A Comprehensive National Survey of Prostate-specific Antigen Testing and Prostate Cancer Management in France: Uncovering Regional and Temporal Disparities - Beyond the Abstract
In this study, based on a national real-life practice of prostate cancer management in France in a population of 4,936,750 men, we analysed all prostate-specific antigen (PSA) blood tests performed between 2006 and 2018, identifying 692,516 men diagnosed with PCa and 3,899,509 men without prostate cancer.
Despite the recommendations of the urology community, which advocates individual screening from the age of 50, or rather in the case of risk factors, we found that the first PSA test was carried out late, with a peak in the decade between 65 and 75 years of age. However, we observed that the median age of the first PSA test decreased steadily from 68 to 64 over this 10-year period. Men whose first PSA test was performed after age 70 appear to have been diagnosed late, with reduced chances of curative therapy and subsequent increased mortality.
The difference in mortality, adjusted for age at inclusion, in the different French administrative regions among men without prostate cancer and patients with prostate cancer showed that specific mortality was higher in the north of France (Odd Ratio 1.45 CI: 1.42-1.47), this difference was not explained by age at first PSA in this specific region. Early diagnosis was the main factor associated with loss of years of life (Odd Ratio 1.96 CI: 1.66-2.31). Interestingly, even men diagnosed with prostate cancer after the age of 80 died earlier than patients without prostate cancer (Odd Ratio CI: 1.19-1.20). The highest disproportion (x3) between regions for the first line therapy for localised prostate cancer concerned the use of brachytherapy. The uptake of initial surveillance remains low (12%) with no significant change over the 10-year survey period. The incidence of metastases at diagnosis, indicated by the use of systemic therapies, increased progressively from 2011.
Thus, despite professional guidelines, we have reported that in France there are still significant regional disparities in the management of prostate cancer and in disease-specific mortality, which may be influenced by a range of factors, including variations in medical practice.
Written by: Olivier Cussenot, MD, PhD, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; CeRePP, Paris, France
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