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Abstract
RÉSUMÉ
Objectif. Déterminer la fréquence du cancer de la prostate chez les sujets de plus 75 ans et décrire les aspects diagnostiques et thérapeutiques de cette affection dans notre service. Population et méthodes. Il s’agit d’une étude descriptive et rétrospective réalisée dans le service d’Urologie-Andrologie, d’anatomie et de cytologie pathologique du CHU de Brazzaville, du 1er janvier 2008 au 31 décembre 2018. Les paramètres étudiés étaient : la fréquence, l’âge, la provenance des patients, les signes révélateurs, le PSAT, le résultat de l’examen anatomopathologique, la classification TNM, le type de traitement et les résultats du traitement après un recul moyen de six mois. Résultats. Durant cette période, 99 patients âgés de 75 ans ou plus ont été hospitalisés et traités pour cancer de la prostate, sur un total de 485 patients avec cancer. La fréquence hospitalière de notre groupe d’étude était de 1,6% et l’âge moyen de 79,6 ans +/- 14,8 ans. Le diabète et l’hypertension artérielle étaient retrouvés respectivement chez 31 et 5 patients. S’agissant des troubles urinaires, 24 patients avaient une rétention d’urine et 12 patients, une hématurie. Seize patients présentaient des troubles neurologiques liés à une compression médullaire. Au toucher rectal, le plus souvent, la prostate avait les caractéristiques d’un cancer de la prostate. Quatre-vingt-seize pour cent des patients avaient des métastases et le traitement hormonal a été indiqué chez tous ses patients. Trente-six cas de décès ont été enregistrés durant cette période. Conclusion. Le cancer de la prostate est une maladie fréquente à cet âge car son incidence augmente avec l’âge. Le diagnostic se fait tardivement car les patents arrivent tard à la consultation d’où l’intérêt de la pratique du dépistage individuel. Sa prise en charge est délicate prenant en compte l’état général du patient, son espérance de vie et la présence des comorbidités.
ABSTRACT
Objective. To determine the frequency of prostate cancer after age 75 and to describe the diagnostic and therapeutic aspects of this condition within our department. Population and methods. This was a descriptive and retrospective study carried out in the Department of urology-andrology, anatomy and pathological cytology at the University Hospital of Brazzaville, from January 1, 2008 to December 31, 2018. The data of study were: prevalence, age, patient origin, main clinical findings, PSAT, histological diagnosis, TNM classification, treatment modalities and outcomes after a 6-month follow up period. Results. During our study period, 99 patients aged 75 years or more were hospitalized and treated for prostate cancer out of a total of 485 patients with prostate cancer. The hospital frequency was 1.6% and the average age was 79.6 years and 14.8 years. The main comorbidities were diabetes (N=31) and high blood pressure (N=5). Concerning urinary disorders, 24 patients had urine retention and 12 patients had hematuria. Sixteen patients had neurological disorders related to spinal compression. On rectal examination, the prostate had diagnostic features of prostate cancer. Ninety-six percent of the patients had metastases and hormonal treatment was administrated to all those patients. Thirty-six deaths were recorded during the six month follow up period. Conclusion. Prostate cancer is a common disease at this age because its incidence increases with age. The diagnosis is late because of the long delay before consultation, hence the interest of individual screening. The management is difficult, and should consider the general condition of the patient, his life expectancy and the presence of comorbidities.
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References
- Ferlay J, SoerJomataram I, Dikshit R, Eser S et al. L'incidence du cancer et de mortalité dans le monde: les sources, les méthodes et les principaux profils. GLOBOCAN 2012. Int J Cancer (2015) ; 136 : 359-386.
- Droz J.P., Balducci L., Bolla M., Emberton M. et al. Background for the proposal of SIOG guidelines for management of prostate cancer in senior adults. Crit Revi Onc Hemat (2010), 73 ; 68–9.
- www.who.int/gho/publications/world_health_statistics/2016/EN_WHS2016_AnnexB. Vu le 25 février 2020.
- Berger N.A, Savvides P, Koroukian S.M, Kahana E.F, Deimling G.T et al. Cancer in the Elderly. Trans Am Clin Climatol Assoc. 2006; 117: 147–156.
- Mongiat-Artusa P, Peyromaurea M, Richauda P, Drozb J P et al. Recommandations pour la prise en charge du cancer de la prostate chez l'homme âgé : un travail du comité de cancérologie de l'association française d'urologie Prog Urol (2009), 19, 11 ; 810-7
- Shah N, Ioffe V. Frequency of Gleason Score 7 to 10 in 5100 Elderly Prostate Cancer Patients. Rev Urol. (2016), 18,4 :181-187.
- Hu JC, Nguyen P, Mao J, Halpern J et al. Increase in Prostate Cancer Distant Metastases at Diagnosis in the United State. JAMA Oncology (2016), http://oncology.jamanetwork.com/ by a University of California - San Diego vu le 13 février 2020.
- Bouya P.A, Odzebe ASW. Cancer de la prostate avant l’âge de 50 ans. Carcinologie pratique en Afrique 2010, 9,1 : 36-40.
- Mitsuzuka K, Arai Y. Controversies associated with the evaluation of elderly men with localized prostate cancer when considering radical prostatectomy. Int J Clin Oncol (2014) 19 :793–9.
- Kunz I, Musch M, Roggenbuck U, Klevecka V et al. Tumour characteristics, oncological and functional outcomes in patients aged ≥ 70 years undergoing radical prostatectomy. BJUI (2013), 111,3b ; 24–9.
- Ko J, Falzarano SM, Walker E, Smith KS et al. Prostate cancer patients older than 70 years treated by radical prostatectomy have higher biochemical recurrence rate than their matched younger counterpart. Prost (2013), 73, 8 ; 897–903.
