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Beckmann, K., Garmo, H., Adolfsson, J., Bosco, C., Johansson, E., Robinson, D., . . . Van Hemelrijck, M. (2019). Androgen Deprivation Therapies and Changes in Comorbidity: A Comparison of Gonadotropin-releasing Hormone Agonists and Antiandrogen Monotherapy as Primary Therapy in Men with High-risk Prostate Cancer. European Urology, 75(4), 676-683
Open this publication in new window or tab >>Androgen Deprivation Therapies and Changes in Comorbidity: A Comparison of Gonadotropin-releasing Hormone Agonists and Antiandrogen Monotherapy as Primary Therapy in Men with High-risk Prostate Cancer
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2019 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 75, no 4, p. 676-683Article in journal (Refereed) Published
Abstract [en]

Background: Some studies suggest that gonadotropin-releasing hormone (GnRH) agonists are associated with higher risk of adverse events than antiandrogens (AAs) monotherapy. However, it has been unclear whether this is due to indication bias.

Objective: To investigate rates of change in comorbidity for men on GnRH agonists versus AA monotherapy in a population-based register study.

Design, setting, and participants: Men with advanced nonmetastatic prostate cancer (PCa) who received primary AA (n = 2078) or GnRH agonists (n = 4878) and age- and area-matched PCa-free men were selected from Prostate Cancer Database Sweden 3.0. Increases in comorbidity were measured using the Charlson Comorbidity Index (CCI), from 5 yr before through to 5 yr after starting androgen deprivation therapy (ADT).

Outcome measures and statistical methods: Multivariable linear regression was used to determine differences in excess rate of CCI change before and after ADT initiation. Risk of any incremental change in CCI following ADT was assessed using multivariable Cox regression analyses.

Results and limitations: Men on GnRH agonists experienced a greater difference in excess rate of CCI change after starting ADT than men on AA monotherapy (5.6% per yr, p < 0.001). Risk of any new CCI change after ADT was greater for GnRH agonists than for AA (hazard ratio, 1.32; 95% confidence interval, 1.20-144).

Conclusions: Impact on comorbidity was lower for men on AA monotherapy than for men on GnRH agonists. Our results should be confirmed through randomised trials of effectiveness and adverse effects, comparing AA monotherapy and GnRH agonists in men with advanced nonmetastatic PCa who are unsuitable for curative treatment.

Patient summary: Hormone therapies for advanced prostate cancer can increase the risk of other diseases (eg, heart disease, diabetes). This study compared two common forms of hormone therapy and found that the risk of another serious disease was higher for those on gonadotropin-releasing hormone agonists than for those on antiandrogen monotherapy.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2019
Keywords
Androgen deprivation therapy, Antiandrogen monotherapy, Comorbidity, Gonadotropin-releasing hormone agonists, Prostate cancer
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-380435 (URN)10.1016/j.eururo.2018.11.022 (DOI)000461049200041 ()30497883 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-04-09Bibliographically approved
Bergengren, O., Garmo, H., Bratt, O., Holmberg, L., Johansson, E. & Bill-Axelson, A. (2019). Determinants for choosing and adhering to active surveillance for localised prostate cancer: a nationwide population-based study. BMJ Open, 9(12), Article ID e033944.
Open this publication in new window or tab >>Determinants for choosing and adhering to active surveillance for localised prostate cancer: a nationwide population-based study
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 12, article id e033944Article in journal (Refereed) Published
Abstract [en]

Objective: Knowledge about factors influencing choice of and adherence to active surveillance (AS) for prostate cancer (PC) is scarce. We aim to identify which factors most affected choosing and adhering to AS and to quantify their relative importance.

Design, setting and participants; In 2015, we sent a questionnaire to all Swedish men aged <= 70 years registered in the National Prostate Cancer Register of Sweden who were diagnosed in 2008 with low-risk PC and had undergone prostatectomy, radiotherapy or started on AS.

Outcome measurements and statistical analysis: Logistic regression was used to calculate ORs with 95% CIs for factors potentially affecting choice and adherence to AS.

