Lagarto Ã¡podo americano

The cancer of the prostate is a frequent Cancer concerning the Prostate and thus exclusively the man. It is a disease in which cancer develops in the prostate, a gland of the male reproductive system. It occurs when the cells of the prostate transfer and start to multiply in an uncontrolled way. These cells can extend (métastaser) since the prostate to other parts of the body, especially the bones and the ganglia lymphatic. The cancer of the prostate can cause pains, a difficulty in urinating, an erectile dysfunction and other symptoms.

The rates of cancer of the prostate vary considerably throughout the world. Despite everything, it is less widespread in South Asia and the Far East, more commun run in Europe and even more common to the the United States. According to the American company of Cancer, the cancer of prostate is less frequent at Asian and the more widespread at the blacks. However, these high rates can be influenced by the increase in the rates of detection.

The cancer of the prostate generally develops at the men of more than fifty years. This cancer touches only the men, since the prostate belongs exclusively to the male reproductive tract. It is the type of the cancer most common at the men to the United States, where it is responsible of more than masculines deaths than any other cancer, if it is not the Lung cancer. However, a great number of men who develop a cancer of the prostate never do not test symptoms, do not undergo any therapy and die finally for other reasons. Many factors, including the Genetic and the food Mode, was implied in the development of this cancer.

The cancer of the prostate is generally discovered during a Medical examination or while carrying out blood tests, like the study of PSA (specific antigen of the prostate). Currently one called into question the exactitude of the study of the PSA and his use. Once suspected, one can confirm the cancer of prostate by removing a piece of the prostate (Biopsie) and by examining it with the Microscope. Additional checks, like the X-rays and the scanner S osseous, can be carried out to determine if the cancer of prostate extended.

One can treat the cancer of the prostate by the Chirurgie, the Radiothérapie, the hormonal therapy, sometimes the Chimiothérapie, or a combination of these methods. The age, the general health of the man as well as the measurement of propagation, the aspect under the microscope and the response of cancer to a head end are important to envisage the exit of the disease. As the cancer of the prostate is a disease of old men, much will die for other reasons before the cancer of prostate could extend or cause symptoms. That makes difficult the choice of the treatment. To decide if one will treat or not a cancer localized of the prostate (a tumor limited inside the prostate) in the intention to cure it is an arbitration which one must make between the favorable effects and vermin until one waits from the point of view of the survival of the patient and his quality of life.

The cancer of the prostate occurs independently of the benign Hypertrophie of the prostate (or prostatic adenoma). It is in the vast majority of the cases a Adénocarcinome.

Epidemiology

Hearths of cancer cells are found in 30 to 70% of the cases at the time of autopsic studies carried out at men of 70 with 80 years; the cancer of the Prostate remains nevertheless generally asymptomatic: a 50 year old man has only one probability of 10% of knowing a diagnosis cancer of the Prostate, and of 3% to die about it.

This cancer would be more frequent at the man of black race and in the event of attack known in the family.

Symptomatology and circumstances of discovery

In the majority of the cases, the cancer of the prostate is asymptomatic, i.e. it is discovered whereas it does not involve any demonstration being clean to him:

Examination rectal carried out on a purely systematic basis, or because of symptoms related to another disease (in particular the benign hypertrophy of the prostate),
tracking by the blood proportioning of the PSA (Prostatic Specific Antigen) more and more frequently proposed, although this tracking did currently not show a benefit in term of public health,
fortuitous discovery on parts of résection prostate sufferer during the surgical treatment of the prostatic adenoma.

When it is symptomatic, the cancer of the prostate is generally at a advanced stage. It can involve:

an acute retention of urine,
a Hématurie,
a Impotence,
a deterioration of the general state,
of the pains and/or the dysfunction or the failure of other bodies related to the presence of metastasis S

Diagnosis

The diagnostic orientation rests on two key elements: rectal examination and the blood proportioning of the PSA. The anormality of one or these two key elements leads to the realization of biopsies prostate sufferers. Only the positivity of these biopsies authorizes to plan and begin the specific treatment from this cancer.

Private clinic

the fundamental clinical examination is the rectal examination.

