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  • 1.
    Bjartell, Anders
    et al.
    Skane Univ Hosp, Dept Urol, SE-20502 Malmo, Sweden.;Lund Univ, Div Urol Canc, Dept Translat Med, S-22100 Lund, Sweden..
    Bottai, Matteo
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden..
    Persson, Josefin
    Sahlgrens Univ Hosp, Dept Cardiothorac Surg, Gothenburg, Sweden..
    Bratt, Ola
    Lund Univ, Div Urol Canc, Dept Translat Med, S-22100 Lund, Sweden.;Cambridge Univ Hosp, Dept Urol, Cambridge, England..
    Damber, Jan-Erik
    Univ Gothenburg, Inst Clin Sci Sahlgrenska Acad, Dept Urol, Gothenburg, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Akre, Olof
    Karolinska Inst, Dept Med Solna, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden..
    Prediction of clinical progression after radical prostatectomy in a nationwide population-based cohort2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 4, s. 255-259Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to create a model for predicting progression-free survival after radical prostatectomy for localized prostate cancer. Material and methods: The risk of biochemical recurrence (BCR) was modelled in a cohort of 3452 men aged 70 years or younger who were primarily treated with radical prostatectomy after being diagnosed between 2003 and 2006 with localized prostate cancer [clinical stage T1c-T2, Gleason score 5-10, N0/NX, M0/MX, prostate-specific antigen (PSA)<20 ng/ml]. The cohort was split into two: one cohort for model development (n = 3452) and one for validation (n = 1762). BCR was defined as two increasing PSA values of at least 0.2 ng/ml, initiation of secondary therapy, distant metastases or death from prostate cancer. Multivariable Cox proportional hazard regression was applied, predictive performance was assessed using the bootstrap resampling technique to calculate the c index, and calibration of the model was evaluated by comparing predicted and observed Kaplan-Meier 1 year BCR. Results: The overall 5 year progression-free survival was 83% after a median follow-up time of 6.8 years in the development cohort and 7.3 years in the validation cohort. The final model included T stage, PSA level, primary and secondary Gleason grade, and number of positive and negative biopsies. The c index for discrimination between high and low risk of recurrence was 0.68. The probability of progression-free survival ranged from 22% to 97% over the range of risk scores in the study population. Conclusions: This model is based on nationwide population-based data and can be used with a fair predictive accuracy to guide decisions on clinical follow-up after prostatectomy. An online calculator for convenient clinical use of the model is available at www.npcr.se/nomogram

  • 2.
    Danielsson, Gun
    et al.
    Karolinska Univ Hosp, Patient Area Pelv Canc, Canc Theme, Stockholm, Sweden; Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Jahnson, Staffan
    Linköping Univ Hosp, Dept Urol, IKE, Linköping, Sweden.
    Wijkström, Hans
    Karolinska Univ Hosp, Patient Area Pelv Canc, Canc Theme, Stockholm, Sweden; Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Nyberg, Tommy
    Karolinska Inst, Dept Oncol Pathol, Clin Canc Epidemiol, Stockholm, Sweden; Univ Cambridge, Ctr Canc Genet Epidemiol, Dept Publ Hlth & Primary Care, Cambridge, England.
    Thulin, Helena
    Karolinska Univ Hosp, Patient Area Pelv Canc, Canc Theme, Stockholm, Sweden; Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Bladder health in patients treated with BCG instillations for T1G2-G3 bladder cancer - a follow-up five years after the start of treatment2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 5-6, s. 377-384Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Investigate symptoms and how they affect daily life in patients with Non-Muscle Invasive Bladder Cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) instillations.

    Materials and methods: Patients treated with BCG were included. After an initial transurethral resection (TURB) followed by a second-look resection, the patients were given an induction course with BCG for 6 weeks followed by maintenance therapy for 2 years. The patients answered a questionnaire before, during and after the treatment. The questionnaire contained questions about specific symptoms combined with bother questions on how each symptom affected patients’ life.

    Results: In total, 113 of 116 patients responded to the first questionnaire. Thirty per cent of all patients were bothered by disease-specific symptoms before the start of BCG. Few patients reported fever, haematuria, illness or urinary tract symptoms. No difference in symptoms was found between patients with or without concomitant CIS (carcinoma in situ). Patients younger than 65 years of age reported a greater worry about the symptom burden in the future than those who were older. Patients younger than 65 years reported a decreased level of mental well-being.

    Conclusion: Patients with bladder cancer T1G2–G3 had disease-specific symptoms present already before the start of the BCG. The burden of symptoms was reduced over time and showed that the bladder might recover. BCG instillations had side-effects that negatively affected the patient’s well-being. It is important to record the patients’ baseline bladder and voiding status before as well as during the BCG-instillation period in order to understand symptoms caused by the treatment.

  • 3.
    Fridriksson, Jon O.
    et al.
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden..
    Folkvaljon, Yasin
    Univ Uppsala Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden..
    Nilsson, Per
    Lund Univ, Skane Univ Hosp, Dept Oncol & Radiat Phys, Lund, Sweden..
    Robinson, David
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden.;Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Franck-Lissbrant, Ingela
    Sahlgrens Univ Hosp, Dept Oncol & Radiat Phys, Gothenburg, Sweden..
    Ehdaie, Behfar
    Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, 1275 York Ave, New York, NY 10021 USA..
    Eastham, James A.
    Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, 1275 York Ave, New York, NY 10021 USA..
    Widmark, Anders
    Umea Univ, Dept Radiat Sci, Oncol, Umea, Sweden..
    Karlsson, Camilla T.
    Umea Univ, Dept Radiat Sci, Oncol, Umea, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden..
    Long-term adverse effects after curative radiotherapy and radical prostatectomy: population-based nationwide register study2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 5, s. 338-345Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to assess the risk of serious adverse effects after radiotherapy (RT) with curative intention and radical prostatectomy (RP). Materials and methods: Men who were diagnosed with prostate cancer between 1997 and 2012 and underwent curative treatment were selected from the Prostate Cancer data Base Sweden. For each included man, five prostate cancer-free controls, matched for birth year and county of residency, were randomly selected. In total, 12,534 men underwent RT, 24,886 underwent RP and 186,624 were controls. Adverse effects were defined according to surgical and diagnostic codes in the National Patient Registry. The relative risk (RR) of adverse effects up to 12 years after treatment was compared to controls and the risk was subsequently compared between RT and RP in multivariable analyses. Results: Men with intermediate- and localized high-risk cancer who underwent curative treatment had an increased risk of adverse effects during the full study period compared to controls: the RR of undergoing a procedures after RT was 2.64 [95% confidence interval (CI) 2.56-2.73] and after RP 2.05 (95% CI 2.00-2.10). The risk remained elevated 10-12 years after treatment. For all risk categories of prostate cancer, the risk of surgical procedures for urinary incontinence was higher after RP (RR 23.64, 95% CI 11.71-47.74), whereas risk of other procedures on the lower urinary tract and gastrointestinal tract or abdominal wall was higher after RT (RR 1.67, 95% CI 1.44-1.94, and RR 1.86, 95% CI 1.70-2.02, respectively). Conclusion: The risk of serious adverse effects after curative treatment for prostate cancer remained significantly elevated up to 12 years after treatment.

  • 4.
    Helenius, Malin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Brekkan, Einar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Dahlman, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Lönnemark, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Magnusson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Bladder cancer detection in patients with gross haematuria: Computed tomography urography with enhancement triggered scan versus flexible cystoscopy2015Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, nr 5, s. 377-381Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    Computed tomography urography (CTU) can be used to direct further investigation of patients if the bladder tumour detection rate is high. The aim of this study was to compare a CTU protocol including an enhancement-triggered scan and flexible cystoscopy for detecting bladder tumours.

    Materials and methods

    Patients with gross haematuria undergoing CTU during 2005–2008 were included. For patients younger than 50 years the CTU protocol included unenhanced, enhancement-triggered corticomedullary, and excretory phases. Patients older than 50 years followed the same protocol plus a nephrographic phase. The entire urinary tract was examined in all phases.

    Results

    Of 435 patients, 55 patients were diagnosed with bladder tumour. CTU detected bladder tumour in 48 patients (87%). Five CTU examination reports were false positive. With CTU, sensitivity for finding bladder tumour was 0.87, specificity 0.99, positive predictive value (PPV) 0.91 and negative predictive value (NPV) 0.98. Cystoscopy detected bladder tumour in 48 patients (87%) and had one false-positive finding, resulting in sensitivity of 0.87, specificity 1.0, PPV 0.98 and NPV 0.98.

    Conclusions

    The detection rate of bladder tumours for the CTU protocol including an enhancement-triggered scan was high and comparable to flexible cystoscopy. Hence, this protocol could be used to assess the bladder as the primary investigation and direct further investigation of the patient.