Results: 1288 out of 1720 men (75%) responded, 451 (35%) chose AS and 837 (65%) underwent curative treatment. Of those starting on AS, 238 (53%) diverted to treatment within 7 years. Most men (83%) choose AS because 'My doctor recommended AS'. Factors associated with choosing AS over treatment were older age (OR 1.81, 95% CI 1.29 to 2.54), a Charlson Comorbidity Index >2 (OR 1.50, 95% CI 1.06 to 2.13), being unaccompanied when notified of the cancer diagnosis (OR 1.45, 95% CI 1.11 to 1.89). Men with a higher prostate-specific antigen (PSA) at the time of diagnosis were less likely to adhere to AS (OR 0.26, 95% CI 0.10 to 0.63). The reason for having treatment after initial AS was 'the PSA level was rising' in 55% and biopsy findings in 36%.

Conclusions: A doctors recommendation strongly affects which treatment is chosen for men with low-risk PC. Rising PSA values were the main factor for initiating treatment for men on AS. These findings need be considered by healthcare providers who wish to increase the uptake of and adherence to AS.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2019
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-407279 (URN)10.1136/bmjopen-2019-033944 (DOI)000512773400283 ()31874896 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2020-03-23 Created: 2020-03-23 Last updated: 2020-03-23Bibliographically approved
Arnsrud Godtman, R., Månsson, M., Bratt, O., Robinsson, D., Johansson, E., Stattin, P. & Kjölhede, H. (2019). Development and validation of a prediction model for identifying men with intermediate- or high-risk prostate cancer for whom bone imaging is unnecessary: a nation-wide population-based study. Scandinavian journal of urology, 53(6), 378-384
Open this publication in new window or tab >>Development and validation of a prediction model for identifying men with intermediate- or high-risk prostate cancer for whom bone imaging is unnecessary: a nation-wide population-based study
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2019 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no 6, p. 378-384Article in journal (Refereed) Published
Abstract [en]

Objective: To develop and validate a nomogram that identifies men for whom bone scan is unnecessary.

Material and methods: The study datasets were derived from the National Prostate Cancer Register (NPCR) of Sweden. All men in the NPCR ≤80 years of age who were diagnosed with intermediate- or high-risk prostate cancer and who had pretreatment bone imaging (99mTc MDP scintigraphy, plain x-ray, computed tomography, magnetic resonance imaging, and/or positron emission tomography fused with computed tomography) were included. Men diagnosed from 2015–2016 formed a development dataset and men diagnosed in 2017 formed a validation dataset. Outcome was metastasis on bone imaging as registered in NPCR. Multivariable logistic regression was used to develop a nomogram.

Results: In the development dataset 482/5084 men (10%) had bone metastasis, the corresponding percentage in the validation dataset was 282/2554 (11%). Gleason grade group, clinical T stage, and prostate-specific antigen were included in the final model. Discrimination and calibration were satisfactory in both the development (AUC 0.80, 95% CI 0.78–0.82) and validation dataset (AUC 0.80, 95% CI, 0.77–0.82). Compared with using the EAU guidelines’ recommendation for selecting men for imaging, using the nomogram with a cut-off at 4% chance of bone metastasis, would have avoided imaging in 519/2068 men (25%) and miss bone metastasis in 10/519 (2%) men in the validation dataset.

Conclusion: By use of our nomogram, bone scans of men with prostate cancer can be avoided in a large proportion of men.

Keywords
Bone metastasis, imaging, prostate cancer, staging
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-406286 (URN)10.1080/21681805.2019.1697358 (DOI)000501064700001 ()31805808 (PubMedID)
Available from: 2020-03-06 Created: 2020-03-06 Last updated: 2020-04-21Bibliographically approved
Ahlberg, M. S., Adami, H.-O., Beckmann, K., Bertilsson, H., Bratt, O., Cahill, D., . . . Bill-Axelson, A. (2019). PCASTt/SPCG-17-a randomised trial of active surveillance in prostate cancer: rationale and design. BMJ Open, 9(8)
Open this publication in new window or tab >>PCASTt/SPCG-17-a randomised trial of active surveillance in prostate cancer: rationale and design
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 8Article in journal (Refereed) Published
Abstract [en]

