title: [Place of bilateral pulpectomy as a method of androgen suppression therapy in prostate cancer].
abstract: OBJECTIVE
  To report the oncologic results and morbidity of bilateral pulpectomy and to identify factors that make this method of androgen suppression therapy the most used in our country.
  
  
  METHODS
  We conducted a prospective study in the urology department of Aristide Le-Dantec hospital (Dakar) between January 2008 and June 2010 (30 months). It included 84 cases of prostate cancer treated by bilateral pulpectomy under local anesthesia.
  
  
  RESULTS
  The mean age of patients was 72.17±12.48 years (53-91). The median PSA level was 101 ng/mL (12.18-9990). Metastasis have been detected in 75% of cases. The Gleason score was higher than 7 in 40 patients (47.6%). Three months after pulpectomy, an improvement of performance status was seen in 76 patients (90.4%). The back pain significantly decreased in intensity or disappeared in 65.3% (32/49) of cases. A complete recovery of lower limbs motor deficit was observed in 50% of cases (7/14). The PSA levels decreased in 57 of the 76 patients alive and the mean PSA level was then 72±11.7 ng/mL (3.8-2433). At six months, of the 53 patients in urinary retention, 18 had recovered spontaneous and complete urination. The PSA level was below 4 ng/mL in 33.8% (22/65) of cases and between 4 and 10 ng/mL in 52.3% (34/65) of cases. At 12 months, the median PSA nadir was 0.76 ng/mL (0,002-8,17) and 57.4% of the 54 patients alive had a PSA nadir less than 2 ng/mL. The mean follow-up was 11.08±10.34 months (1-30). A rising PSA occurred in 17 patients (20.2%) after an mean progression-free survival of 10.5 months (6-25). The overall survival at 6, 12 and 24 months were respectively 77.3, 64.3 and 52.3%. The overall cost of pulpectomy was 50 000 FCFA (76€). The specific morbidity of pulpectomy was two cases (2.4%) of infection of the operative site.
  
  
  CONCLUSIONS
  The bilateral pulpectomy was a method of androgen suppression immediately effective, efficacious with a low morbidity. Its very low cost is the main reason why it is still the most used method in our country.
authors.affiliation: Service urologie-andrologie, CHU Aristide Le-Dantec, avenue Cheickh Anta Diop, Dakar, Sénégal. bbcrfall@yahoo.fr
authors.forename: B
authors.initials: B
authors.lastname: Fall
authors.forename: K
authors.initials: K
authors.lastname: Tengue
authors.forename: Y
authors.initials: Y
authors.lastname: Sow
authors.forename: A
authors.initials: A
authors.lastname: Sarr
authors.forename: A
authors.initials: A
authors.lastname: Thiam
authors.forename: S
authors.initials: S
authors.lastname: Mohamed
authors.forename: B
authors.initials: B
authors.lastname: Diao
authors.forename: P A
authors.initials: PA
authors.lastname: Fall
authors.forename: A K
authors.initials: AK
authors.lastname: Ndoye
authors.forename: M
authors.initials: M
authors.lastname: Ba
authors.forename: B A
authors.initials: BA
authors.lastname: Diagne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000601:surgery*