La Castration Chirurgicale dans la Prise en Charge des Cancers Métastatiques de la Prostate à Yaoundé

Franck Biongolo, Freddy Bombah, Vincent de Paul Mama, Zoa Mebara, Bernadette Ngo Nonga

Abstract


RÉSUMÉ
Introduction. Le cancer de la prostate occupe la 5e place des cancers dans le monde. Au stade métastatique, la suppression androgénique demeure la base du traitement. A l’heure où l’utilisation des analogues de la LHRH est répandue, leurs effets secondaires et leurs coûts imposent de reconsidérer la place à accorder à la castration chirurgicale en zone peu développée. L’objectif était d’apprécier l’impact de la castration chirurgicale dans la prise en charge des cancers métastatiques dans notre contexte. Méthodologie. Nous avons réalisé une étude rétrospective et descriptive au Centre Hospitalier et universitaire de Yaoundé de Janvier 2016 au 31 Décembre 2017. Résultats. Nous avons retenu 08 dossiers. L’âge médian était de 72,5 ans. En phase pré-opératoire, les principales plaintes étaient les douleurs osseuses (62,5%), les signes urinaires (50%), et des signes respiratoires (25%). Le taux de PSA médian était de 1050 ng/ml. Le score de Gleason variait entre 7 et 9, le stade TxNxM1b était le plus fréquent. Toutes les interventions ont été faites sous anesthésie locale. Le ratio traitement chirurgical/ médical variait de 0,016 à 0,091. En phase post opératoire on notait un amendement de la symptomatologie en dehors des signes respiratoires. Le taux de PSA avait diminué avec une valeur médiane de 7 ng/ml. La qualité de vie était jugée satisfaisante dans 75% des cas. Nous avons enregistré le décès de 02 patients dans le mois qui a suivi leur intervention. Conclusion. La castration chirurgicale améliore l’état général et la symptomatologie. Elle est une option de choix dans notre contexte socio-économique.
ABSTRACT
Background. Prostate cancer ranks 5th among cancers in the world. At the metastastic stage, androgen suppression remains the basis of treatment. At a time when the use of LHRH analogues is widespread, their side effects and their costs make it necessary to reconsider the place to be given to surgical castration in underdeveloped areas. The objective was to appreciate the impact of surgical castration in the management of metastatic cancers in our context. Methods. We carried out a retrospective and descriptive study at the Yaounde University Hospital Center from January 2016 to December 31, 2017. Results. We retained 08 files. The median age was 72.5 years. In the preoperative phase The main complaints were bone pain (62.5%), urinary signs (50%), and respiratory signs (25%). The median PSA level was 1050 ng / ml. The Gleason score varied between 7 and 9, the TxNxM1b stage was the most frequent. All procedures were performed under local anesthesia. The surgical / medical treatment ratio ranged from 0.016 to 0.091. In the postoperative phase there was an improvement in the symptomatology apart from the respiratory signs. The PSA level had decreased with a median value of 7 ng / ml. The quality of life was considered satisfactory in 75% of the cases. We recorded the deaths of 02 patients in the month following their intervention. Conclusion. Surgical castration improves the general condition and the symptomatology. It is an option of choice in our socio-economic context.

Keywords


Cancer, prostate, orchidectomy, pulpectomy.

Full Text:

PDF (Français)

References


Grosclaude JL, Neuzillet C, Coulange C. Evolution de l’épidémiologie du cancer de la prostate depuis 20 ans. Prog En Urol. 2006;16(1):653–660.

White JW. I. The results of double castration in hypertrophy of the prostate. Ann Surg. 1895;22(1):1.

Huggins C. Studies on prostatic cancer: ii. The effects of castration on advanced carcinoma of the prostate gland. Arch Surg. 1 août 1941;43(2):209.

Rebillard X, Villers A, Ruffion A, Beuzeboc P, Soulie A, Richaud P, et al. Cancer de la prostate. Prog Urol. 2002;12(Suppl 2):5.

Fellows GJ, Clark PB, Beynon LL, Boreham J, Keen C, Parkinson MC, et al. Treatment of advanced localised prostatic cancer by orchiectomy, radiotherapy, or combined treatment. A Medical Research Council Study. Urological Cancer Working Party--Subgroup on Prostatic Cancer. Br J Urol. sept 1992;70(3):304 9.

