Adenocarcinoma of the prostate in paraplegics

Chapitre I - Les particularités du diagnostic précoce du cancer de la prostate en présence d’une vessie neurologique

Due to their increased life expectancy, a growing number of neurological patients, particularly spinal cord injury patients, develop prostate cancer. Although prostate cancer appears to be slightly less frequent in spinal cord injury patients than in the general population (level of proof 3b), especially in the case of high and severe spinal cord injury (level of proof 3b), there is evidence to suggest that prostate cancer is responsible for morbidity (level of proof 4) and excess mortality (level of proof 5) in neurological patients with a life expectancy greater than 10 or 15 years. According to urology society guidelines, prostate cancer screening should be proposed to neurological patients with a life expectancy greater than 10 or 15 years (level of proof 5), particularly paraplegics aged 50 to 60 or 65 years. As in the general population, this screening could be based on digital rectal examination and annual PSA assay, which can still be interpreted, even in patients performing intermittent catheterization (level of proof 3b). However; PSA cannot be used in patients with an indwelling catheter (level of proof 3b). The histological diagnosis is based on prostatic biopsies, which should probably be preceded by systematic urine culture with appropriate antibiotic therapy, if necessary, to limit the risk of infection (level of proof 5). The treatment of localized prostate cancer in neurological patients, as in the general population, is based on radical prostatectomy and external beam radiotherapy. The indication must be adapted to each patient, taking into account the voiding mode and urodynamic assessment of lower urinary tract function. Brachytherapy does not appear to be an appropriate treatment modality because of its adverse effects (level of proof 5).

The management of pressure sores

The authors review their clinical experience in diagnosis and management of over 2,500 cases of pressure sores, of which more than half (1,351) required surgical operations. Pressure sores have been classified in 4 grades, a classification that the authors believe is helpful in planning treatment. Different conservative regimens of management are given. Surgical operations are tabulated. Pre- and postoperative management is especially stressed.