- Walter L.C, Fung K.Z, Kirby K.A, Shi Y et al 5-Year Downstream Outcomes Following Prostate-Specific Antigen (PSA) Screening in Older Men. JAMA Intern Med. (2013), 173,10 ; 866–73.
- Parker C, Gillessen S, Heide nreich A, Horwich A. On be half of the ESMO Guidelines Committee. Cancer of the prostate : ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology (2015), 26, 5 ; 69-77.
- Saad F, Chi KN, Finelli A, Hotte SJ et al. The 2015 CUA-CUOG Guidelines for the management of castration-resistant prostate cancer (CRPC). Can Uro Assoc J. (2015), 9, 3-4 ; 90-6.
- Mangiat-Artus P, Alvelin D. Prise en charge diagnostique et thérapeutique des cancers de la prostate chez l'homme de plus de 75 ans. Presse Med. (2017). http://dx.doi.org/10.1016/j.lpm.2017.09.009.
- Ziouziou I, Karmouni T, El Khader K, Koutani A, et al. Complications de l’hormonothérapie anti-androgénique du cancer de la prostate. Can Urol Assoc J. (2014), 8, 3-4 ; 159–62.
- Smith MR, Lee H, Fallon MA, Nathan D.M. Adipocytokines, obesity, and insulin resistance during combined androgen blockade for prostate cancer : Evidence for a Distinct Hypogonadal Metabolic Syndrome ? Urology. (2008), 71 ; 318–22.
- Keating NL, O’Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol (2006), 24 ; 4448–56.
- Office for National Statistics. Cancer survival in England: adults diagnosed in 2009 to 2013, followed up to 2014. Newport : ONS ; 2015.
References
Ferlay J, SoerJomataram I, Dikshit R, Eser S et al. L'incidence du cancer et de mortalité dans le monde: les sources, les méthodes et les principaux profils. GLOBOCAN 2012. Int J Cancer (2015) ; 136 : 359-386.
Droz J.P., Balducci L., Bolla M., Emberton M. et al. Background for the proposal of SIOG guidelines for management of prostate cancer in senior adults. Crit Revi Onc Hemat (2010), 73 ; 68–9.
www.who.int/gho/publications/world_health_statistics/2016/EN_WHS2016_AnnexB. Vu le 25 février 2020.
Berger N.A, Savvides P, Koroukian S.M, Kahana E.F, Deimling G.T et al. Cancer in the Elderly. Trans Am Clin Climatol Assoc. 2006; 117: 147–156.
Mongiat-Artusa P, Peyromaurea M, Richauda P, Drozb J P et al. Recommandations pour la prise en charge du cancer de la prostate chez l'homme âgé : un travail du comité de cancérologie de l'association française d'urologie Prog Urol (2009), 19, 11 ; 810-7
Shah N, Ioffe V. Frequency of Gleason Score 7 to 10 in 5100 Elderly Prostate Cancer Patients. Rev Urol. (2016), 18,4 :181-187.
Hu JC, Nguyen P, Mao J, Halpern J et al. Increase in Prostate Cancer Distant Metastases at Diagnosis in the United State. JAMA Oncology (2016), http://oncology.jamanetwork.com/ by a University of California - San Diego vu le 13 février 2020.
Bouya P.A, Odzebe ASW. Cancer de la prostate avant l’âge de 50 ans. Carcinologie pratique en Afrique 2010, 9,1 : 36-40.
Mitsuzuka K, Arai Y. Controversies associated with the evaluation of elderly men with localized prostate cancer when considering radical prostatectomy. Int J Clin Oncol (2014) 19 :793–9.
Kunz I, Musch M, Roggenbuck U, Klevecka V et al. Tumour characteristics, oncological and functional outcomes in patients aged ≥ 70 years undergoing radical prostatectomy. BJUI (2013), 111,3b ; 24–9.
Ko J, Falzarano SM, Walker E, Smith KS et al. Prostate cancer patients older than 70 years treated by radical prostatectomy have higher biochemical recurrence rate than their matched younger counterpart. Prost (2013), 73, 8 ; 897–903.
Walter L.C, Fung K.Z, Kirby K.A, Shi Y et al 5-Year Downstream Outcomes Following Prostate-Specific Antigen (PSA) Screening in Older Men. JAMA Intern Med. (2013), 173,10 ; 866–73.
Parker C, Gillessen S, Heide nreich A, Horwich A. On be half of the ESMO Guidelines Committee. Cancer of the prostate : ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology (2015), 26, 5 ; 69-77.
Saad F, Chi KN, Finelli A, Hotte SJ et al. The 2015 CUA-CUOG Guidelines for the management of castration-resistant prostate cancer (CRPC). Can Uro Assoc J. (2015), 9, 3-4 ; 90-6.
Mangiat-Artus P, Alvelin D. Prise en charge diagnostique et thérapeutique des cancers de la prostate chez l'homme de plus de 75 ans. Presse Med. (2017). http://dx.doi.org/10.1016/j.lpm.2017.09.009.
Ziouziou I, Karmouni T, El Khader K, Koutani A, et al. Complications de l’hormonothérapie anti-androgénique du cancer de la prostate. Can Urol Assoc J. (2014), 8, 3-4 ; 159–62.
Smith MR, Lee H, Fallon MA, Nathan D.M. Adipocytokines, obesity, and insulin resistance during combined androgen blockade for prostate cancer : Evidence for a Distinct Hypogonadal Metabolic Syndrome ? Urology. (2008), 71 ; 318–22.
Keating NL, O’Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol (2006), 24 ; 4448–56.
Office for National Statistics. Cancer survival in England: adults diagnosed in 2009 to 2013, followed up to 2014. Newport : ONS ; 2015.