The prostate

Anatomy of the prostate

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1/ Bladder; 2/ Pubis; 3/ Urethra; 4/ Testicle; 5/ Vas deferens; 6/ Prostate; 7/ Rectum

The prostate is a gland of the male genitalia located in the lesser pelvis just below the bladder and surrounding part of the urethra.
The prostate is located in front of the rectum (anal canal), which explains why digital rectal examination is a routine clinical examination for evaluating the volume and consistency of the prostate. The doctor performs endorectal ultrasound via the rectum to obtain a clear image of the prostate.

Prostate cancer: Is it common? How is it detected?

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Low-risk prostate cancer (PCa) represents 40-60% of new prostate cancers.
Prostate cancer is often asymptomatic in the early localised forms and the symptoms (urinary signs) do not appear until a more advanced stage.

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The diagnosis is based on several components:

  • Digital rectal examination and PSA: An elevation in PSA (prostate-specific antigen) and an abnormal digital rectal examination may suggest prostate cancer.
  • Prostate biopsy: Is needed to confirm the diagnosis. It consists of removing several fragments from the different parts of the prostate under local anaesthesia. These fragments are analysed under a microscope by a doctor: this examination is called anatomical pathology.
    In the case of positive biopsies (presence of cancerous cells), the aggressiveness is assessed using a scale (Gleason score), the number of positive biopsies and staging of the cancer.
  • Screening for distant metastases: A series of examinations that detail the spread of the cancer (local, lymph node or metastatic), particularly MRI , which provides a clear image of the contours of the prostate and makes it possible to specify whether the cancer has breached the prostate capsule. This screen may be supplemented by a bone scintigraphy scan to screen for bone metastases.

The cancer is classified into several stages (known as TNM classification): localised cancer, locally-advanced cancer (outside the capsule), with lymph node involvement and the most advanced stage with metastases.

The prognosis for low-risk localised cancer is good if it is detected early but it exposes the patient to a change in quality of life (urinary and sexual) caused by the radical treatments that are currently regarded as the reference treatments.