  • 5.
    Hemdan, Tammer
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Turker, Polat
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Segersten, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Choline-phosphate cytidylyltransferase-alpha as a possible predictor of survival and response to cisplatin neoadjuvant chemotherapy in urothelial cancer of the bladder2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 3, s. 200-205Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The aim of this study was to test choline-phosphate cytidylyltransferase-alpha (CCT-alpha) protein as a biomarker for neoadjuvant cisplatin chemotherapy response in a bladder tumor setting. Materials and methods: A total of 238 patients with T2-T4 bladder cancer enrolled into two prior randomized trials comparing neoadjuvant cisplatin-based chemotherapy (NAC) plus cystectomy with cystectomy only (no-NAC) were used as discovery and validation cohorts. Protein expression was determined with immunohistochemistry and assessed with Histo (H)-scoring. Results: In the discovery cohort, comprising 61 patients, the survival ratio after NAC treatment for CCT-alpha-negative patients was significantly increased (p = 0.001) while there was no survival advantage in the CCT-alpha-positive patient group. Similarly, in the validation cohort with 177 patients, NAC treatment improved survival only in the CCT-alpha-negative group (p = 0.006). Although there was a tendency for a good NAC response with negative CCT-alpha status, the interaction variable between biomarker and treatment was not significant (p = 0.24). In the cystectomy-only group, patients with positive CCT-alpha expression had a better survival than CCT-alpha-negative patients. This prognostic effect of CCT-alpha expression remained significant after adjusting for well-known prognostic factors in a multivariate analysis. In a pooled database of both patient data sets, multivariate analyses showed CCT-alpha status as an independent factor for overall survival (p = 0.018; hazard ratio = 1.80, 95% confidence interval 1.11-2.93). Conclusion: CCT-alpha status was not predictive of outcome of NAC response; however, in the control group with cystectomy only it was found to have prognostic value.

  • 6.
    Jahnson, Staffan
    et al.
    Linkoping Univ, Dept Clin & Expt Med, Div Urol, Linkoping, Sweden.
    Gårdmark, Truls
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.
    Hosseini, Abolfazl
    Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden.
    Jedström, Tomas
    Orebro Univ Hosp, Dept Urol, Orebro, Sweden.
    Liedberg, Fredrik
    Skane Univ Hosp, Dept Urol, Malmo, Sweden;Lund Univ, Inst Translat Med, Malmo, Sweden.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Rosell, Johan
    Linkoping Univ, Reg Canc Ctr Southeast Sweden, Linkoping, Sweden;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Sherif, Amir
    Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.
    Ströck, Viveka
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden.
    Häggström, Christel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Umea Univ, Dept Biobank Res, Umea, Sweden.
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Kings Coll London, Sch Med, London, England.
    Aljabery, Firas
    Linkoping Univ, Dept Clin & Expt Med, Div Urol, Linkoping, Sweden.
    Management and outcome of TaG3 tumours of the urinary bladder in the nationwide, population-based bladder cancer database Sweden (BladderBaSe)2019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 4, s. 200-205Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To investigate the management of TaG3 tumours of the urinary bladder using nationwide population-based data in relation to the prevailing guidelines, patients' characteristics, and outcome. Materials and methods: The Bladder Cancer Data Base Sweden (BladderBaSe), including data from the Swedish National Register for Urinary Bladder Cancer (SNRUBC), was used to study all patients with TaG3 bladder cancer diagnosed from 2008 to 2014. Patients were divided into the following management groups: (1) transurethral resection (TUR) only, (2) TUR and intravesical instillation therapy (IVIT), (3) TUR and second-look resection (SLR), and (4) TUR with both SLR and IVIT. Patient and tumour characteristics and outcome were studied. Results: There were 831 patients (83% males) with a median age of 74 years. SLR was performed more often on younger patients, on men, and less often in the Western and Uppsala/orebro Healthcare regions. IVIT was performed more often with younger patients, with men, in the Western Healthcare region, and less often in the Uppsala/orebro Healthcare region. Death from bladder cancer occurred in 6% of cases within a median of 29 months (0-84 months) and was lower in the TUR/IVIT and TUR/SLR/IVIT groups compared to the other two groups. Conclusion: In the present study, there was, according to the prevailing treatment guidelines, an under-treatment with SLR for older patients, women, and in some healthcare regions and, similarly, there was an under-treatment with IVIT for older patients. Cancer-specific survival and relative survival were lower in the TUR only group compared to the TUR/IVIT and TUR/SLR/IVIT groups.

  • 7. Jahnson, Staffan
    et al.
    Hosseini Aliabad, Abolfazl
    Holmäng, Sten
    Jancke, Georg
    Liedberg, Fredrik
    Ljungberg, Börje
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Rosell, Johan
    Swedish National Registry of Urinary Bladder Cancer: No difference in relative survival over time despite more aggressive treatment.2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 1, s. 14-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to use the Swedish National Registry of Urinary Bladder Cancer (SNRUBC) to investigate changes in patient and tumour characteristics, management and survival in bladder cancer cases over a period of 15 years.

    MATERIALS AND METHODS: All patients with newly detected bladder cancer reported to the SNRUBC during 1997-2011 were included in the study. The cohort was divided into three groups, each representing 5 years of the 15 year study period.

    RESULTS: The study included 31,266 patients (74% men, 26% women) with a mean age of 72 years. Mean age was 71.7 years in the first subperiod (1997-2001) and 72.5 years in the last subperiod (2007-2011). Clinical T categorization changed from the first to the last subperiod: Ta from 45% to 48%, T1 from 21.6% to 22.4%, and T2-T4 from 27% to 25%. Also from the first to the last subperiod, intravesical treatment after transurethral resection for T1G2 and T1G3 tumours increased from 15% to 40% and from 30% to 50%, respectively, and cystectomy for T2-T4 tumours increased from 30% to 40%. No differences between the analysed subperiods were found regarding relative survival in patients with T1 or T2-T4 tumours, or in the whole cohort.

    CONCLUSIONS: This investigation based on a national bladder cancer registry showed that the age of the patients at diagnosis increased, and the proportion of muscle-invasive tumours decreased. The treatment of all tumour stages became more aggressive but relative survival showed no statistically significant change over time.

  • 8. Jan, Michael
    et al.
    Bonn, Stephanie E
    Sjölander, Arvid
    Wiklund, Fredrik
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Holmberg, Erik
    Grönberg, Henrik
    Bälter, Katarina
    The roles of stress and social support in prostate cancer mortality2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 1, s. 47-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study aimed to evaluate the association between perceived stress, social support, disease progression and mortality in a nationwide population-based cohort of men with prostate cancer.

    MATERIALS AND METHODS: The study surveyed 4105 Swedish men treated for clinically localized prostate cancer regarding stress, grief, sleep habits and social support. Associations between these factors and mortality were assessed using multivariate Cox regression analysis.

    RESULTS: Men with the highest levels of perceived stress had a statistically significantly increased rate of prostate cancer-specific mortality compared with men with low stress levels (hazard ratio 1.66, 95% confidence interval 1.05-2.63). Men with high stress levels also had a high frequency of grieving and sleep loss. They also had fewer people with whom to share their emotional problems and felt an inability to share most of their problems with partners, friends and family.

    CONCLUSIONS: This study contributes to the growing field of psychosocial quality of life research in men with prostate cancer. The findings show a significant association between prostate cancer-specific mortality and perceived stress in patients initially diagnosed with localized, non-metastatic prostate cancer. Significant associations between perceived stress and various psychosocial factors were also seen. The findings of this study could prove useful to target interventions to improve quality of life in men with prostate cancer.

  • 9.
    Jancke, Georg
    et al.
    Skane Univ Hosp, Dept Urol, Malmo, Sweden.;Lund Univ, Dept Translat Med, Malmo, Sweden..
    Liedberg, Fredrik
    Skane Univ Hosp, Dept Urol, Malmo, Sweden.;Lund Univ, Dept Translat Med, Malmo, Sweden..
    Aljabery, Firas
    Linkoping Univ Hosp, Dept Urol, Linkoping, Sweden..
    Sherif, Amir
    Norrland Univ Hosp, Dept Urol, Umea, Sweden..
    Strock, Viveka
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden..
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Hosseini-Aliabad, Abolfazl
    Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden..
    Jahnson, Staffan
    Linkoping Univ Hosp, Dept Urol, Linkoping, Sweden..
    Intravesical instillations and cancer-specific survival in patients with primary carcinoma in situ of the urinary bladder2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 2, s. 124-129Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to evaluate the use of intravesical treatment and cancer-specific survival of patients with primary carcinoma in situ (CIS). Materials and methods: Data acquisition was based on the Swedish National Registry of Urinary Bladder Cancer by selecting all patients with primary CIS. The analysis covered gender, age, hospital type and hospital volume. Intravesical treatment and death due to bladder cancer were evaluated by multivariate logistic regression and multivariate Cox analysis, respectively. Results: The study included 1041 patients (median age at diagnosis 72 years) with a median follow-up of 65 months. Intravesical instillation therapy was given to 745 patients (72%), and 138 (13%) died from bladder cancer during the observation period. Male gender [odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.13-2.17] and treatment at county (OR = 1.65, 95% CI 1.17-2.33), university (OR =2.12, 95% CI 1.48-3.03) or high-volume (OR= 1.92, 95% CI 1.34-2.75) hospitals were significantly associated with higher odds of intravesical instillations. The age category >80 years had a significantly lower chance of receiving intravesical therapy (OR = 0.44, 95% CI 0.26-0.74) and a significantly higher risk of dying from bladder cancer (hazard ratio = 3.03, 95% CI 1.71-5.35). Conclusion: Significantly more frequent use of intravesical treatment of primary CIS was found for males and for patients treated at county, university and high-volume hospitals. Age >80 years was significantly related to less intravesical treatment and poorer cancer-specific survival.

