Variations in radical prostatectomy practice in France

Objective: A description of radical prostatectomy (PR) practice in the gene ral population in France has never been reported. The objective of this stu dy was to analyse RP practice in France, and its determinants and geographi cal variations based on the CCAFU-Francim survey on prostate cancer (PC) di agnosed in 1995. Material and Method: 175 PR were performed on the sample of 798 patients se lected at random from the cases of PC identified in 1995 by four cancer reg istries (Bas-Rhin, Calvados, Isere and Tarn). Analysis was based on tumour characteristics, diagnostic methods and histopathological results. Multivar iate analysis by logistic regression taking into account age, PSA and clini cal stage studied variations between departments and types of urology pract ice (private or public). Results: The mean age of the patients at the time of the diagnosis was 65.3 years (46-76). The median PSA was 18.3 ng/ml (1-184). The diagnosis was ma de by biopsies (91%) which were systematized in 74% of cases or by transure thral resection (7%). The clinical state was T1 (22.3%), T2 (64%), T3 (8.6% ), N+ (0.611) and unknown (4.5%). The pathological stage was pT2N0 (46.3%), pT3N0 (40%), pT4N0 (1.7%), pTxN0 (8.6%) and unknown (3.4%). Adjuvant treat ment (radiotherapy; 13.7%, endocrine therapy: 13.7% or both: 31%) was perfo rmed in 54 patients (31%). Multivariate analysis showed that the adjusted p robability to be treated by RP was 3 times high in one department compared to others and 2.6 times higher in the private sector. Conclusion: This study of RP practice in the general population shows a con cordance with the 1995 recommendations, but it also shows practice variatio ns according to the region and the type of practice, reflecting different s chools of thought and medical education within the same country.