Introduction Overtreatment of localised prostate cancer is substantial despite increased use of active surveillance. No randomised trials help define how to monitor patients or when to initiate treatment with curative intent. Methods and analysis A randomised, multicentre, intervention trial designed to evaluate the safety of an MRI-based active surveillance protocol, with standardised triggers for repeated biopsies and radical treatment. The aim is to reduce overtreatment of prostate cancer. 2000 men will be randomly allocated to either surveillance according to current practice or to standardised triggers at centres in Sweden, Norway, Finland and the UK. Men diagnosed in the past 12 months with prostate cancer, <= T2a, prostate-specific antigen (PSA) <15ng/mL, PSA density <less than or equal to>0.2ng/mL/cc, any International Society of Urological Pathology (ISUP) grade 1 are eligible. Men with ISUP grade 2 in <30% of cores on systematic biopsy and <10mm cancer in one core on systematic or targeted biopsy are also eligible. Men diagnosed on systematic biopsy should have an MRI and targeted biopsies against Prostate Imaging and Reporting Data System V.2 3-5 lesions before inclusion. Identical follow-up in the two study arms: biannual PSA testing, yearly clinical examination and MRI every second year. In the experimental arm, standardised triggers based on MRI and PSA density elicit repeated biopsies. MRI and histopathological progression trigger radical treatment. Primary outcome measure is progression-free survival. Secondary outcome measures are cumulative incidence of metastatic disease, treatments with curative intent, pT3-4 at radical prostatectomy, switch to watchful waiting, prostate cancer mortality and quality of life. Inclusion started in October 2016 and in October 2018; 275 patients have been enrolled. Ethics and dissemination Ethical approval was obtained in each participating country. Results for the primary and secondary outcome measures will be submitted for publication in peer-reviewed journals. Trial registration number NCT02914873.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2019
Keywords
active surveillance, MRI, prostate cancer, randomised trial
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-401175 (URN)10.1136/bmjopen-2018-027860 (DOI)000502537200134 ()31444180 (PubMedID)
Funder
Swedish Cancer Society, 2016/466Swedish Cancer Society, 2014/1275Swedish Research Council, 2016-00177Swedish Research Council, 2016-01293
Available from: 2020-01-07 Created: 2020-01-07 Last updated: 2020-01-07Bibliographically approved
Cazzaniga, W., Godtman, R. A., Carlsson, S., Ahlgren, G., Johansson, E., Robinson, D., . . . Stattin, P. (2019). Population-based, nationwide registration of prostatectomies in Sweden. Journal of Surgical Oncology, 120(4), 803-812
Open this publication in new window or tab >>Population-based, nationwide registration of prostatectomies in Sweden
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2019 (English)In: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 120, no 4, p. 803-812Article in journal (Refereed) Published
Abstract [en]

Introduction Radical prostatectomy (RP) is a common surgical procedure with a risk of postoperative erectile dysfunction and urinary incontinence. There is a need for data on RP as a basis for quality assurance and benchmarking. Methods In 2015, prostatectomies in Sweden (PiS) form was implemented in the National Prostate Cancer Register (NPCR) of Sweden with data on pre-, peri- and post-operative variables. Results Out of all radical prostatectomies performed in 2016 in Sweden, 3096/3881 (80%) were registered in PiS. A total of 2605 (84%) were robot-assisted radical prostatectomy (RARP) and 491 (16%) were RRP (retropubic radical prostatectomy). RARP was performed by 91 surgeons of whom 47% operated more than 25 RP/year; and RRP was performed by 69 surgeons of whom 10% performed more than 25 RP/year. RARP had a longer operative time (median operating time: RARP 155 minutes [IQR 124-190]; RRP 129 minutes [IQR 105-171]; P < .001) but was associated with smaller bleeding (median intraoperative blood loss: RARP 100 mL [IQR 50-200], RRP 700 mL [IQR 500-1100]; P < .001). Conclusions We report on a nationwide, population-based register with transparent reporting of data on the performance of radical prostatectomy. These data are needed as a basis for quality assurance with comparisons of results from individual surgeons and hospitals.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
NPCR, prostate cancer, radical prostatectomy, registry
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-396126 (URN)10.1002/jso.25643 (DOI)000478404300001 ()31355454 (PubMedID)
Funder
Swedish Research Council, 2017-00847Swedish Cancer Society, 160700
Available from: 2019-10-30 Created: 2019-10-30 Last updated: 2019-10-30Bibliographically approved
Bratt, O., Holmberg, E., Andren, O., Carlsson, S., Drevin, L., Johansson, E., . . . Robinsson, D. (2019). The Value of an Extensive Transrectal Repeat Biopsy with Anterior Sampling in Men on Active Surveillance for Low-risk Prostate Cancer: A Comparison from the Randomised Study of Active Monitoring in Sweden (SAMS). European Urology, 76(4), 461-466
Open this publication in new window or tab >>The Value of an Extensive Transrectal Repeat Biopsy with Anterior Sampling in Men on Active Surveillance for Low-risk Prostate Cancer: A Comparison from the Randomised Study of Active Monitoring in Sweden (SAMS)
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2019 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 76, no 4, p. 461-466Article in journal (Refereed) Published
Abstract [en]