  • 10. Jerlstrom, Tomas
    et al.
    Gardmark, Truls
    Carringer, Malcolm
    Holmang, Sten
    Liedberg, Fredrik
    Hosseini, Abolfazl
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Ljungberg, Borje
    Hagberg, Oskar
    Jahnson, Staffan
    Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database2014Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, nr 4, s. 334-340Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration. Material and methods. Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression. Results. During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis. Conclusions. It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

  • 11.
    Jerlstrom, Tomas
    et al.
    Orebro Univ, Sch Hlth & Med Sci, Dept Urol, Orebro, Sweden..
    Gardmark, Truls
    Karolinska Inst, Danderyd Hosp, Dept Urol, Dept Clin Sci, Stockholm, Sweden..
    Strock, Viveka
    Sahlgrenska Univ Hostpital, Dept Urol, Gothenburg, Sweden..
    Aljabery, Firas A. -S.
    Linkoping Univ Hosp, Dept Clin & Expt Med, Linkoping, Sweden..
    Hosseini, Abolfazl A.
    Karolinska Inst, Sect Urol, Dept Mol Med & Surg, Stockholm, Sweden..
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Ullen, Anders
    Karolinska Hosp, Dept Oncol Pathol, Stockholm, Sweden..
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Liedberg, Fredrik
    Lund Univ, Skane Univ Hosp, Dept Translat Med, Malmo, Sweden..
    Jahnson, Staffan
    Linkoping Univ Hosp, Dept Clin & Expt Med, Linkoping, Sweden..
    Carringer, Malcolm
    Orebro Univ, Sch Hlth & Med Sci, Dept Urol, Orebro, Sweden..
    Significantly more downstaging in patients recieving preoperative (neoadjuvant and induction) chemotherapy prior to cystectomy for muscle-invasive bladder cancer2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, s. 34-35Artikkel i tidsskrift (Annet vitenskapelig)
  • 12. Kaasinen, Eero
    et al.
    Wijkström, Hans
    Rintala, Erkki
    Mestad, Oddvar
    Jahnson, Staffan
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Seventeen-year follow-up of the prospective randomized Nordic CIS study: BCG monotherapy versus alternating therapy with mitomycin C and BCG in patients with carcinoma in situ of the urinary bladder2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 5, s. 360-368Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to compare the long-term efficacy of BCG monotherapy to alternating therapy of mitomycin C (MMC) and BCG in patients with carcinoma in situ (CIS).

    MATERIALS AND METHODS: Between 1992 and 1997, 321 patients with CIS were randomized from Finland, Norway and Sweden in a prospective multicenter trial into two treatment groups. The alternating therapy comprised six weekly instillations of MMC 40 mg followed by 10 instillations of BCG (Connaught 120 mg) or MMC alternating monthly for 1 year. BCG monotherapy followed the same 6 + 10 schedule. Stratification was done by nationality and CIS category. Primary endpoints were time to first recurrence and time to progression. Secondary endpoints were disease-specific mortality and overall survival. The main statistical methods were the proportional subdistribution hazards model and Cox proportional hazards model with the cumulative incidence and Kaplan-Meier analyses.

    RESULTS: The median follow-up time was 9.9 years (maximum 19.9 years) in the BCG group and 8.9 years (maximum 20.3 years) in the alternating group. The risk of recurrence was significantly lower in the BCG group than in the alternating group (49 vs 59% at 15 years, respectively; hazard ratio 0.74, 95% confidence interval 0.54-1.00, p = 0.048). There were no significant differences in the other endpoints. Patients who progressed after 2 years were particularly prone to dying from bladder carcinoma. Younger patients performed worse than older ones.

    CONCLUSIONS: BCG monotherapy including monthly maintenance was effective and better than the alternating therapy. The risk of dying from bladder carcinoma after progression was high.

  • 13. Liedberg, Fredrik
    et al.
    Hagberg, Oskar
    Holmang, Sten
    Aliabad, Abolfazl Hosseini
    Jancke, Georg
    Ljungberg, Borje
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Aberg, Hanna
    Jahnson, Staffan
    Local recurrence and progression of non-muscle-invasive bladder cancer in Sweden: a population-based follow-up study2015Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, nr 4, s. 290-295Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. The aim of this study was to investigate recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) in a large population-based setting. Materials and methods. Patients with bladder cancer (stage Ta, T1 or carcinoma in situ) diagnosed in 2004-2007 (n = 5839) in Sweden were investigated 5 years after diagnosis using a questionnaire. Differences in time to recurrence and progression were analysed in relation to age, gender, tumour stage and grade, intravesical treatment, healthcare region, and hospital volume of NMIBC patients (stratified in three equally large groups). Results. Local bladder recurrence and progression occurred in 50 and 9% of the patients, respectively. The rate of local recurrence was 56% in the southern healthcare region compared to 37% in the northern region. A multivariate Cox proportional hazards model, adjusting for age, gender, tumour stage and grade, intravesical treatment, healthcare region and hospital volume, showed that recurrence was associated with TaG2 and T1 disease, no intravesical treatment and treatment in the southern healthcare region, but indicated a lower risk of recurrence in the northern healthcare region. Adjusting for the same factors in a multivariate analysis suggested that increased relative risk of progression correlated with older age, higher tumour stage and grade, and diagnosis in the Uppsala/Orebro healthcare region, whereas such risk was decreased by intravesical treatment (relative risk 0.72, 95% confidence interval 0.55-0.93, p = 0.012). Conclusions. The incidence of NMIBC recurrence and progression was found to be high in Sweden, and important disparities in outcome related to care patterns appear to exist between different healthcare regions.

  • 14.
    Lissbrant, Ingela Franck
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden.
    Ventimiglia, Eugenio
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Osped San Raffaele, IRCCS, URI, Div Expt Oncol, Unit Urol, Milan, Italy.
    Robinson, David
    Ryhov Cty Hosp, Dept Urol, Jönköping, Sweden.
    Törnblom, Magnus
    Visby Cty Hosp, Dept Surg, Visby, Sweden.
    Hjalm-Eriksson, Marie
    Capio St Gorans Hosp, Dept Surg, Stockholm, Sweden; Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.
    Lambe, Mats
    Uppsala Univ Hosp, Reg Canc Ctr, Uppsala, Sweden.
    Folkvaljon, Yasin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Nationwide population-based study on the use of novel antiandrogens in men with prostate cancer in Sweden2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 2, s. 143-150Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The aim of this study was to examine the use of abiraterone and enzalutamide, two oral novel antiandrogens (NOVAs), in men with prostate cancer (PCa) in Sweden.

    Materials and methods: This cross-sectional study investigated filled prescriptions for NOVAs recorded in the Swedish Prescribed Drug Register between July 2015 and April 2016. Associations between age, comorbidity, educational level, marital status and county of residence and filled prescriptions were analyzed in the National Prostate Cancer Register (NPCR) and other health population-based registers, using multivariable logistic regression.

    Results: Of 91,209 men, 1650 (2%) had at least one prescription filled for NOVAs, of whom 1350 (82%) had high-risk or metastatic PCa at diagnosis.. Of 1914 men with M1 disease and a high probability of castration-resistant prostate cancer (CRPC), 22% had a prescription for NOVAs at a median 3 years after the date of diagnosis. At multivariable logistic regression analysis,, the likelihood of NOVA use was lower in older men [age >80 vs <70 years: odds ratio (OR) 0.23, 95% confidence interval (CI) 0.15–0.35] and in men with lower educational level (high vs low education: OR 1.64, 95% CI 1.23–2.20). There was up to a five-fold difference in the use of NOVAs between county councils.

    Conclusions: Less than one-third of potentially eligible men with CRPC received NOVAs in 2015–2016. There were large differences in use according to age and region of residence, indicating that efforts are needed to improve equal access to novel cancer drugs.

