Prostate cancer in France: results of the CCAFU-FRANCIM survey.

Objective: The management, diagnosis and treatment of prostate cancer (PC) in the general population are poorly defined in France. The objective of th is survey was to analyse the diagnostic and therapeutic modalities of prost ate cancer in 1995, on the basis of a population derived from 4 French canc er registries. Material and Method. A sample of 803 PCs diagnosed in 1995 were selected at random from the cases listed in the 4 registries (Bas-Rhin, Calvados, Is r e and Tarn). Analysis by questionnaire concerned the modalities of diagnosi s, clinical tumour stage and the treatment performed. Clinical stage (TNM 1 992) was submitted to centralized coding. Logistic regression was used to q uantify the various practices, taking into account the patient's age, PSA l evel and clinical stage. The probability of receiving each treatment modali ty was studied by using the same clinical determinants. Results: The mean age of the patients was 71.6 years (range: 46-94). The cl inical stage was T1 or T2 in 60% of cases, T3 or T4 in 14% of cases and Nor M+ in 17% of cases. PSA (median: 18.2 ng/ml) was assayed in 92.4% of cas es. The diagnosis was established by biopsy in 63% of cases and by endoscop ic resection (TURP) in 32% (5% unknown). The main treatments were: radical prostatectomy (RP): 21.9%, radiotherapy: 19.4%, endocrine therapy: 33%, iso lated TURP: 16.3%, conservative management: 6% and unspecified treatment: 5 .6% of cases. 31% of cases received combinations of various treatment modal ities. RP was performed more frequently in patients over the age of 60 year s, for T2 tumours (OR: 3.3) and for 4 < PSA < 20 ng/ml. Radiotherapy tended to be reserved for older patients with T3-T4 tumours and 20 < PSA < 50 ng/ ml. The frequency of endocrine therapy increased with age and PSA (> 50 ng/ ml). The frequency of TURP and surveillance also increased with age, decrea sed with high PSA and essentially concerned T1 tumours. Conclusion: PC was diagnosed relatively early in France in 1995 with clinic ally, localized tumours in 60% of cases. In this survey, 94% of patients re ceived treatment during the year following diagnosis, with 40% of curative treatments and 31 % of combined treatments.