[Management of locally advanced prostatic adenocarcinoma in France. OCTAVE observational survey]

To describe the management of patients with locally advanced prostate cancer in France and the changes in this management between 2000 and 2003.

Observational survey on a sample of urologists and radiotherapists throughout France, comprising 2 aspects: a retrospective aspect (patients diagnosed and treated in 2000) and a prospective aspect (patients diagnosed in 2003 during the survey period). Eligible patients presented locally advanced prostate cancer (T3, biopsy pT3, T4, NO-N1-Nx, M0), not treated in the context of a therapeutic trial. Demographic data, prognostic factors and first-line treatments were collected.

From September 2003 to January 2004, 1,076 patients with a mean age of 69.2 years were included in 188 centres. The percentage of most favourable stages, T3-pT3, N0-Nx, M0 was 84.6% in 2000 and 90.6% in 2003. The median PSA was 18 ng/ml and 21% of patients had a Gleason score > 7. Lymph node invasion was demonstrated in 9.4% of patients. Changing management practices between 2000 and 2003 were marked by an increased use of the radiotherapy/hormonal therapy combination (p<0.001) rather than exclusive radiotherapy (p< 0.001) and total prostatectomy either alone or combined with another modality (p=0.001). No other treatment was associated with prostatectomy in 70% of operated patients. One quarter of patients received exclusive hormonal therapy, and this rate remained stable between 2000 and 2003.

Epidemiological data of the survey are concordant with those of the literature with a migration of TNM stages towards less advanced stages. In terms of treatment, there is a growing use of the radiotherapy-hormonal therapy combination, with a predominant place of hormonal therapy. The indication for prostatectomy appears to be optimized and constitutes the only therapeutic procedure in almost 70% of operated patients.