Soulié M, Villers A, Grosclaude P, Menegoz F, Schaffer P, Mace-Lesec'h J, Sauvage-Machelard M, Molinier L, Grand A
INSERM U518, Laboratoire d'Epidémiologie et de Santé Publique, Toulouse, France.
Prog Urol. 2001 Jun;11(3):478-85.
The management, diagnosis and treatment of prostate cancer (PC) in the general population are poorly defined in France. The objective of this survey was to analyse the diagnostic and therapeutic modalities of prostate cancer in 1995, on the basis of a population derived from 4 French cancer registries.
A sample of 803 PCs diagnosed in 1995 were selected at random from the cases listed in the 4 registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis by questionnaire concerned the modalities of diagnosis, clinical tumour stage and the treatment performed. Clinical stage (TNM 1992) was submitted to centralized coding. Logistic regression was used to quantify the various practices, taking into account the patient's age, PSA level and clinical stage. The probability of receiving each treatment modality was studied by using the same clinical determinants.
The mean age of the patients was 71.6 years (range: 46-94). The clinical stage was T1 or T2 in 60% of cases, T3 or T4 in 14% of cases and N+ or M+ in 17% of cases. PSA (median: 18.2 ng/ml) was assayed in 92.4% of cases. The diagnosis was established by biopsy in 63% of cases and by endoscopic resection (TURP) in 32% (5% unknown). The main treatments were: radical prostatectomy (RP): 21.9%, radiotherapy: 19.4%, endocrine therapy: 33%, isolated TURP: 16.3%, conservative management: 6% and unspecified treatment: 5.6% of cases. 31% of cases received combinations of various treatment modalities. RP was performed more frequently in patients over the age of 60 years, 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, decreased with high PSA and essentially concerned T1 tumours.
PC was diagnosed relatively early in France in 1995 with clinically localized tumours in 60% of cases. In this survey, 94% of patients received treatment during the year following diagnosis, with 40% of curative treatments and 31% of combined treatments.
在法国，普通人群中前列腺癌（PC）的管理、诊断和治疗定义尚不明确。本调查的目的是基于来自4个法国癌症登记处的人群，分析1995年前列腺癌的诊断和治疗方式。
从4个登记处（下莱茵省、卡尔瓦多斯省、伊泽尔省和塔恩省）列出的病例中随机抽取1995年诊断的803例前列腺癌样本。通过问卷调查分析诊断方式、临床肿瘤分期和所进行的治疗。临床分期（1992年TNM分期）进行集中编码。采用逻辑回归对各种诊疗行为进行量化，同时考虑患者年龄、前列腺特异性抗原（PSA）水平和临床分期。利用相同的临床决定因素研究接受每种治疗方式的概率。
患者的平均年龄为71.6岁（范围：46 - 94岁）。60%的病例临床分期为T1或T2期，14%为T3或T4期，17%为N+或M+期。92.4%的病例检测了PSA（中位数：18.2 ng/ml）。63%的病例通过活检确诊，32%通过内镜切除（经尿道前列腺切除术，TURP）确诊（5%情况不明）。主要治疗方式为：根治性前列腺切除术（RP）：21.9%；放疗：19.4%；内分泌治疗：33%；单纯TURP：16.3%；保守治疗：6%；未明确治疗：5.6%。31%的病例接受了多种治疗方式的联合治疗。60岁以上患者、T2期肿瘤患者（比值比：3.3）以及PSA在4 < PSA < 20 ng/ml的患者中，RP实施更为频繁。放疗往往用于年龄较大、T3 - T4期肿瘤且20 < PSA < 50 ng/ml的患者。内分泌治疗的频率随年龄和PSA水平升高（> 50 ng/ml）而增加。TURP和观察的频率也随年龄增加，随高PSA水平降低，且主要针对T1期肿瘤。
1995年在法国，前列腺癌诊断相对较早，60%的病例为临床局限性肿瘤。在本次调查中，94%的患者在诊断后的一年内接受了治疗，其中40%为根治性治疗，31%为联合治疗。
