[An experience of individual and early diagnosis of prostate cancer in a Tunisian centre]. / Une expérience de diagnostic individuel et précoce du cancer de la prostate dans le centre de la Tunisie.

INTRODUCTION: The introduction of prostate specific antigen (PSA) and progress in transrectal ultrasound and ultrasound-guided prostatic biopsies have allowed considerable progress in the diagnosis of prostate cancer. However prostate cancer is still usually diagnosed at an advanced stage in Tunisia. METHODS: We prospectively evaluated the prevalence of localized prostate cancer in the population of a Tunisian centre during a screening programme. This study included all men consulting for a urological problem between January 1998 and June 2001, between the ages of 50 and 75 years with an estimated life expectancy of at least 10 years. Screening consisted of digital rectal examination (DRE) and total and free PSA assay. Systematic ultrasound-guided prostatic biopsies (9 biopsies) were performed in the case of a suspicious DRE, total PSA between 4 and 20 ng/ml and a free PSA/total PSA ratio less than 25%. RESULTS: 642 patients were screened. 521 patients (81%) had a PSA less than 4 ng/ml, 23 had a suspicious DRE and PSA less than 4 ng/ml. No cancer was detected by prostatic biopsies. 92 patients (14%) had a PSA between 4 and 20 ng/ml and 44 of them had a free PSA/total PSA ratio less than 25%. Prostatic biopsies were performed in 59 of these 92 patients with PSA between 4 and 20 ng/ml and revealed 18 cancers: 3 stage pN+ and 15 stage pN0, including 1 stage pT3 and 14 stage pT2 after radical prostatectomy. 14 cancers detected in a population of 642 men (2.2%) were therefore stage pT2. 29 patients (4.5%) had a PSA higher than 20 ng/ml. All underwent surgical prostatic disobstruction demonstrating adenocarcinoma. A total of 47 cancers (7.3%) were therefore detected. CONCLUSION: Early individualized screening is possible in Tunisia and allows the detection of localized prostate cancer in 77% of patients with PSA less than 20 ng/ml. The use of prostatic biopsies in the case of abnormal screening tests improves the management of prostate cancer in Tunisia.

[Leriche technique for the treatment of La Peyronie's disease]. / La technique de Leriche dans le traitement de la maladie de La Peyronie.

OBJECTIVE: The treatment of La Peyronie's disease comprises medical treatment during the inflammatory acute phase and surgical treatment at the stage of stabilization of the lesions. This technical report describes the Leriche technique for the treatment of the stable phase of La Peyronie's disease. OPERATIVE TECHNIQUE: Patients are operated on an outpatient basis under local anaesthesia, after localization of the plaque by intraoperative ultrasound of the penis with erection induced by physiological saline. A percutaneous tear of the plaque is performed with an 18 gauge needle. MATERIALS AND METHODS: Ten patients with a mean age of 58 years (range: 32-82 years) were operated for La Peyronie's disease between January 2002 and January 2004. They all presented with painless penile curvature on erection, but severe discomfort or impossibility of sexual intercourse. The patients were reviewed at 1 and to 3 months. The results were assessed in terms of the degree of penile straightening and resumption of sexual activity. RESULTS: Three patients obtained complete cure. Two patients gained sufficient penile straightening to allow sexual intercourse and recovery was insufficient to allow sexual intercourse for 3 patients, but the result was improved after a second or even a third attempt. The last 2 patients were classified as treatment failures and were treated by penile prosthesis in one case and by the Nesbit technique in the other case. The results observed at 1 month persisted at 3 months. CONCLUSION: The Leriche technique for the treatment of La Peyronie's disease is a simple, minimally invasive technique with satisfactory results. It does not compromise a subsequent procedure and does not present any short-term or long-term complications.