common in men Blacks and in case of attack known in the family. From 1983-2002, while deaths from cancer were generally higher in the Caribbean metropolis, deaths from prostate cancer and stomach were twice as frequent in the West Indies in the mainland (while colorectal cancer and lung cancer were three times less frequent). This could be due to a combination of genetic susceptibility and food (green tea and / or soybeans and foods rich in selenium, for example semblance protect most Japanese living in Japan (while those living in the U.S. as the Americans are not)

Symptomatology and detection
In most cases, prostate cancer is asymptomatic, ie it is discovered as he does any event it is clean. It is most often found;

* During blood tests, including the study of PSA (specific antigen of the prostate, whose predictive value and use, without proven benefit in terms of public health, have recently been challenged). The PSA is a protein normally secreted by the prostate cells, but cancer cells to secrete 10 times more than a normal cell. This property has raised many hopes in terms of screening. The blood level of PSA may also be increased by many other factors (prostate volume, infections and / or inflammation, mechanical (rectal examination, another )...) or decreased by some treatments for benign hypertrophy (finasteride ). It is difficult to define thresholds of significance. It is recognized that a rate of PSA between 4 and 10 ng / ml is doubtful clearly significant beyond. Some authors have proposed to bring the rate to its actual weight of the prostate, or enjoying the report free PSA / total PSA, or the kinetic growth rate over 2 years. Scorer still uncertain for screening, the rate of PSA is, however, a crucial indicator for monitoring and treatment of cancers reported.

* During a rectal examination, conducted as systematic, or because of symptoms related to another illness (especially benign prostatic hypertrophy)

* Incidentally, on parts of resection of the prostate during surgical treatment of prostate adenoma.

When it is symptomatic prostate cancer is most often at an advanced stage. It can lead to:

* An acute retention of urine,
* Hematuria,
* Impotence,
* A deterioration of general condition
* Pain and / or dysfunction or failure of other organs associated with the presence of metastases

The orientation diagnosis based on two key elements: the rectal examination and determination of PSA blood. The abnormality of one or both elements leaves suspect prostate cancer. It will be confirmed or not, taking a sample of the prostate (biopsy) for examination under a microscope. Only the positivity of these biopsies approves plan and start the specific treatment of this cancer. Once confirmed the diagnosis of prostate cancer, will conduct a bone scan in search of bone metastases and a TDM abdomino-pelvic or MRI abdomino-pelvic to clarify the extension of the tumor in the prostate and housing d ' possible pelvic lymph node metastases, retroperitoneal or liver.


* The clinical examination is the fundamental rectal examination.

The most specific is induration of the gland. This may be nodular induration, it may also be of interest to an entire lobe or all of the gland palpable. A heterogeneous consistency or asymmetry signs are much less specific, which can both reflect a simple adenoma, particularly when the prostate is large.

Ultrasound with trans-rectal biopsies
There is currently no consideration imaging practice that could detect only a hotbed of prostate adenocarcinoma with a sensitivity and specificity satisfactory.

Contrary to popular belief still widespread, and although this review and is still often prescribed ultrasound endorectale alone has no use for the positive diagnosis of prostate cancer, given the inconvenience it is likely to cause. It takes, on the other hand, while his interest when it is used to guide prostate biopsies. Other imaging modalities (scanner, MRI) have an interest in the record expansion.

An ultrasound probe endorectale fitted with a guide needle is inserted into the rectum. The biopsies are done with needles fitted with a chuck encoché. The mandrel penetrates the first. The needle just cover it, to decide and imprison and the fragment of prostate located in the notch. The movements of chuck and the needle are automated by a system of springs and the levy is made within a few hundredths of a second. The screen of the ultrasound, with a landmark representing the journey of the needle allows, for example, fire biopsiques very precise.

The number of biopsies, and where they should be, are not well codified and many protocols have been proposed: the aim is to obtain a sample as representative as possible. Currently, it is frequently done 5 to 6 samples per lobe, or 10 to 12 in total. These numbers can be reduced or increased depending on the size of the prostate, tolerance of the patient, or whether a second series of biopsies.

Preparation and conduct
It is a review frequently done on an outpatient basis, ie without hospitalization, or during a hospitalization "de jour". A rectal preparation (enemas) is often advocated. Many centres now offer a systematic antibiotic (short antibiotic treatment to reduce infectious complications). The concomitant anticoagulant treatment is in principle against inappropriate and that any treatment can be a judgement or a temporary modification.

The tolerance of the review is particularly variable from one patient to another. Each hit biopsy itself is very little painful. However, their repetition, and especially the presence and movement of the probe are the main factors discomfort. The inconvenience of this review may justify recourse to a local or general anesthesia. The local anesthesia with a gel anesthetic (lidocaine gel) has never demonstrated its effectiveness. The local anesthetic injection of lidocaine on each side of the prostate (nerves pudendaux) has shown in numerous studies improved tolerance of the examination, however incomplete, because of its low efficiency in the discomfort associated with the presence of the probe. An anesthesia "general" a slight equimolar mixture of oxygen and nitrous oxide ( "MEOPA") has recently been evaluated and appears very effective in this indication. It is even more interesting that easy to implement because does not require the presence of an anaesthetist and seems virtually devoid of side effects. The general anesthesia "classic" is rarely used, reserved for patients who have suffered greatly during a first round of prostate biopsies.

The potential pain disappear within a few tens of minutes. Can occur fairly frequent small bleeding through the anus and in urine for 24 to 72 hours without any seriousness. Small nets blood can also interfere with sperm for several days, again without any consequences.

They are rare and exceptionally serious. It does mention that the main bleeding more abundant, infectious complications (prostatitis).

The cancer began peripheral portion of the gland, unlike benign prostatic hypertrophy of interest to the central area, périurétrale.

The diagnosis is focused on the examination of the biopsy or the operating room.

The seriousness of evolution is correlated with the microscopic appearance (Gleason score), the level of PSA and the spread of the disease.

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