  • 15.
    Loeb, Stacy
    et al.
    NYU, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
    Folkvaljon, Yasin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Robinson, David
    Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.;Ryhov Cty Hosp, Dept Urol, Jonkoping, Sweden..
    Makarov, Danil V.
    NYU, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
    Bratt, Ola
    Addenbrookes Hosp, CamPARI Clin, Dept Urol, Cambridge, England.;Lund Univ, Dept Translat Sci, Lund, Sweden..
    Garmo, Hans
    Kings Coll London, Div Canc Studies, Fac Life Sci & Med, London, England..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Immediate versus delayed prostatectomy: Nationwide population-based study2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 4, s. 246-254Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to compare the outcome of immediate versus delayed radical prostatectomy (RP) in men with low-grade prostate cancer. Materials and methods: The study included a nationwide population-based cohort in the National Prostate Cancer Register of Sweden, of 7608 men with clinically localized, biopsy Gleason score 6 prostate cancer who underwent immediate or delayed RP in 1997-2007. Multivariable models compared RP pathology, use of salvage radiotherapy and prostate cancer mortality based on timing of RP (< 1, 1-2 or > 2 years after diagnosis). Median follow-up was 8.1 years. Results: Men undergoing RP more than 2 years after diagnosis had a higher risk of Gleason upgrading [odds ratio 2.93, 95% confidence interval (CI) 2.34-3.68] and an increased risk of salvage radiotherapy [hazard ratio (HR) 1.90, 95% CI 1.41-2.55], but no significant increase in prostate cancer-specific mortality (HR 1.85, 95% CI 0.57-5.99). In competing risk analysis, 7 year prostate cancer-specific cumulative mortality was similar, at less than 1%, for immediate RP and active surveillance regardless of later intervention. Limitations of this study include the lack of data on follow-up biopsies and the limited follow-up time. Conclusion: Men undergoing RP more than 2 years after diagnosis had more adverse pathological features and second line therapy, highlighting the trade-off in deferring immediate curative therapy. However, men with delayed RP constitute a minority with higher risk cancer among the much larger group of low-risk men initially surveilled, and the overall risk of prostate cancer mortality at 7 years was similarly low with immediate RP or active surveillance.

  • 16.
    Lundström, Karl-Johan
    et al.
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden..
    Folkvaljon, Yasin
    Reg Canc Ctr, Uppsala, Sweden..
    Loeb, Stacy
    NYU, Dept Urol & Populat Hlth, New York, NY USA.;NYU, Laura & Isaac Perlmutter Canc Ctr, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
    Axelson, Anna Bill
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden..
    Nordin, Pär
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden..
    Small bowel obstruction and abdominal pain after robotic versus open radical prostatectomy2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 3, s. 155-159Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to examine whether intraperitoneal robot-assisted surgery leads to small bowel obstruction (SBO), possibly caused by the formation of intra-abdominal adhesions.

    Materials and methods: In total, 7256 men treated by intraperitoneal robot-assisted radical prostatectomy (RARP) and 9787 men treated by retropubic radical prostatectomy (RRP) in 2005-2012 were identified in the Prostate Cancer data Base Sweden (PCBaSe). Multivariable Cox proportional hazards models were used to calculate the risk of readmission for SBO, SBO-related surgery and admissions due to abdominal pain up to 5 years postoperatively.

    Results: During the first postoperative year, the risk of readmission for SBO was higher after RARP than after RRP [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.14-3.25] but after 5 years there was no significant difference (HR 1.28, 95% CI 0.86-1.91), and there was no difference in the risk of SBO surgery during any period. The risk of admission for abdominal pain was significantly increased after RARP during the first year (HR 2.24, 95% CI 1.50-3.33) but not after 5 years (HR 1.23, 95% CI 0.92-1.63).

    Conclusion: Intraperitoneal RARP had an increased risk of SBO and abdominal pain in the short term during the first year, but not in the long term, compared to RRP.

  • 17.
    Lundström, Karl-Johan
    et al.
    Umea Univ, Inst Surg & Perioperat Sci, Umea, Sweden.
    Söderström, Lars
    Östersund Hosp, Unit Res Educ & Dev, S-83183 Östersund, Sweden.
    Jernow, Henning
    NU Hosp Grp, Trollhättan, Sweden.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umeå Univ, Inst Surg & Perioperat Sci, Umeå, Sweden;Uppsala Univ, Dept Surg Sci, Uppsala, Sweden.
    Nordin, Pär
    Umeå Univ, Inst Surg & Perioperat Sci, Umeå, Sweden.
    Epidemiology of hydrocele and spermatocele; incidence, treatment and complications2019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 2-3, s. 134-138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To estimate the incidence of men seeking specialized care and receiving treatment for hydro or spermatocele complaints. Also, to determine the risk of complications of treatment. Materials and methods: The total number of men living in Sweden each year from 2005 to 2014 was used to calculate incidence and age distribution of adult (>= 18 years) men seeking specialized healthcare with either hydro or spermatocele. This was done by using nationwide registries, mandatory by law. They contain information on primary or discharge diagnosis, procedure codes and antibiotic prescriptions. Also, complication rates comparing aspiration (with or without sclerotherapy) and conventional surgery were analysed. Results: The incidence of men with either hydro or spermatocele diagnosis in specialized healthcare was similar to 100/100,000 men. The treatment incidence was 17/100,000 men. Orchiectomy was used as primary treatment in 2.4% of cases. The risk of experiencing a complication was clinically and statistically significantly increased with conventional surgery as compared with aspiration, 17.5% (1607/9174) vs 4.6% (181/3920), corresponding to relative risk of 3.79 (95% CI = 3.27-4.40). Hematoma and infections were the most common complications. Conclusion: Hydro and spermatoceles are common, affecting elderly men. Aspiration seems advantageous with respect to complications and can be recommended due to the benign course of the disease. The indication for conventional surgery might be questioned such as the use of orchiectomy as primary treatment.

  • 18.
    Lycken, Magdalena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Drevin, Linda
    Reg Canc Ctr, Uppsala, Sweden..
    Garmo, Hans
    Reg Canc Ctr, Uppsala, Sweden.;Kings Coll London, Sch Med, Div Canc Studies, London, England..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Uppsala Univ, Dept Surg Sci, Uppsala, Sweden.;Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, New York, NY 10021 USA.;Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
    Adolfsson, Jan
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Lissbrant, Ingela Franck
    Sahlgrens Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Reg Canc Ctr, Uppsala, Sweden.;Kings Coll London, Sch Med, Div Canc Studies, London, England..
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Uppsala Univ, Dept Surg Sci, Uppsala, Sweden..
    Use of palliative medications before death from prostate cancer: a population based study2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr SI 220, s. 25-26Artikkel i tidsskrift (Annet vitenskapelig)
  • 19.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Drugs and risk of cancer2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 3, s. 212-212Artikkel i tidsskrift (Annet vitenskapelig)
  • 20.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Half a decade of fluorescence in the bladder2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 3, s. 219-219Artikkel i tidsskrift (Annet vitenskapelig)
  • 21.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    How do we acquire high-level evidence in urology? A 30 year perspective2015Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 1, s. 1-1Artikkel i tidsskrift (Fagfellevurdert)
  • 22.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Scientific breakthrough or "fake news"?2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 3, s. 177-177Artikkel i tidsskrift (Annet vitenskapelig)
  • 23.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Agrawal, Sachin
    St Peters Hosp, Ashford & St Peters NHS Trust, Dept Urol, Chertsey, England..
    Blackberg, Mats
    Helsingborg Hosp, Dept Urol & Surg, Helsingborg, Sweden..
    Boström, Peter J.
    Turku Univ Hosp, Dept Urol, Turku, Finland..
    Malavaud, Bernard
    Toulouse Canc Inst, Dept Urol, Toulouse, France..
    Zaak, Dirk
    Traunstein Hosp, Dept Urol, Traunstein, Germany..
    Hermann, Gregers G.
    Univ Copenhagen, Dept Urol, Herlev & Gentofte Hosp, Herlev, Denmark..
    Non-muscle-invasive bladder cancer: a vision for the future2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 2, s. 87-94Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    The management of non-muscle-invasive bladder cancer (NMIBC) has evolved from the first reports on bladder endoscopy and transurethral resection to the introduction of adjuvant intravesical treatment. However, disease recurrence and progression remain an ongoing risk, placing a heavy burden on healthcare resources and on patients' quality of life. Deeper understanding of the molecular basis of the disease and developments in optics, lasers and computer science are already offering opportunities to revolutionize care and improve long-term prognosis. This article discusses developments likely to cause a paradigm shift towards the delivery of personalized care and reduced burden of disease in NMIBC.

  • 24.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Gårdmark, Truls
    Danderyd Hosp, Dept Surg, Urol Sect, Danderyd, Sweden;Karolinska Inst, Stockholm, Sweden.
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.
    Ströck, Viveka
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden;Sahlgrens Acad, Inst Clin Sci, Gothenburg, Sweden.
    Hosseini-Aliabad, Abolfazl
    Karolinska Univ Hosp, Ctr Pelv Canc, Stockholm, Sweden.
    Jahnson, Staffan
    Linkoping Univ Hosp, Dept Urol, Linkoping, Sweden.
    Aljabery, Firas
    Linkoping Univ Hosp, Dept Urol, Linkoping, Sweden.
    Liedberg, Fredrik
    Skane Univ Hosp, Dept Urol, Malmo, Sweden;Lund Univ, Dept Translat Med, Malmo, Sweden.
    Incidence, survival and mortality trends of bladder cancer in Sweden 1997-20162019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 4, s. 193-199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate trends in bladder cancer incidence, survival and mortality in Sweden from 1997-2016.

