A family history of prostate cancer was noted in 22 patients (6.91%).

Clinical features included lower urinary tract obstructive symptoms in 166 (52.2%), a urinary retention 75 (23.6%), a hematuria 96 (30.1%), bone pain 72 (22.64%). Table 1 shows a distribution of PCa according to the circumstances of discovery. General condition was maintained in 41% of patients. On digital rectal examination (DRE), the prostate was suspicious of malignancy in the form of indurated, nodular or pelvic shielding appearance in 55.4% of patients. Total PSA was less than 10 ng/ml in 6.31% of patients and greater than 100 ng/ml in 35.53% of cases. Table 1 shows a distribution of prostate cancers according to DRE and PSA results (N = 318).

The different imaging explorations carried out are summarized in Table 1. Technetium 99 bone scintigraphy was performed in 3 patients.

Prostatic adenocarcinoma was the only histopathological type (100%). Figure 3 shows a distribution of prostate cancers according to Gleason score (N = 318). Gleason score very high between 7 and 10. The tumor was well differentiated in 39.9% and poorly differentiated in 6.29% patients.

At the end of the extension assessment and according to the 2016 cTNM classification, localized cancer represented 7.2% and locally advanced cancer occurred in 36.5% of cases, while metastatic cancer accounted for 56.3%. The locations of the metastases were bone (92.6%), visceral (19.8%) and lymph node (13.8%).

The urological management of PCa is reported in Table 2. Open radical prostatectomy was performed in 10 patients (3.18%). Bilateral orchiectomy alone was performed in 71 patients (22.32%) and in combination with anti-androgens in 23 patients (7.23%). LHRH agonists in combination with antiandrogens, to achieve complete androgen blockade, were used in 16 patients (5.03%). Castration resistance was observed in 26 patients (8.17%) of patients placed on hormonal therapy.

The overall survival rate was observed in 91.50% of patients after 1 year.

Prostate cancer is the second most common cancer in men worldwide with 1.4 million new cases worldwide [1] [2] . In our series, the annual frequency was 70.6 cases and prostate cancer accounted for 87.4% for all urogenital cancers. In our region, prostate cancer ranks first among urogenital cancers. Osegbe et al. [9] reported a hospital-based incidence of 127 per 100,000.

However, in Europe, Prostate cancer is the most common cancer in men with an estimated number of 382,000 cases occurring during 2008 [10] . The highest incidence rate of prostate cancer was seen in Australia/New Zealand, in North America and the Caribbean and South Africa [1] .

Prostate cancer is the third leading cause of deaths from cancer in men. Prostate cancer is the third leading cause of death cancer in men and the mortality rate increases with age. The practice of early detection and the improvement of therapeutic management, particularly for metastatic forms of the disease, have contributed to the reduction in specific mortality due to PCa [4] [10] .

The average age at diagnosis is currently 70 years [2] [4] . In our study it was 72.7 years. Which is consistent with the age of predilection for prostate cancer as in most African, European and American series [2] [3] [4] [6] [10] . However, there is a significant difference in the average ages noted by other authors in Ghana, Togo and Burkina Faso who reported 60 years [11] - [16] .

Identified risk factors for CaP include age, ethnicity, and family history of prostate and breast cancer [4] . PCa is the most frequently diagnosed malignancy in elderly men [1] [10] . It has been observed that the risk increases especially after age 40 in black men or men with a family history of prostate cancer and after age 50 in white men with no family history of prostate cancer [1] . The incidence of prostate cancer and mortality are twice as high in the French West Indies as in mainland France [4] . Hereditary and environmental factors are known to play some role in the genesis of PCa [4] [17] . Additionally, 10% of hereditary PCa occur in relatively young patients [4] [17] .

In our series, the circumstances of prostate cancer diagnosis were mainly represented by lower urinary tract symptoms (LUTS). For some authors, the existence of clinical signs in CaP reflects a locally advanced or metastatic stage [4] .

Palpation of irregularity or nodule during DRE still remains an indication for prostate biopsy regardless of the level of PSA [18] . In our study, DRE was suspicious of malignancy in 55.4% of cases and was an indication for prostate biopsy regardless of the PSA value. Niang et al. [19] found a suggestive EDR in 87% of patients followed for advanced prostate cancer. According Descott et al. [20] more than 60% of PCas are diagnosed in asymptomatic patients, with normal DRE and elevated PSA.

A high PSA greater than 20 n/ml was noted in a large proportion of patients. This corroborates data observed in the literature regarding African studies where patients had elevated total PSA levels at the time of diagnosis, which demonstrates the absence of early detection and screening policy for prostate cancer in our regions [11] - [16] [21] [22] [23] . For Gueye et al. [3] as well as Cussenot et al. [24] , the high mean PSA level is correlated with the long course of the disease. For Niang et al. [19] , it is established that there is extra-prostatic involvement in 80% of cases for PSA values above 50 ng/mL.