The most specific sign is an induration of gland. This induration can be nodular, it can also interest a whole lobe even the whole of palpable gland. A heterogeneous consistency or an asymmetry is signs much less specific, which can as well translate a simple adenoma, in particular when the prostate is of big size.

Biological

Measurement of the rate of PSA.

The PSA is a protein normally secreted by the cells prostate sufferers; one considers nevertheless whom an cancer cell secretes 10 times more than one normal cell. This property raised many hopes in term of tracking. The blood rate of PSA however is increased by very many factors (prostatic volume, mechanical infections and/or ignitions, constraints (examination rectal, other)…) or decreased by certain treatments of benign hypertrophy (finasteride). It is thus difficult to define thresholds of significativity. It is allowed that a rate of PSA ranging between 4 and 10 ng/ml is doubtful, definitely significant beyond. Certain authors proposed to bring back the rate to the net weight of the prostate, or to appreciate the free report/ratio PSA/total PSA, or the kinetics of growth of the rate over 2 years.

Still dubious marker for tracking, the rate of PSA is on the other hand an essential indicator for the follow-up and the treatment of declared cancers.

Tracking

The difficulties of the tracking of the cancer of the prostate are multiple, and the unsolved stake is at the end of the lifetime to differentiate the potentially evolutionary and dangerous forms from the quiescent forms probably reaching a man on two.

Tracking in its current form rests only on two examinations intrinsically very insufficient (with a view to this tracking): the proportioning of the rate of PSA and the Examination rectal (this last which can find a nodule or a localized induration). These examinations have a Spécificité and a low Sensibilité. More recently, an analysis of the gene PCA3, follow-up of biopsies was proposed.

The tracking campaigns thus carried out make certainly it possible to detect a great number of “carriers” of cancer cells, but the risk of “surtraitement” and related morbidity remains difficult to evaluate. Moreover, it was not shown in an unquestionable way a reduction of mortality nor a frank improvement of quality of life at the people thus detected and treated surgically.

Echography with Biopsy S trans-rectal

There does not exist currently any examination of imagery of current practice likely to detect only a hearth of prostatic adenocarcinomist with a satisfactory sensitivity and a specificity.

Contrary to an idea still largely spread, and although this examination still is thus often prescribed, the echography endorectale, only, does not have utility for the positive diagnosis of the cancer of the prostate, taking into consideration nuisance which it is likely to cause. It takes, on the other hand, all its interest when it is used to guide biopsies prostate sufferers. The other methods of imagery (scanner, IRM) have an interest in the assessment of extension.

Technique

A probe of echography endorectale provided with a guide of needle is introduced into the rectum. The biopsies are carried out with needles provided with a notched chuck. The chuck penetrates the first. The needle comes to cover it, to slice and imprison thus the fragment of prostate located in the notch. The movements of the chuck and the needle are automated by a system of springs and the taking away is carried out in some hundredths of second. The screen of the echograph, provided with a reference mark representing the way of the needle, allows, thus, of the very precise shootings biopsic.

The number of the biopsies, and the place where they must be done, are not well codified and of many protocols were proposed: the goal is to obtain a sampling as representative as possible. Currently, it is frequently carried out 5 to 6 taking away per lobe, that is to say 10 to 12 on the whole. These numbers can be decreased or increased according to the size of the prostate, the tolerance of the patient, or if it is about one of a second series of biopsies.

Preparation and unfolding

It is about an examination frequently carried out into ambulatory, i.e. without hospitalization, or at the time of a hospitalization “of day”. A rectal preparation (rectal injections) is often recommended. Many centers propose from now on a antibio systematic Prophylaxie (short antibiotic treatment in order to limit the infectious complications). The concomitant catch of an anticoagulant treatment is contra-indicated in theory and this possible treatment can be the object of a temporary stop or a modification.