Penson DF, Ramsey S, Veenstra D, Clarke L, Gandhi S, Hirsch M. The cost-effectiveness of combined androgen blockade with bicalutamide and luteinizing hormone releasing hormone agonist in men with metastatic prostate cancer. J Urol. août 2005;174(2):547 552; discussion 552.

Rohde V, Grabein K, Hessel F, Siebert U, Wasem J. Orchiectomy versus medical therapy with LH-RH analogues for the treatment of advanced prostatic carcinoma. GMS Health Technol Assess. 26 mai 2006;2:Doc13.

Fournier G, Valeri A, Mangin P, Cussenot O. Cancer de la prostate. Épidémiologie. Facteurs de risques. Anatomopathologie. /data/revues/00034401/v0038i05/04000609/ [Internet]. [cité 30 janv 2018]; Disponible sur: http://www.em-consulte.com/en/article/27479

McNeal JE. Regional morphology and pathology of the prostate. Am J Clin Pathol. mars 1968;49(3):347 57.

Seisen T, Rouprêt M, Faix A, Droupy S. La prostate : une glande au carrefour uro-génital. /data/revues/11667087/v22sS1/S1166708712700283/ [Internet]. 5 juill 2012 [cité 30 janv 2018]; Disponible sur: http://www.em-consulte.com/en/article/735764

Bailleul JP, Mauroy B. Anatomie du testicule, des voies spermatiques et des bourses. EMC Urol. 1991;18–600.

Tostain J, Rossi D, Martin PM. Physiologie des androgènes chez l’homme adulte. Prog Urol. 2004;14(5):639–660.

Rohde V, Grabein K, Weidner W, Wasem J, Hessel F. [The German HTA report: orchiectomy versus LH-RH analogues in the treatment of advanced prostate carcinoma: are there any consequences for the daily health service?]. Aktuelle Urol. nov 2008;39(6):448 55.

Terris MK, Qureshi SM, Rhee A. Metastatic and advanced prostate cancer. EMedicine Website Available Httpemedicine Medscape Comarticle454114-Overv Accessed Oct 12 2012. 2012;

Metastatic and Advanced Prostate Cancer: Overview, Epidemiology of Advanced Prostate Cancer, Presentation of Advanced Prostate Cancer. 20 nov 2017 [cité 3 févr 2018]; Disponible sur: https://emedicine.medscape.com/article/454114-overview

Masson E. Cancer de la prostate. Traitement [Internet]. EM-Consulte. [cité 30 janv 2018]. Disponible sur: http://www.em-consulte.com/article/27802/cancer-de-la-prostate-traitement

Rud O, Peter J, Kheyri R, Gilfrich C, Ahmed AM, Boeckmann W, et al. Subcapsular Orchiectomy in the Primary Therapy of Patients with Bone Metastasis in Advanced Prostate Cancer: An Anachronistic Intervention? [Internet]. Advances in Urology. 2012 [cité 30 janv 2018]. Disponible sur: https://www.hindawi.com/journals/au/2012/190624/

GDP per capita (current US$) | Data [Internet]. [cité 30 janv 2018]. Disponible sur: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD

De Paula AAP, Piccelli HRS, Pinto NP, Teles AG, Franqueiro AG, Maltez ARL, et al. Economical impact of orchiectomy for advanced prostate cancer. Int Braz J Urol Off J Braz Soc Urol. avr 2003;29(2):127-130; discussion 130-132.

Mariani AJ, Glover M, Arita S. Medical versus surgical androgen supression therapy for prostate cancer: a 10-year longitudinal cost study. J Urol. 2001;165(1):104–107.

Sangar VK, Ragavan N, Matanhelia SS, Watson MW, Blades RA. The economic consequences of prostate and bladder cancer in the UK. BJU Int. janv 2005;95(1):59 63.

Rohde V, Grabein K, Hessel F, Siebert U, Wasem J. Orchiectomy versus medical therapy with LH-RH analogues for the treatment of advanced prostatic carcinoma. GMS Health Technol Assess [Internet]. 26 mai 2006 [cité 30 janv 2018];2. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011358/

Nyga ard R, Norum J, Due J. Goserelin (Zoladex) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis. Anticancer Res. 2001;21(1B):781–788.

Hering FL, Dall’oglio MF, Caponero R, Rodrigues PR, Nesrallah LJ, Srougi M. Total versus subcapsular orchiectomy for treatment of advanced prostatic carcinoma: Comparison of serum testosterone and PSA levels. J Bras Urol. 1999;25:221–4.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

********************************************************************************************