Digital Rectal examination (DRE) and PSA measurement play a key role in the diagnosis of prostate cancer. In addition, this association makes it possible to detect cases of CaP early. Individual detection, based on fair and honest information of the patient, is based on the search for risk factors, digital rectal examination and PSA measurement, whereas screening consisting of systematically searching for a disease in an asymptomatic population remains controversial.

Prostatic adenocarcinoma was the only histological type in our series [4] . Ndoye et al. [25] reported a case of primary prostate sarcoma.

Ultrasound is not specific and is not sensitive for detecting CaP. It has no place in detection and staging [4] . It is used for post-void voiding assessment residual urine, prostate volume assessment and to guide biopsies [4] [24] . Mutiparmetric MRI makes it possible to measure prostate volume; to describe each suspicious area (or target) identified and analyzed with the Prostate Imaging Reporting and Data System (PI-RADS) version available and to carry out the assessment of locoregional extension. However we do not have MRIs in hospitals in the Thies region [4] .

A combination of DRE results, total PSA value and ISUP biopsy score improves the prediction of pT stage and lymph node spread [26] . Total PSA is correlated with the risk of metastasis, especially above 20 ng/ml [27] . In case of a locally advanced disease or lymph node or bone metastases, the thoraco-abdomino-pelvic CT scan remains useful to detect visceral metastases [28] . Also the number of positive biopsies is correlated with the risk of positive margins, extraprostatic extension and SV involvement [26] . Currently CT scanning is unnecessary if prostate MRI with lymph node acquisition is available. However, it remains indicated in cases of contraindication to MRI [29] . A nomogram associated with MRI data, biological data (PSA levels) and histological data of systematic and targeted biopsies can predict risk of lymph node extension and could avoid up to 60% of heals lymph nodes [30] . Whole body diffusion-weighted MRI allows a global evaluation of the skeleton and lymph node chains without irradiation or contrast product [31] . The performance of MRI is superior to scintigraphy coupled with standard radiography for identifying bone metastases and is identical to a CT scan for lymph node evaluation [31] [32] . In our context of daily practice in the region of Thies, in Senegal we do not have MRI and bone scintigraphy. Furthermore, few patients are eligible for these means of diagnostic assistance due to a delay in treatment.

In our series the proportion of locally advanced and metastatic cancers remains high, reflecting the delay in treatment. Gueye et al. [3] diagnosed 40% of tumors at advanced stages.

According to the guidelines of the Cancerology Committee of the French Society of Urology (CCAFU), active surveillance (AS) must be based on the performance of a clinical examination, total PSA, MRI and a control biopsy is necessary 12 months after the start of the SA [4] . Also, it recommends stopping AS is indicated in the event of the appearance of a higher grade (ISUP 2 or higher) on control biopsies [4] .

The high prevalence of metastatic and locally advanced tumors in elderly patients reflects on the choice of our treatment and reduces the possibilities of radical surgical treatment. This explains on the one hand the low rate of radical prostatectomy (RP) performed in our series (3.18%), on the other hand the use of anti-androgen treatment. Radical prostatectomy (RP) can be offered to patients with low and intermediate risk PCA, depending on the co-morbidities and the life expectancy (>10 years) [4] [33] [34] . Several authors have established the benefit of performing RP with extensive dissection, without preserving the nerve bands, in patients with high-risk or locally advanced CaP [4] [33] [35] . The indications are those for curative treatment of localised or locally advanced PCA. Lymphadenectomy includes bilateral excision of the ilio-obturator, internal iliac and external iliac lymph nodes up to the iliac bifurcation [36] [37] .

Currently in hospitals in the Thiès region, Senegal, we do not have radiotherapy or laparoscopy. However, as part of the multidisciplinary consultation, our patients are sometimes referred to Dakar which only has one radiotherapy center. In our study none of the patients had received radiotherapy.

Thus bilateral testicular pulpectomy (surgical castration) was the most used method in our series due to the low socio-economic level of our patients. Fall et al. [38] in Dakar as well as Diallo et al. [5] in Thies demonstrated the effectiveness of surgical castration which improves the clinical symptoms of patients. Surgical castration was also the most used treatment in the series of Kaboré et al. [14] and Tengue et al. [15] with respectively 43.4% and 80.5% of testicular pulpectomy performed. Even if new generation hormone therapies have led to an improvement in symptoms and quality of life with good clinical and biological tolerance, in Africa as in Senegal, the use of medical hormone therapy is generally limited due to its high cost and its inaccessibility.

Survival is related to histopathologic feature, stage of disease and therapeutic response. In our study, the 1 year survival rate after treatment is 91.50%. Survival rates for prostate cancer are better in developed countries than in underdeveloped countries due to early detection of the disease.