DOI: 10.36347/sasjm.2021.v07i12.007

Pages: 674-680

Purpose: the aim of this study was to rapport the experience of Military Teaching Hospital Mohammed V and specifically the radiotherapy department in the management of high risk prostate cancer. Materials and Methods: This is a retrospective descriptive and analytical study, involving 149 patients followed for high risk prostate cancer proven histologically, in the radiotherapy department of HMIMV in Rabat between April 2009 and December 2018. All patients with low or intermediate risk prostate cancer were excluded. Results: The mean age is 68.1 years ± 6.4; screening is performed in 29.5% of cases. Urinary signs were the most frequent symptoms (obstructive syndrome 16.7%, irritative 37.5%), the initial median PSA 22ng / ml [11.1- 40]; histological evidence was obtained by prostate biopsy in 87.24% of cases. Evaluation of locoregional extension by pelvic MRI was performed in 99.3% of patients. Treatment: 132 patients (88.59%) benefited from a combination of external beam radiotherapy and androgen deprivation therapy (LH-RH analogues) for long duration (2 to 3 years), 17 patients (11.41%) underwent radical prostatectomy coupled with ilio-obturator dissection (in 14 patients); all these patients received postoperative radiotherapy (adjuvant or salvage) ± hormone therapy. Evolution: With a follow-up of 117 months, 14 of our patients (9.39%) presented a recurrence: 2 biochemical relapses (1.34%), 5 locoregional relapses (3.35%) and 7 systemic relapses (4.69%); The univariate and multivariate analyzes made it possible to retain the level of PSA Nadir (P = 0.022) and lymph node invasion (P = 0.049) as predictors of relapse. Conclusion: High risk prostate cancer is a group at high risk of specific mortality linked to progression after treatment. Hence the interest of a multidisciplinary consultation meeting management to define the optimal therapeutic strategy for these patients.