    Patients and methods: The Swedish National Registry of Urinary Bladder Cancer is a nation-wide quality register that started in 1997. It includes information on initial tumor characteristics and treatment; 41,097 new cases were registered up to 2016. Patients were stratified into four time periods. Deaths were monitored through the national death register. Overall and relative survival in time periods were studied with respect to differences in stage, age and gender.

    Results: The number of new cases increased by 38% for men and 39% for women from 1997 to 2016. The corresponding age-standardized incidence per 100,000 was less dramatic, with increases of 6% and 21%, respectively, and the increase was most evident in the oldest age group. The survival rate was stable until 2012, but thereafter a significant improvement occurred. The survival trends in stage-groups show that this improvement is found in all categories as well as irrespective of age and gender. The mortality rate during this period was stable for women, but showed a slight decrease for men. The main limitation of this study is the use of administrative data for defining some of the endpoints.

    Conclusion: The most recent Swedish bladder cancer statistics show an increased incidence, improved survival, but stable mortality.

  • 25.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Skaaheim, Erik
    Vestfold Hosp Trust, Dept Urol, Tonsberg, Norway; Oslo Univ Hosp, Inst Canc Genet & Informat, Oslo, Norway.
    Boström, Peter J.
    Turku Univ Hosp, Dept Urol, Turku, Finland.
    Gudjonsson, Sigidur
    Landspitali Univ Hosp, Dept Urol, Reykjavik, Iceland.
    Jensen, Jorgen Bjerggaard
    Aarhus Univ, Dept Clin Med, Aarhus, Denmark; Aarhus Univ Hosp, Dept Urol, Aarhus, Denmark.
    Progress towards a Nordic standard for the investigation of hematuria: 20192019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 1, s. 1-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe the management of patients with hematuria in the Nordic countries in relation to bladder cancer epidemiology, especially in the context of introducing fast track pathways with the aim of proposing a common guideline.

    Materials and methods: Epidemiological data on bladder cancer from each country, and the combined cancer registry, Nordcan, were analyzed. The evolution of the different national recommendations and the introduction of fast track pathways were assessed. Patients' demographics, type of hematuria and cancer detection rates were analysed if available.

    Results: The crude incidence of bladder cancer has increased substantially since the 1960s, while the age standardized incidence has been stable during recent decades. The relative survival has increased in all countries, while the mortality has been stable. For those with microscopic hematuria there has been a clear trend towards less rigorous investigations. In the fast track pathways, introduced in three of five countries, about one in five patients with macroscopic hematuria had a cancer diagnosis. Data show that time to diagnosis has been reduced.

    Conclusions: The number of patients with bladder cancer is increasing in the Nordic region. The introduction of fast track pathways has been important in improving the management of patients with suspicion of the disease. Our recommendation is to focus on macroscopic hematuria in the fast track pathways. Microhematuria without any symptoms should not be an indication for cystoscopy. However, urinary tract symptoms accompanied by microhematuria can still be investigated according to respective guidelines but not necessarily within fast track pathways.

     

  • 26.
    Mints, Michael
    et al.
    Umea Univ, Dept Surg & Perioperat Sci, Stockholm, Sweden..
    Hiltbrunner, Stefanie
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Eldh, Maria
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Rosenblatt, Robert
    Umea Univ, Dept Surg & Perioperat Sci, Stockholm, Sweden..
    Holmström, Benny
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Alamdari, Farhood
    Vastmanland Hosp, Dept Urol, Vasteras, Sweden..
    Johansson, Markus
    Sundsvall Hosp, Dept Urol, Sundsvall, Sweden..
    Hansson, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala Univ, Fac Med, Uppsala, Sweden..
    Vasko, Jonas
    Umea Univ, Dept Med Biosci, Umea, Sweden..
    Winqvist, Ola
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci, Stockholm, Sweden..
    Gabrielsson, Susanne
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Exosomes in urine retain a malignant protein profile after primary tumour ablation in patients with invasive urinary bladder cancer2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, s. 38-39Artikkel i tidsskrift (Annet vitenskapelig)
  • 27.
    Mints, Michael
    et al.
    Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
    Krantz, David
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Johansson, Markus
    Sundsvall Hosp, Dept Urol, Sundsvall, Sweden..
    Hansson, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Vasko, Jonas
    Umea Univ, Dept Med Biosci, Umea, Sweden..
    Winerdal, Malin
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Zirakzadeh, Ali
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Riklund, Katrin
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Zubarev, Roman
    Karolinska Inst, Dept Med Biochem & Biophys, Stockholm, Sweden..
    Rutishauser, Dorothea
    Karolinska Inst, Dept Med Biochem & Biophys, Stockholm, Sweden..
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
    Winqvist, Ola
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Individual immunoproteomics identifies il-16 processing in tregs as a factor in bladder cancer tumour immunity2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr SI 220, s. 36-37Artikkel i tidsskrift (Annet vitenskapelig)
  • 28.
    Nugin, Hampus
    et al.
    Falun Cent Hosp, Dept Surg, Falun, Sweden.
    Folkvaljon, Yasin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Damber, Jan-Erik
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Clin Sci, Dept Urol,Sahlgrenska Acad, Gothenburg, Sweden.
    Adolfsson, Jan
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Robinson, David
    Ryhov Hosp, Dept Urol, Jonkoping, Sweden.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Work-up and treatment of prostate cancer before and after publication of the first national guidelines on prostate cancer care in Sweden2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 4, s. 277-284Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Objectives: In 2007, the Swedish National Board of Health and Welfare published the first Swedish guidelines on prostate cancer (PCa) to improve care and decrease geographical and social inequalities. The aim of this analysis was to assess how these guidelines affected PCa care.

    Materials and Methods: Work-up and treatment for men diagnosed with PCa between 1998 and 2014 were assessed by use of data in the Prostate Cancer data Base Sweden (PCBaSe) with information from the National Prostate Cancer Register (NPCR) and other healthcare registries and demographic databases.

    Results: Overall, there were modest improvements in the performance for 14 selected quality indicators, with some notable exceptions. There was a strong increase in the use of active surveillance for very low-risk PCa, up from 56% in 2009 to 92% in 2014, and use of bone imaging for high-risk PCa up from 50% in 2008 to 77% in 2014. There were large differences in work-up and treatment of PCa between healthcare providers with modest decreases over time. The differences between counties were larger than differences according to socioeconomic status with one exception: use of curative treatment for high-risk PCa was more common in men with high income, highest versus lowest tertile, OR 2.74 (95% CI, 1.85-4.06).

    Conclusion: The modest improvements in PCa care after the publications of national guidelines indicate that if these are to make an impact on care, feedback to each point of care on their performance as well as local quality improvement programs implementing the guidelines are needed.

  • 29. Ohmann, Erin L.
    et al.
    Loeb, Stacy
    Robinson, David
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Berglund, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Stattin, Par
    Nationwide, population-based study of prostate cancer stage migration between and within clinical risk categories2014Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, nr 5, s. 426-435Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. In countries with widespread prostate cancer screening there has been strong stage migration, but little is known about changes within clinical risk categories. Such data are important for the proper interpretation of studies that recruited cases in an earlier era. The purpose of this study was to examine stage migration between and within clinical risk categories. Material and methods. Using the population-based National Prostate Cancer Register (NPCR) of Sweden, changes in the distribution of prostate-specific antigen (PSA), Gleason score, tumor stage and volume overall between and within clinical risk categories were examined in 120 228 prostate cancer cases diagnosed from 1998 to 2011. Results. Between 1998 and 2011, there was a two-fold increase in the proportion of low-risk prostate cancer (stage T1/T2, Gleason score 2-6 and PSA < 10 ng/ml), from 14% to 28%, and more than a two-fold decrease in the proportion of metastatic disease, from 25% to 11%. The proportion of men in the low-risk category with T1c tumors increased two-fold, from 36% to 71%, and PSA levels between 4 and 6 ng/ml increased from 24% to 38%; T2 tumors decreased from 39% to 20% and PSA between 8 and 10 ng/ml decreased from 24% to 15%. The proportion of men with less than 25% of cores involved with cancer increased from 41% to 52% between 2003-2006 and 2007-2011. Conclusions. Low-risk cases today have substantially lower tumor volume and PSA levels than low-risk cases diagnosed in 1998, indicating that outcomes in studies that recruited cases in previous decades represent worst case scenarios.

