A comparative study of prostate cancer detection and management in China and in France

To compare the detection and management of prostate cancer in one French and six Chinese urological institutions.

All the patients subjected to prostate biopsy for suspected prostate cancer in six Chinese urological institutions and in the department of urology of the Cochin hospital, France, between January 2003 and December 2005 were included. The characteristics of patients and tumors, and the management of prostate cancer were then analyzed.

In the Chinese institutions, 95.8% of patients undergoing prostate biopsy presented with urinary disorders. The rate of abnormal digital rectal examination (DRE) ranged from 29.2% to 45.1%. In the French institution, 72.7% of prostate biopsies were performed as a result of prostate cancer screening, and the rate of abnormal DRE was 16.8%. In the Chinese institutions, a total of 979 patients underwent prostate biopsy, with median PSA values varying between 10.2 ng/ml and 33 ng/ml among the institutions. Overall, 408 cases of prostate cancer were diagnosed, with median PSA values varying between 24.3 ng/dl and 174.9 ng/dl and 19.4% of tumors were clinically localized. In the French institution, 565 patients underwent prostate biopsy, with a median PSA value of 7.4 ng/ml and 251 cases of prostate cancer were diagnosed, with a median PSA value of 8.1 ng/ml and 80.9% of tumors were clinically localized. In the Chinese institutions, the majority of patients received surgical or medical castration. The rate of patients subjected to surgical castration varied between 24.2% and 100%. Radical prostatectomy (RP) was performed in only three Chinese hospitals, in which the percentage of patients treated with RP varied between 12.1% and 31.1%. In the French institution, RP was the most common treatment of prostate cancer (43.8% of patients).

In China, most patients subjected to prostate biopsy suffer from urinary symptoms and have elevated PSA levels. The lack of mass screening for prostate cancer results in a high rate of advanced tumors with nodal involvement and/or metastases. RP is rarely performed in Chinese hospitals, and castration represents the usual treatment of prostate cancer.