Background: A systematic repeat biopsy is recommended for men starting on active surveillance for prostate cancer, but the optimal number and distribution of cores are unknown. Objective: To evaluate an extensive repeat transrectal biopsy with anterior sampling in men starting on active surveillance. Design, setting, and participants: Randomised multicentre trial. From 2012 to 2016, 340 Swedish men, aged 40-75 yr, with recently diagnosed low-volume Gleason grade group 1 prostate cancer were included. Intervention: Either an extensive transrectal biopsy with anterior sampling (median 19 cores) or a standard transrectal biopsy (median 12 cores). Outcome measurements and statistical analysis: Primary outcome measure: Gleason grade group >= 2 cancer. Secondary outcomes: Cancer in anteriorly directed biopsy cores and postbiopsy infection. Nonparametric statistical tests were applied. Results and limitations: Gleason grade group >= 2 cancer was detected in 16% of 156 men who had an extensive biopsy and in 10% of 164 men who had a standard biopsy, a 5.7% difference (95% confidence interval [CI]-0.2% to 13%, p = 0.09). There was a strong linear association between prostate-specific antigen (PSA) density and cancer in the anteriorly directed biopsy cores. The odds ratios for cancer in the anteriorly directed cores were for any cancer 2.2 (95% CI 1.3-3.9, p = 0.004) and for Gleason grade group >= 2 cancer 2.3 (95% CI 1.2-4.4, p = 0.015) per 0.1-ng/ml/cm(3) increments. Postbiopsy infections were equally common in the two groups. A limitation is that magnetic resonance imaging was not used. Conclusions: The trial did not support general use of the extensive transrectal repeat biopsy template, but cancer in the anteriorly directed cores was common, particularly in men with high PSA density. The higher the PSA density, the stronger the reason to include anterior sampling at a systematic repeat biopsy. Patient summary: This trial compared two different templates for transrectal prostate biopsy in men starting on active surveillance for low-risk prostate cancer. Cancer was often found in the front part of the prostate, which is not sampled on a standard prostate biopsy. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER, 2019
Keywords
Active surveillance, Biopsy, Prostate cancer, Randomised clinical trial
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-395727 (URN)10.1016/j.eururo.2019.02.035 (DOI)000487930900025 ()30878303 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2019-10-24Bibliographically approved
Ventimiglia, E., Folkvaljon, Y., Carlsson, S., Bratt, O., Montorsi, F., Volz, D., . . . Stattin, P. (2018). Nationwide, population-based study of post radical prostatectomy urinary incontinence correction surgery. Journal of Surgical Oncology, 117(2), 321-327
Open this publication in new window or tab >>Nationwide, population-based study of post radical prostatectomy urinary incontinence correction surgery
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2018 (English)In: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 117, no 2, p. 321-327Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To assess the use of post radical prostatectomy (RP) urinary incontinence (PPI) surgery and to investigate factors related to its use.

METHODS: Cohort study in Prostate Cancer database Sweden (PCBaSe) of men who underwent primary RP between 1998 and 2012. PPI correction procedures were identified in the Patient Registry. Hazard ratios (HR) and 95% confidence intervals (CIs) of PPI surgeries were estimated.

RESULTS: Seven hundred eighty-two out of 26 280 (3%) men underwent PPI surgery at a median time of 3 years after RP. There was an eightfold increase in the absolute number of PPI surgeries during 2000-2014 and a threefold increase in the number per 1000 RPs performed. Factors associated with high use PPI surgery were age >70, HR 1.96 (1.54-2.50), and high hospital RP volume (>100 RPs/year), HR 0.81 (0.66-0.99). There was a 10-fold difference in use of PPI surgery per 1000 RPs between the county with the highest versus lowest use. In a subgroup of men with Patient-Reported Outcome Measures (PROM); severe PPI was reported by 7% of men and 24% of them underwent PPI surgery.