Tolerance

The tolerance of the examination is particularly variable from one patient to another. Each shooting biopsic is in itself far from painful. On the other hand, their repetition, and especially the presence and the movements of the probe are the independent factors of discomfort. The nuisances of this examination justify sometimes the recourse to a local anesthesia or general. The local anesthesia with an anesthetic gel (freezing of lidocaïne) forever been the proof of its effectiveness. The local anesthesia by injection of lidocaïne on each side of the prostate (pudendaux nerves) showed in many studies an improvement of the tolerance of the examination, however incomplete, because of its low effectiveness on discomfort related to the presence of the probe. A “general” anesthesia light by équimolaire mixture of oxygen and nitrogen protoxide (“MEOPA”) recently was evaluated and seems very effective in this indication. It is all the more interesting as easy to implement because the presence of an anesthetist does not require and seems practically stripped of undesirable effects. The general anesthesia “traditional” is seldom practiced, held to the patients having suffered much during a first series from biopsies prostate sufferers.

Continuations

The possible pains disappear in a few tens of minutes. Can occur in way rather frequent of small bleedings by the anus and in the urines, during 24 to 72 hours without any gravity. Small blood nets can also mix with sperm, during several days, once again without any consequence.

Complications

They are rare and exceptionally low registers. Only the principal ones will be quoted: more abundant bleedings, infectious complications (prostatitis).

Anatomopathology

Cancer undertakes the peripheral portion of gland, contrary to the hypertrophy benign prostate sufferer which interests the central zone, périurétrale.

The diagnosis is related only to the examination of the biopsy or the operational part.

The gravity of the evolution is correlated with the microscopic aspect ( score of Gleason ), the level of the PSA and the extension of the disease.

Assessment of extension

Although determining for the therapeutic assumption of responsibility, the assessment of extension of cancers of the prostate is difficult. Indeed, the examinations of imagery usable in routine have overall a low capacity to show (echography, scanner, IRM) or to precisely locate (scintiscanning) the lesions of origin prostate sufferer, in particular because of the character slightly vascularized of this cancer. The IRM is the least bad examination to determine the local extension. The IRM or the scanners of new generation (voluminal) is practiced to seek the attack of the ganglia, but only the ganglia whose size is increased are detected. New products of contrast in IRM, known as “superparamagnetic” could improve detection of the ganglia reached. The scintiscanning is useful for the research of the osseous métastatses. The tomography by emission of positons (camera Mtoe, Fart-scan) does not have on the other hand an indication, because of the character very little or not hypermetabolic of the cancer of the prostate.

Treatment

The treatment must be discussed on a case-by-case basis according to the extension cancer, the general state of the patient and the associated diseases.

Medical

Hormonothérapie

There is a correlation between the production of testosterone (hormone male) and the multiplication of the cancer cells. A treatment blocking or strongly reducing the production of this hormone makes it possible to very effectively slow down the evolution of the disease. Certain drugs are managed in the form of a subcutaneous injection every 3 months. Others are managed by oral way. The side effects are however many, but seldom serious. The hormonothérapie, which was the reserved treatment with the evolved/moved forms, or metastatic, saw its indications extended to the treatment of the tumors challenged for the surgery (because of size of the tumor, of the risk of chirugie noncomplete,…) and for which the rate of relapse after radiotherapy remained important. The more total control of the disease, by adding radiotherapy and hormonothérapie for 3 years, makes it possible to notably improve the number of patients for whom the disease remains undetectable.

The pulpectomy (ablation of the fabrics testiculaires) is hardly any more used since the Nineties.

Chemotherapy

Until the beginning of the year 2000, the use of cytotoxic chemotherapies, in metastatic cancers of prostate, and whose usual treatment by hormonothérapie became ineffective (judged in particular on the increase repeated in the PSA in spite of a androgenic suppression), proved to be a failure. The advent of the docetaxel (Taxotere°) modified the therapeutic possibilities, between opened by the mitoxantrone (Novantrone°) a few years earlier. For the first time, a molecule used at a advanced stage of the disease, managed to improve survival and quality of life of the patients. Three controlled studies confirm these results, and others, are in hand more precociously to integrate chemotherapy in the history of the disease: for tumors locally advanced, in the event of biological progression but before the appearance of metastases, and why not, as of after the surgery, to treat possible microphone-metastases.