  • 30.
    Patschan, Oliver
    et al.
    Lund Univ, Dept Translat Med, SE-20502 Malmo, Sweden.;Skane Univ Hosp, Dept Urol, SE-20502 Malmo, Sweden..
    Holmang, Sten
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden..
    Hosseini, Abolfazl
    Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden..
    Jancke, Georg
    Lund Univ, Dept Translat Med, SE-20502 Malmo, Sweden.;Skane Univ Hosp, Dept Urol, SE-20502 Malmo, Sweden..
    Liedberg, Fredrik
    Lund Univ, Dept Translat Med, SE-20502 Malmo, Sweden.;Skane Univ Hosp, Dept Urol, SE-20502 Malmo, Sweden..
    Ljungberg, Borje
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Rosell, Johan
    Linkoping Univ, Reg Canc Ctr Southeast Sweden, Linkoping, Sweden.;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Jahnson, Staffan
    Univ Hosp, Dept Urol, Linkoping, Sweden.;Linkoping Univ, IKE, Linkoping, Sweden..
    Second-look resection for primary stage T1 bladder cancer: a population-based study2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 4, s. 301-307Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study aimed to evaluate the use of second-look resection (SLR) in stage T1 bladder cancer (BC) in a population-based Swedish cohort. Materials and methods: All patients diagnosed with stage T1 BC in 2008-2009 were identified in the Swedish National Registry for Urinary Bladder Cancer. Registry data on TNM stage, grade, primary treatment and pathological reports from the SLR performed within 8weeks of the primary transurethral resection were validated against patient charts. The endpoint was cancer-specific survival (CSS). Results: In total, 903 patients with a mean age of 74years (range 28-99 years) were included. SLR was performed in 501 patients (55%), who had the following stages at SLR: 172 (35%) T0, 83 (17%) Ta/Tis, 210 (43%) T1 and 26 (5%) T2-4. The use of SLR varied from 18% to 77% in the six healthcare regions. Multiple adjuvant intravesical instillations were given to 420 patients (47%). SLR was associated with intravesical instillations, age younger than 74 years, discussion at multidisciplinary tumour conference, G3 tumour and treatment at high-volume hospitals. Patients undergoing SLR had a lower risk of dying from BC (hazard ratio 0.62, 95% confidence interval 0.45-0.84, p<.0022). Five-year CSS rates were as follows, in patients with the indicated tumours at SLR (p=.001): 82% in those with T1, 90% in T0, 90% in Ta/Tis and 56% in T2-4. Conclusions: There are large geographical differences in the use of SLR in stage T1 BC in Sweden, which are presumably related to local treatment traditions. Patients treated with SLR have a high rate of residual tumour but lower age, which suggests that a selection bias affects CSS.

  • 31. Patschan, Oliver
    et al.
    Holmäng, Sten
    Hosseini, Abolfazl
    Liedberg, Fredrik
    Ljungberg, Börje
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Rosell, Johan
    Jahnson, Staffan
    Use of bacillus Calmette-Guérin in stage T1 bladder cancer: Long-term observation of a population-based cohort2015Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, nr 2, s. 127-132Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract Objective. The aim of this study was to analyse the rate of use of bacillus Calmette-Guérin (BCG) at a population-based level, and the overall mortality and bladder cancer mortality due to stage T1 bladder cancer in a national, population-based register. Materials and methods. In total, 3758 patients with primary stage T1 bladder cancer, registered in the Swedish Bladder Cancer Register between 1997 and 2006, were included. Age, gender, tumour grade and primary treatment in the first 3-6 months were registered. High-volume hospitals registered 10 or more T1 tumours per year. Date and cause of death were obtained from the National Board of Health and Welfare Cause of Death Register. Results. BCG was given to 896 patients (24%). The use of BCG increased from 18% between 1997 and 2000, to 24% between 2001 and 2003, and to 31% between 2004 and 2006. BCG was given more often to patients with G3 tumours, patients younger than 75 years and patients attending high-volume hospitals. BCG treatment, grade 2 tumours and patient age younger than 75 years were associated with lower mortality due to bladder cancer. Hospital volume, gender and year of diagnosis were not related to bladder cancer mortality. However, selection factors might have affected the results since comorbidity, number of tumours and tumour size were unknown. Conclusions. Intravesical BCG is underused at a population-based level in stage T1 bladder cancer in Sweden, particularly in patients 75 years or older, and in those treated at low-volume hospitals. BCG should be offered more frequently to patients with stage T1 bladder cancer in Sweden.

  • 32.
    Russell, Beth
    et al.
    Kings Coll London, Sch Canc & Pharmaceut Sci, TOUR, London, England.
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden.
    Häggström, Christel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Josephs, Debra
    Kings Coll London, Sch Canc & Pharmaceut Sci, TOUR, London, England.
    Kumar, Pardeep
    Royal Marsden NHS Fdn Trust, London, England.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Van Hemelrijck, Mieke
    Kings Coll London, Sch Canc & Pharmaceut Sci, TOUR, London, England.
    Neoadjuvant chemotherapy for muscle invasive bladder cancer: a nationwide investigation on survival2019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 4, s. 206-212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Randomised controlled trials (RCTs) have investigated the use of neoadjuvant chemotherapy (NAC) and its effect on survival patients with non-metastatic muscle-invasive bladder cancer (MIBC). However, these RCTs have limited external validity and generalisability and, therefore, the current study aims to use real world evidence in the form of observational data to identify the effect that NAC may have on survival, compared to the use of radical cystectomy (RC) alone. Materials and methods: The study cohort (consisting of 944 patients) was selected as a target trial from the Bladder Cancer Data Base Sweden (BladderBaSe). This study calculated 5-year survival and risk of bladder cancer (BC)-specific and overall death by Cox proportional hazard models for the study cohort and a propensity score (PS) matched cohort. Results: Those who had received NAC had higher 5-year survival proportions and decreased risk of both overall and BC specific death (HR = 0.71, 95% CI = 0.52-0.97 and HR = 0.67, 95% CI = 0.48-0.94), respectively, as compared to patients who did not receive NAC. The PS matched cohort showed similar estimates, but with larger statistical uncertainty (Overall death: HR = 0.76, 95% CI = 0.53-1.09 and BC-specific death: HR = 0.73, 95% CI = 0.50-1.07). Conclusion: Results from the current observational study found similar point estimates for 5-year survival and of relative risks as previous studies. However, the results based on real world evidence had larger statistical variability, resulting in a non-statistically significant effect of NAC on survival. Future studies with detailed validated data can be used to further investigate the effect of NAC in narrower patient groups.

  • 33.
    Sahlén, Klara
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Dahlman, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Brekkan, Einar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Lönnemark, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Sahlén, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Segelsjö, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Magnusson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Predictive value of secondary signs of obstruction in follow-up computed tomography of ureteral stones: a study with dynamic computed tomography2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 1, s. 59-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: This study aimed to determine the ratio of obstruction and predictive values of secondary signs in follow-up computed tomography (CT) of ureterolithiasis patients; to correlate stone characteristics with obstruction; to compare enhancement of obstructed and non-obstructed kidneys; and to compare radiation dose of the dynamic CT protocol to an excretory-phase protocol.

    MATERIALS AND METHODS: This retrospective study assessed 49 follow-up CT scans of patients with remaining ureterolithiasis after a renal colic episode. Obstruction was measured as time taken to excretion of contrast medium in dynamic CT. Degree of secondary signs of obstruction was evaluated from the unenhanced CT. Data were collected on patients' gender and age, stone size and location, time from renal colic to follow-up, attenuation of the renal cortex and radiation dose.

    RESULTS: Obstruction was present in 28% (n = 14) at follow-up. Predictive values (sensitivity, specificity, positive predictive value, negative predictive value) were calculated for hydronephrosis (1.0, 0.63, 0.52, 1.0), hydroureter (1.0, 0.4, 0.4, 1.0), perirenal stranding (0.21, 0.94, 0.6, 0.75), Gerota's fascia (0.21, 0.97, 0.75, 0.76) and renal swelling (0.21, 0.97, 0.75, 0.76). Obstruction was not correlated with stone characteristics. Enhancement was lower in obstructed kidneys (p < 0.01). Radiation dose was reduced by 43% (1.8 mSv).

    CONCLUSIONS: Obstruction was found in 28% of patients. Secondary signs were scarce and of indeterminate value to the diagnosis of obstruction. The absence of hydronephrosis and hydroureter contradicted obstruction. Stone characteristics were not correlated with obstruction. Enhancement of the renal cortex was lower in obstructed kidneys. The dynamic protocol reduced the radiation dose.

  • 34. Schumacher, Martin C
    et al.
    Radecka, Eva
    Hellström, Magnus
    Jacobsson, Hans
    Sundin, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi. Department of Radiology, Molecular Medicine & Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm , Sweden.
    [11C]Acetate positron emission tomography-computed tomography imaging of prostate cancer lymph-node metastases correlated with histopathological findings after extended lymphadenectomy2015Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, nr 1, s. 35-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The aim of this study was to determine the efficacy of combined [11C]acetate positron emission tomography and computed tomography ([11C]acetate-PET/CT) in regional lymph-node staging in patients with prostate cancer (PCa).