CONCLUSIONS: Three percent of all men received PPI surgery, with a 10-fold variation among health care providers. Only a quarter of men with severe PPI underwent PPI surgery, suggesting that PPI surgery remains underutilized.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
PROM, artificial urinary sphincter, population based, post radical prostatectomy urinary incontinence
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-336235 (URN)10.1002/jso.24816 (DOI)000426165700026 ()28876467 (PubMedID)
Funder
Swedish Research Council, 825-2012-5047Swedish Cancer Society, 160700
Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2019-06-28Bibliographically approved
Johansson, E., Steineck, G., Holmberg, L., Johansson, J.-E., Nyberg, T. & Bill-Axelson, A. (2018). Quality of life after radical prostatectomy or watchful waiting with or without androgen deprivation therapy: The SPCG-4 Randomized Trial. European Urology Oncology, 1(2), 134-142
Open this publication in new window or tab >>Quality of life after radical prostatectomy or watchful waiting with or without androgen deprivation therapy: The SPCG-4 Randomized Trial
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2018 (English)In: European Urology Oncology, Vol. 1, no 2, p. 134-142Article in journal (Refereed) Published
Abstract [en]

Background: Men with prostate cancer experience adjuvant androgen deprivation therapy (ADT) differently.

Objective: To evaluate the effect of ADT on quality of life (QoL), patients' experience of clinical check-ups, and differences in cancer information as explanatory factors.

Design, setting, and participants: A study-specific questionnaire was sent to all men randomized in the SPCG-4 trial to radical prostatectomy (RP) or watchful waiting (WW) still alive (400/695) and a control group of 281 men.

Intervention: ADT.

Outcome measurements and statistical analysis: Self-assessed QoL, worry at clinical check-ups, and amount of information received. Estimated relative risks with associated 95% confidence intervals (CI) for risk comparisons between groups using a log-binomial regression.

Results and limitations: The SPCG-4 men had median follow-up of 12.2 yr and median age of 77.0 yr; 26% in the RP group and 40% in the WW group received ADT treatment. High QoL for men without ADT was 36% for the RP group, 44% for the WW group, and 45% for the control group. High QoL for men with ADT was 30% for the RP group and 20% for the WW group. Among men with ADT, those in the WW group received significantly less information about the disease than men in the RP group. Receiving no or little information about prostate cancer was reported by 17% of patients in the RP group and 39% in the WW group among men receiving ADT (relative risk 0.44, 95% CI 022-0.89). At clinical check-ups, men treated with ADT had significantly higher levels of worry, regardless of study group, than men without ADT. Limitations include the lack of longitudinal data and a low number of men receiving ADT in the RP group.

Conclusions: Men on WW without ADT reported high QoL comparable to that for men without prostate cancer. ADT treatment in the WW group was associated with the lowest scores for all psychological parameters, and these men reported that they were least informed about prostate cancer and its consequences.

Patient summary: Good communication and information from caregivers are associated with less negative psychological effects at prostate cancer progression.

Keywords
Prostate cancer, Quality of life, Androgen deprivation therapy, Castration, Radical prostatectomy, Watchful waiting, Randomized trial, Information
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-158093 (URN)10.1016/j.euo.2018.03.003 (DOI)000474513200007 ()
Funder
Swedish Cancer Society
Note

Manuscript title: Quality of life after radical prostatectomy or watchful waiting with or without androgen deprivation therapy: The Scandinavian Prostate Cancer Group-4 Randomized Trial

Available from: 2011-08-30 Created: 2011-08-30 Last updated: 2019-12-11Bibliographically approved
Bergengren, O., Garmo, H., Bratt, O., Holmberg, L., Johansson, E. & Bill-Axelson, A. (2018). Satisfaction with Care Among Men with Localised Prostate Cancer: A Nationwide Population-based Study. European Urology Oncology, 1(1), 37-45
Open this publication in new window or tab >>Satisfaction with Care Among Men with Localised Prostate Cancer: A Nationwide Population-based Study
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2018 (English)In: European Urology Oncology, Vol. 1, no 1, p. 37-45Article in journal (Refereed) Published
Abstract [en]

Background

Information about how men with prostate cancer (PC) experience their medical care and factors associated with their overall satisfaction with care (OSC) is limited.

Objective

To investigate OSC and factors associated with OSC among men with low-risk PC.

Design, setting, and participants

Men registered in the National Prostate Cancer Register of Sweden as diagnosed in 2008 with low-risk PC at the age of ≤70 yr who had undergone radical prostatectomy (RP), radiotherapy (RT), or started on active surveillance (AS) were invited in 2015 to participate in this nationwide population-based survey (n = 1720).

Outcome measurements and statistical analysis

OSC data were analysed using ordinal logistic regression. Odds ratios (ORs) were calculated for comparisons between the highest and lowest possible response categories.

