A population-based study on radical prostatectomy in France

There has as yet been no descriptive study of the practice of radical prostatectomy in the general population in France. The objective of this work was to investigate the use of radical prostatectomy (RP) in France and its determinants and geographic variations. A total of 175 radical prostatectomies was identified in a random sample of 798 cases of prostate cancer recorded in 1995 by four cancer registries, in the departments of Bas-Rhin, Calvados, Isere and Tarn. Tumour characteristics, diagnostic procedures and histopathological results were analysed. Multivariate analysis by logistic regression was used to take into account age, prostate specific antigen (PSA) levels and clinical stage in order to study variations between geographical departments and sectors of activity (private or public). The mean age of the patients at the time of diagnosis was 65.3 y (range 46 - 76). Median PSA level was 18.2 ng/ml (range 1-184). Diagnosis was made by randomised biopsies in 73.8% of cases or by transurethral resection (6.9%). Clinical stage was classified T-1 (22.3%), T-2 (64%), T-3 (8.6%), N+ (0.6%) and unknown (4.5%). The histopathological result was pT(2)NO in 46.3% of cases, pT(3)NO in 40%, pT(4)NO in 1.7%, pT(x)N(+) in 8.6% and unknown in 3.4%. Adjuvant therapy (radiotherapy 13.7%, hormonal treatment 13.7% or both 3%) was administered in 54 patients (31%). Logistic regression showed that the probability of undergoing RP was three times higher in one department than in the other departments, and was 2.6 times as high in the private sector. This study on the practice of RP is the first performed in the general population in France. It shows that practice differs according to geographical region and sector of activity, indicating that schools of thought and medical culture vary within the same country.