    Material and methods

    [11C]Acetate-PET/CT was performed in 19 PCa patients who subsequently underwent extended pelvic lymph-node dissection (ePLND). The [11C]acetate-PET/CT results were compared with the surgical and histopathological findings from 13 defined lymph-node regions.

    Results

    [11C]Acetate-PET/CT was true-positive for lymph-node metastases in nine patients, false-positive in three, false-negative in one patient and true-negative in six. The patient-by-patient-based sensitivity was 90% and the specificity 67%, the positive predictive value (PPV) was 75% and the negative predictive value (NPV) 86%. From a total of 114 nodal regions (mean 5.9 regions per patient), 484 lymph nodes (mean 25.5 nodes per patient) were removed and evaluated histopathologically. Forty-six lymph nodes from 24 out of 114 (21%) nodal regions were positive for PCa metastasis. The nodal-region-based sensitivity of [11C]acetate-PET/CT was 62%, specificity was 89%, PPV 62% and NPV 89%.

    Conclusion

    [11C]Acetate-PET/CT detects PCa lymph-node metastases with high patient-by-patient-based sensitivity but low specificity, and low nodal-region-based sensitivity but high specificity. Its limited ability to detect microscopic lymph-node involvement makes ePLND essential in all patients diagnosed with positive nodes on [11C]acetate-PET/CT.

  • 35.
    Sherif, Amir
    et al.
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Stockholm, Sweden..
    Rosenblatt, Robert
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Stockholm, Sweden..
    Johansson, Markus
    Sundsvall Hosp, Dept Urol, Sundsvall, Sweden..
    Almadari, Farhood
    Vastmanland Hosp, Dept Urol, Vasteras, Sweden..
    Sidiki, Alexander
    Lanssjukhuset Ryhov, Dept Urol, Jonkoping, Sweden..
    Holmström, Benny
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Hansson, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Vasko, Janos
    Umea Univ, Dept Med Biosci, Pathol, Umea, Sweden..
    Marits, Per
    Karolinska Inst, Dept Med, Unit Immunol & Allergy, Stockholm, Sweden..
    Gabrielsson, Susanne
    Karolinska Inst, Dept Med, Unit Immunol & Allergy, Stockholm, Sweden..
    Riklund, Katrine
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Winqvist, Ola
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Sentinel node detection in muscle invasive urothelial bladder cancer is feasible after neoadjuvant chemotherapy in all pT-stages2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr SI 220, s. 37-37Artikkel i tidsskrift (Annet vitenskapelig)
  • 36.
    Sjostrom, Carin
    et al.
    Capio St Gorans Hosp, Dept Surg, Sect Urol, Sankt Goransplan 1, SE-11281 Stockholm, Sweden;Karolinska Inst, Dept Mol Med & Surg, Sect Urol, Stockholm, Sweden.
    Thorstenson, Andreas
    Capio St Gorans Hosp, Dept Surg, Sect Urol, Sankt Goransplan 1, SE-11281 Stockholm, Sweden;Karolinska Inst, Dept Mol Med & Surg, Sect Urol, Stockholm, Sweden.
    Strock, Viveka
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden.
    Hosseini-Aliabad, Abolfazl
    Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden.
    Aljabery, Firas
    Linkoping Univ, Univ Hosp & IKE, Dept Urol, Linkoping, Sweden.
    Liedberg, Fredrik
    Lund Univ, Dept Translat Med, Malmo, Sweden;Skane Univ Hosp, Dept Urol, Malmo, Sweden.
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Rosell, Johan
    Linkoping Univ, Reg Canc Ctr South East Sweden, Linkoping, Sweden;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Gardmark, Truls
    Danderyd Hosp, Dept Surg, Sect Urol, Stockholm, Sweden;Karolinska Inst, Danderyds Hosp, Dept Clin Sci, Stockholm, Sweden.
    Jahnson, Staffan
    Linkoping Univ, Univ Hosp & IKE, Dept Urol, Linkoping, Sweden.
    Treatment according to guidelines may bridge the gender gap in outcome for patients with stage T1 urinary bladder cancer2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 3, s. 186-193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this investigation was to study differences between male and female patients with stage T1 urinary bladder cancer (UBC) regarding intravesical instillation therapy, second resection and survival. Materials and methods: This study included all patients with non-metastatic primary T1 UBC reported to the Swedish National Register of Urinary Bladder Cancer (SNRUBC) from 1997 to 2014, excluding those treated with primary cystectomy. Differences between groups were evaluated using chi-squared tests and logistic regression, and survival was investigated using Kaplan-Meier and log-rank tests and Cox proportional hazards analysis. Results: In all, 7681 patients with T1 UBC (77% male, 23% female) were included. Females were older than males at the time of diagnosis (median age at presentation 76 and 74 years, respectively; p < .001). A larger proportion of males than females underwent intravesical instillation therapy (39% vs 33%, p<.001). Relative survival was lower in women aged >= 75 years and women with G3 tumours compared to men. However, women aged >= 75 years who had T1G3 tumours and underwent second resection followed by intravesical instillation therapy showed a relative survival equal to that observed in men. Conclusions: This population-based study demonstrates that women of all ages with T1 UBC undergo intravesical instillation therapy less frequently than men, and that relative survival is poorer in women aged >= 75 years than in men of the same age when intravesical instillation therapy and second resection are not used. However, these disparities may disappear with treatment according to guidelines.

  • 37.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, SE-90185 Umea, Sweden..
    Sandin, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Sandback, Torsten
    Evry Consulting, Stockholm, Sweden..
    Damber, Jan-Erik
    Sahlgrens Acad, Dept Urol, Gothenburg, Sweden..
    Lissbrant, Ingela Franck
    Sahlgrens Acad, Dept Oncol, Gothenburg, Sweden..
    Robinson, David
    Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, SE-90185 Umea, Sweden.;Ryhov Cty Hosp, Dept Urol, Jonkoping, Sweden..
    Bratt, Ola
    Lund Univ, Dept Translat Med, Lund, Sweden..
    Lambe, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Dashboard report on performance on select quality indicators to cancer care providers2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 1, s. 21-28Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Materials and methods: Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, What''s Going On, Prostate Cancer provides rapid, at-a-glance performance feedback to care providers. Results: The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. Conclusion: What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.

  • 38.
    Stranne, J.
    et al.
    Univ Gothenburg, Dept Urol, Inst Clin Sci, Sahlgrenska Acad, Gothenburg, Sweden.
    Brasso, K.
    Rigshosp Copenhagen, Copenhagen Prostate Canc Ctr, Copenhagen, Denmark; Rigshosp Copenhagen, Dept Urol, Copenhagen, Denmark.
    Brennhovd, B.
    Oslo Univ Hosp HF, Dept Urooncol, Radiumhosp, Oslo, Norway.
    Johansson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Jäderling, F.
    Univ Hosp, Karolinska Inst, Dept Radiol, Stockholm, Sweden.
    Kouri, M.
    Helsinki Univ Hosp, Dept Oncol, Helsinki, Finland.
    Lilleby, W.
    Oslo Univ Hosp HF, Dept Urooncol, Radiumhosp, Oslo, Norway.
    Petersen, P. Meidahl
    Copenhagen Univ Hosp, Dept Oncol, Finsen Ctr, Copenhagen, Denmark.
    Mirtti, T.
    Univ Helsinki, Inst Mol Med Finland FIMM, Helsinki, Finland.
    Pettersson, A.
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden.
    Rannikko, A.
    Helsinki Univ Hosp, Dept Urol, Helsinki, Finland.
    Thellenberg, C.
    Norrlands Univ Hosp, Cancerctr, Umeå, Sweden.
    Akre, O.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    SPCG-15: a prospective randomized study comparing primary radical prostatectomy and primary radiotherapy plus androgen deprivation therapy for locally advanced prostate cancer2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 5-6, s. 313-320Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 39.
    Styrke, Johan
    et al.
    Umea Univ, Sundsvall Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Henriksson, Helene
    Umea Univ, Sundsvall Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Ljungberg, Borje
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Hasan, Mudhar
    Danderyd Hosp, Dept Urol, Danderyd, Sweden..
    Silfverberg, Ingrid
    Enkoping Hosp, Dept Urol, Enkoping, Sweden..
    Einarsson, Roland
    IDL Biotech AB, Stockholm, Sweden..
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Evaluation of the diagnostic accuracy of UBC® Rapid in bladder cancer: a Swedish multicentre study2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 4, s. 293-300Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to determine the diagnostic accuracy of UBC® Rapid - a urine-based marker for bladder cancer - in patients with bladder cancer and controls, and to compare the test results across risk groups. Materials and methods: This prospective phase II study was conducted at four Swedish hospitals. UBC Rapid was evaluated in four groups: A, newly diagnosed bladder cancer (n=94); B, follow-up of non-muscle-invasive bladder cancer (n=75); C, benign urinary tract diseases (n=51); and D, healthy controls (n=50). Tumours were divided into high risk (carcinoma in situ, TaG3, T1, T2 and T3) and low risk (low malignant potential, TaG1 and TaG2). Urine samples were quantitatively analysed by UBC Rapid. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated based on optimal cut-off (receiver operator characteristics curve analysis). A linear regression compared the UBC Rapid results in the different risk groups. Results: The optimal cut-off was 8.1g/l. The median UBC Rapid values were 9.3g/l [interquartile range (IQR) 30.9] and 4.3g/l (IQR 7.8) in patients with positive and negative cystoscopy, respectively (p<.001). The value for group A was 15.6g/l (IQR 37.9), group B 5.6g/l (IQR 8.6), group C 5.1g/l (IQR 9.0) and group D 3.3g/l (IQR 7.1). Sensitivity was 70.8%, specificity 61.4%, PPV 71.3% and NPV 60.8%. The high-risk group had significantly higher UBC Rapid values than the low-risk group: 20.5g/l (IQR 42.2), sensitivity 79.2% and specificity 61.4% versus 7.0g/l (IQR 9.9), sensitivity 60.0% and specificity 61.4% (p=.039). Conclusions: The UBC Rapid urine-based marker for bladder cancer gave higher values in patients with positive than in those with negative cystoscopy. The diagnostic accuracy was better in patients with high-risk than in those with low-risk tumours, and was better during primary detection than during surveillance.