palliatives

The treatment of the pain, by using the usual range of the analgesics (classified by stages from 1 to 3, according to their power, 3 representative opiated analgesics, should never be forgotten top of the list of the palliative treatments. Even if they are not specific cancers of the prostate, these treatments are very frequently employed, taking into account the great frequency of osseous metastases at a given time of the evolution, and the importance of the pains which they can generate. The biphosphonates, by oral way (clodronate) or injectable (zoledronate, pamidronate, ibandronate) are of a utility statistically shown like higher than the placebo, in the treatment of osseous metastases. The irradiation of painful osseous metastases or the compressive masses, can regularly, especially in the first case, to make a durable symptomatic improvement. The scintiscanning with the samarium (Quadramet), is business of specialists, resting on the administration, in nuclear medicine, as on the principle of the diagnostic osseous scintiscanning to technetium 99, of an isotope which is distributed almost exclusively in bone tissue. So and thanks to its duration of action, it can bring a relief in 50 to 70% of the cases, and for several months. But its access is not inevitably easy, the patient must be in general good state and avecc a satisfactory hémogramme. Moreover, chemotherapy must be stopped during several weeks for this procedure.

Surgical

It rests on the Prostatectomie, known as radical or total. It comprises the ablation of the prostate and the seminal blisters and can be preceded by a taking away of the ganglia of drainage of the prostate. The surgery can be realized by open way (surgical incision on the level of the abdomen or the level of périnée) or by abdominal coelioscopic way; the surgery is reserved for the cancers located with the prostate and offers great chances of cure if cancer is indeed localized and little or fairly aggressive (aggressiveness estimated by the score of Gleason); it can involve a urinary, generally temporary incontinence and disorders of erection. Currently, there is no superiority of a technique compared to another with regard to the carcinological results and the urinary and sexual functional results.

Coelioscopy

Cœlioscopic prostatectomy was used by an American team which published in 1997 qu ' it gave up after 8 cases so much the intervention was difficult. They are the French teams which at the end of 1997 and at the beginning of 1998 took again the torch and showed that this technique was feasible. Gaston of Bordeaux, and Vallancien and Guillonneau of Paris developed the technique by standardizing it. Vallancian and his team published the technique by way transpéritonéale then by way under péritonéale which seems simpler. She is now recognized in the whole world. With an experiment of almost 3000 operations carried out, the surgical team of the institute Montsouris in Paris could show the advantages of cœlioscopic prostatectomy: it is necessary to retain the shorter hospital stay (5 days against 8 on average according to the statistics of the PMSI 2004, the pain post operational less even quasi null, the rate of transfusion from approximately 2 to 3% compared with on average 15% for the open surgery. The contractings of the joining between the bladder and the channel of the urethra are rarer (1,5%). The renewal of activity is fast after approximately a semaine..

Cryoablation

The prostatic fabric cancer patients can be destroyed by local application of a very cold gas. The cryosonde (generally cooled with nitrogen liquidates) is introduced in endourétral to the prostate, the good position of the cryode can be checked by varied technique and in particular an endoscopy carried out by a pubic trocard known, transvésical. A cycle of congelation and defrosting will be implemented during a few minutes and repeated if necessary, a probe urétrovésicale is posed at the end of the technique and will allow the progressive evacuation of fabrics necrosed by the application of the cold, some practice a résection transurétrale fabrics mortified by the cryothérapie to accelerate the process. Another technique passes by the installation of particular needles per way périnéale and under echographic control.

Ultrasounds focused of high intensity (HIFU)

This technique is recent and noninvasive. Its use in first intention is particularly well adapted to certain indications and in particular the patients reached of cancer localized of the prostate not candidates to the surgery, either because of their age (more than 70 years), or because of factors of Co-morbidity (previous, obesity, disorders cardiac, etc) In second intention, this treatment was the proof of its utility in the case of patient in situation of failure after radiotherapy. The principle consists in focusing beams of ultrasounds of high intensity in the prostate so as to obtain an effect of thermal ablation of this one.

Radiotherapy

It can be external or by establishment of radioactive components in the body even of the prostate.

Prevention

There does not exist preventive medication with a shown effectiveness. The Finastéride was tested and seems to decrease the incidence of this cancer but the latter seem to be more serious, which cancels the advantage of it.

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