La prostate is a gland of themale reproductive system. It is located just below the bladder and, like a ring, it surrounds the urethra, the channel through which urine and semen exit the body. The role of the prostate is to produce prostatic fluid, one of the components of semen along with seminal fluid and sperm, to temporarily store semen before ejaculation, and then to contract during ejaculation, thus participating in the process of ejaculation. expulsion of semen.

Le prostate cancer is the most common type of cancer in men: it is estimated that 1 in 7 men will be diagnosed with it, most often in their XNUMXs. Although no specific cause has been discovered, there is a genetic predisposition.

Most prostate cancers progress very slowly. Moreover, the vast majority of men in whom this cancer is detected will die of another cause. Very often the tumor remains located in the prostate and has limited health effects, sometimes causing urinary or erectile disorders. However, some cancers can grow and spread more quickly.

In France, prostate cancer is the most frequent male cancer (71 new cases estimated in 200) and the third leading cause of cancer death in men (2011 deaths per year). The median age of diagnosis is 3 years, and 8% of prostate cancers are diagnosed after 700 years. The average age of death from prostate cancer is 74, which is almost the average life expectancy of men in France. Prostate cancer is a cancer with a good prognosis: 44-year relative survival has improved dramatically, from 75% for cases diagnosed in 78 to 5% in 70.

Prostate cancer is the 2^e cause of male cancer death in North America, after lung cancer.

Types

THEadenocarcinoma is the most common form of prostate cancer. It represents about 95% of cases.

The severity of cancer depends on the extent of the tumor (local, with nearby or distant metastases) and the type of cancer cellsThere is a score to measure the prognosis of prostate cancer, that is to say the risks it presents for the person affected. This is the Gleason score.

This score assigns two numbers from 3 to 5 when examining the prostate tissue under a microscope, numbers corresponding to grades 3, 4 or 5. The number 3 corresponds to more benign prostatic tissue and the number 5 to the most aggressive.

With these figures, to obtain a score which can range from 2 to 10, we add up 2 grades, that of the most frequent populations of cells in the prostate and the highest score observed. Thus, a score of 6 (1-1) corresponds to a less aggressive cancer, 7 a little more, and the higher the number, the more the aggressiveness of the tumor increases. This number is important in determining the choice of the best treatment for each man.

Diagnosis and screening

·         Blood test: measurement of prostate antigen level (APS ou PSA). Prostate cancer can be detected by seeing an increase in a protein in the blood: prostate specific antigen or PSA. PSA is a substance produced by the prostate. However, a high result on this test does not necessarily mean that there is a cancer. Indeed, an amount of more than 4 nanograms / ml of this protein in the blood is associated with prostate cancer in about 25% of cases, and with another prostate disorder in 75% of cases. In the event that it is not cancer, an elevated PSA may correspond to benign prostatic hyperplasia, inflammation or infection of the prostate. prostate.

On the other hand, the PSA assay does not detect all cases of cancer. In a study evaluating the effectiveness of the PSA test, 15% of men who tested negative on this test (from a cohort of 2 men aged 950 to 62 years) had prostate cancer91. Let us mention that the PSA dosage is also used to monitor the course of prostate cancer.

The biopsy is not devoid ofside effects. The most common are the presence for a very short time of blood in urine, stool or semen, fever and infection of the prostate.

In practice :

– If the prostate is abnormal on digital rectal examination and its palpation suggests cancer, the biopsy is performed, even if the PSA are normal.

– If the prostate is normal on palpation and the PSA is greater than 4 ng / ml, the biopsy will be performed if the PSA increases over time.

• Rectal touch. Its purpose is the palpation of the prostate gland. To do this, the doctor inserts a finger covered with a glove into the rectum and he can thus estimate the volume and consistency of the prostate. This gesture allows only a partial appreciation. But it can sometimes detect cancers in people who have a rate ofantigen prostatic specific (= APS or PSA for “Prostatic Specific Antigen”) normal.
  • Transrectal ultrasound. It is only performed to perform a prostate biopsy and is not of interest on its own.
  • Biopsy during transrectal ultrasound. During an ultrasound, the doctor may guide a needle to practice of the prostate biopsies, that is, to take a little prostate tissue to have it examined under a microscope. This allows the Gleason score to be quantified. Only a biopsy can diagnose prostate cancer with certainty. The biopsy is usually done using a needle inserted into the prostate. 10 to 12 tissue samples are taken in the same session, in different areas of the prostate

    This technique is used for purposes diagnostic, not screening. This means that it is performed when a man has a high PSA or when the digital rectal examination finds an abnormal prostate.