  • 40.
    Thomsen, Frederik B.
    et al.
    Rigshosp, Copenhagen Prostate Canc Ctr, Dept Urol, Copenhagen, Denmark..
    Sandin, Fredrik
    Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden..
    Garmo, Hans
    Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.;Kings Coll London, Sch Med, Canc Epidemiol Grp, Div Canc Studies, London, England..
    Lissbrant, Ingela F.
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
    Ahlgren, Goran
    SUS Malmo, Dept Urol, Malmo, Sweden..
    Van Hemelrijck, Mieke
    Kings Coll London, Sch Med, Canc Epidemiol Grp, Div Canc Studies, London, England.;Karolinska Inst, Epidemiol Unit, Inst Environm Med, Stockholm, Sweden..
    Adolfsson, Jan
    Karolinska Inst, CLINTEC Dept, Stockholm, Sweden..
    Robinson, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Ume, Sweden..
    No difference in risk of cardiovascular disease in men with prostate cancer treated with GnRH agonists or orchiectomy: semi-ecologic, nationwide, population-based study2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr SI 220, s. 16-16Artikkel i tidsskrift (Annet vitenskapelig)
  • 41.
    Thorstenson, Andreas
    et al.
    Karolinska Inst, Urol Sect, Dept Mol Med & Surg, Stockholm, Sweden.;Capio St Gorans Hosp, Dept Surg, Urol Sect, Sankt Goransplan 1, Stockholm, Sweden..
    Hagberg, Oskar
    Lund Univ, Reg Canc Ctr, Lund, Sweden..
    Ljungberg, Borje
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Liedberg, Fredrik
    Lund Univ, SUS, Dept Urol, Malmo, Sweden..
    Jancke, Georg
    Linkoping Univ, Univ Hosp, Dept Urol, Linkoping, Sweden..
    Holmang, Sten
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden..
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Hosseini, Abolfazl
    Karolinska Inst, Urol Sect, Dept Mol Med & Surg, Stockholm, Sweden..
    Jahnson, Staffan
    Linkoping Univ, Univ Hosp, Dept Urol, Linkoping, Sweden..
    Gender-related differences in urothelial carcinoma of the bladder: a population-based study from the Swedish National Registry of Urinary Bladder Cancer2016Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 4, s. 292-297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this investigation was to describe tumour characteristics, treatments and survival in patients with urinary bladder cancer (UBC) in a national population-based cohort, with special reference to gender-related differences. Material and methods: All primary UBC patients with urothelial pathology reported to the Swedish National Registry of Urinary Bladder Cancer (SNRUBC) from 1997 to 2011 were included in the study. Groups were compared regarding tumour, node, metastasis classification, primary treatment and survival. Results: In total, 30,310 patients (74.9% male, 25.1% female) with UBC were analysed. A larger proportion of women than men had stage T2-T4 (p<0.001), and women also had more G1 tumours (p<0.001). However, compared to women, a larger proportion of men with carcinoma in situ or T1G3 received intravesical treatment with bacillus Calmette-Guerin or intravesical chemotherapy, and a larger proportion of men with stage T2-T4 underwent radical cystectomy (38% men vs 33% women, p<0.0001). The cancer-specific survival at 5 years was 77% for men and 72% for women (p<0.001), and the relative survival at 5 years was 72% for men and 69% for women (p<0.001). Conclusions: In this population-based cohort comprising virtually all patients diagnosed with UBC in Sweden between 1997 and 2011, female gender was associated with inferior cancer-specific and relative survival. Although women had a higher rate of aggressive tumours, a smaller proportion of women than men received optimal treatment.

  • 42.
    Turker, Polat
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Segersten, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Hemdan, Tammer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Is Bcl-2 a predictive marker of neoadjuvant chemotherapy response in patients with urothelial bladder cancer undergoing radical cystectomy?2019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 1, s. 45-50Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Response to neoadjuvant cisplatin treatment in bladder cancer has been linked to expression of Bcl-2 protein by cancer cells. The objective of this study was to test Bcl-2 as a predictive marker of neoadjuvant cisplatin chemotherapy response in a patient cohort from randomized cystectomy trials.Methods: Tumor samples were taken from 247 patients with T2-T4 bladder cancer enrolled in two randomized trials comparing cystectomy with or without neoadjuvant chemotherapy. Tissue microarrays from pre-intervention transurethral resection specimens were assessed for Bcl-2 protein status by immunohistochemistry. Extension of staining above 10% was regarded as positive. Downstaging and survival ratios in relation to Bcl-2 immunoreactivity and neoadjuvant chemotherapy utilization were calculated using the log rank test and multivariate Cox proportional hazards regression analyses.Results: Bcl-2 expression was positive in 38% and negative in 62% of the 236 evaluable patients. Bcl-2 negative patients receiving neoadjuvant chemotherapy had a significant increase in survival (p=0.009), while Bcl-2 positive patients showed no difference (p=0.4). However, the interaction variable between neoadjuvant chemotherapy and biomarker status was not significant (p=0.38). When the prognostic value was assessed in the no-chemotherapy group, 5-year overall survival times were significantly better among Bcl-2 positive patients than among Bcl-2 negative patients (42 months vs 33 months, p=0.04), but again Bcl-2 status did not remain independent when other factors were adjusted. Also, in a multivariate analysis with all patients, Bcl-2 was not significant.Conclusions: Bcl-2 status is not an independent predictor of neoadjuvant cisplatin chemotherapy response and is not prognostic in muscle-invasive bladder cancer.

  • 43.
    von Below, Catrin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Wassberg, Cecilia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Norberg, Mona
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Tolf, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi.
    Kullberg, Joel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Ladjevardi, Sam
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Häggman, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Ahlström, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Additional value of magnetic resonance-targeted biopsies to standard transrectal ultrasound-guided biopsies for detection of clinically significant prostate cancer2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 2, s. 107-113Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to evaluate the additional value of magnetic resonance imaging-targeted biopsy (MRI-TB) to standard transrectal ultrasound-guided biopsy (SB) for detection of clinically significant prostate cancer (PCa). An additional aim was to compare the biopsy results to MRI evaluation using a Likert scale.

    MATERIALS AND METHODS: Patients with newly diagnosed localized PCa (n = 53) by clinical routine SB were prospectively included. The majority of the patients were scheduled for curative therapy before enrollment. The patients underwent multiparametric MRI (mpMRI) at 3 T using an endorectal coil followed by two MRI-TBs, using ultrasound with cognitive fusion. All included patients underwent MRI-TB, even those who had low to very low suspicion of significant PCa on mpMRI. The detection rate of significant cancer on SB versus SB + MRI-TB was compared in the 53 included patients and with whole-mounted histopathology as reference in 34 cases. Comparison of the biopsy results to MRI evaluation and interreader agreement calculation of five-point Likert score evaluation were performed.

    RESULTS: In total, 32 significant (Gleason ≥7) PCa were detected by SB, while SB + MRI-TB detected an additional five significant PCa. MRI-TB alone detected 20 and missed 17 significant PCa. Ten of the significant PCa cases missed by MRI-TB had a Likert score of 3 or lower. Interreader agreement using the Likert scale was high, with a kappa value of 0.77 (95% confidence interval 0.63-0.92, p < 0.0001).

    CONCLUSION: Detection of significant PCa increased by adding MRI-TB to SB. This may not be of enough clinical value to justify the use of targeted biopsies in this patient group.

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