Results and limitations

A total of 1288 men (74.9%) responded. High OSC was reported by 958 (74.4%). Factors associated with high OSC were high participation in decision-making (OR 4.18, 95% confidence interval [CI] 2.61–6.69), receiving more information (OR 11.1, 95% CI 7.97–15.6), high-quality information (OR 7.85, 95% CI 5.46–11.3), access to a nurse navigator (OR 1.80, 95% CI 1.44–2.26), and better functional outcomes (defined as 25 points higher on the EPIC-26 questionnaire; OR 1.34, 95% CI 1.21–1.48). OSC was not affected by whether a doctor or specialist nurse conducted follow-up (OR 0.84, 95% CI 0.66–1.07). These findings were similar across treatment groups. Men who had undergone RP or RT reported high OSC more often than men on AS (78.2% vs 84.0% vs 72.6%), high participation in decision-making (70.5% vs 64.5% vs 49.2%), and having received more information (40.5% vs 45.8% vs 28.6%), and were less likely to believe they would die from PC (3.8% vs 3.9% vs 8.0%). Limitations include the nonrandomised retrospective design and potential recall bias.

Conclusions

Information and participation in decision-making, as well as access to a nurse navigator, are key factors for OSC, regardless of treatment. Men on AS need more information about their treatment and need to participate more in decision-making. OSC was as high among men who had nurse-led follow-up as among men who had doctor-led follow-up.

Patient summary

Information about how men with low-risk prostate cancer experience their medical care is limited. In this nationwide population-based study we found that information and participation in decision-making as well as access to a nurse navigator are key factors for satisfaction regardless of treatment. Men who are being closely watched for prostate cancer without immediate curative treatment need more information than they now receive and need to participate more in decision-making than they currently do.

Keywords
Information, Low-risk prostate cancer, Nurse-navigator, Participation in decision-making, Satisfaction
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-381228 (URN)10.1016/j.euo.2018.02.003 (DOI)000474512200006 ()
Funder
Swedish Cancer Society
Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-12-10Bibliographically approved
Stranne, J., Brasso, K., Brennhovd, B., Johansson, E., Jäderling, F., Kouri, M., . . . Akre, O. (2018). SPCG-15: a prospective randomized study comparing primary radical prostatectomy and primary radiotherapy plus androgen deprivation therapy for locally advanced prostate cancer. Scandinavian journal of urology, 52(5-6), 313-320
Open this publication in new window or tab >>SPCG-15: a prospective randomized study comparing primary radical prostatectomy and primary radiotherapy plus androgen deprivation therapy for locally advanced prostate cancer
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2018 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, no 5-6, p. 313-320Article in journal (Refereed) Published
Abstract [en]

Objective: To describe study design and procedures for a prospective randomized trial investigating whether radical prostatectomy (RP) ± radiation improves cause-specific survival in comparison with primary radiation treatment (RT) and androgen deprivation treatment (ADT) in patients with locally advanced prostate cancer (LAPC).

Materials and methods: SPCG-15 is a prospective, multi-centre, open randomized phase III trial. Patients are randomized to either standard (RT + ADT) or experimental (RP with extended pelvic lymph-node dissection and with addition of adjuvant or salvage RT and/or ADT if deemed necessary) treatment. Each centre follows guidelines regarding the timing and dosing of postoperative RT and adjuvant treatment such as ADT The primary endpoint is cause-specific survival. Secondary endpoints include metastasis-free and overall survival, quality-of-life, functional outcomes and health-services requirements. Each subject will be followed up for a minimum of 10 years.

Results: Twenty-three centres in Denmark, Finland, Norway and Sweden, well established in performing RP and RT for prostate cancer participated. Each country’s sites were coordinated by national coordinating investigators and sub-investigators for urology and oncology. Almost 400 men have been randomized of the stipulated 1200, with an increasing rate of accrual.

Conclusions: The SPCG-15 trial aims to compare the two curatively intended techniques supplying new knowledge to support future decisions in treatment strategies for patients with LAPC The Scandinavian healthcare context is well suited for performing multi-centre long-term prospective randomized clinical trials. Similar care protocols and a history of entirely tax-funded healthcare facilitate joint trials.

Keywords
Locally advanced prostate cancer, radical prostatectomy, radiotherapy, androgen deprivation therapy
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-381395 (URN)10.1080/21681805.2018.1520295 (DOI)000461876400001 ()30585526 (PubMedID)
Funder
Swedish Research Council, 2017-00546
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-10-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4039-0547

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