A population-based study on radical prostatectomy in France

There has as yet been no descriptive study of the practice of radical prost atectomy in the general population in France. The objective of this work wa s to investigate the use of radical prostatectomy (RP) in France and its de terminants and geographic variations. A total of 175 radical prostatectomie s was identified in a random sample of 798 cases of prostate cancer recorde d in 1995 by four cancer registries, in the departments of Bas-Rhin, Calvad os, Isere and Tarn. Tumour characteristics, diagnostic procedures and histo pathological results were analysed. Multivariate analysis by logistic regre ssion was used to take into account age, prostate specific antigen (PSA) le vels and clinical stage in order to study variations between geographical d epartments 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 l evel was 18.2 ng/ml (range 1-184). Diagnosis was made by randomised biopsie s in 73.8% of cases or by transurethral resection (6.9%). Clinical stage wa s 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 thera py (radiotherapy 13.7%, hormonal treatment 13.7% or both 3%) was administer ed in 54 patients (31%). Logistic regression showed that the probability of undergoing RP was three times higher in one department than in the other d epartments, 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 Fran ce. It shows that practice differs according to geographical region and sec tor of activity, indicating that schools of thought and medical culture var y within the same country.