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  • 201.
    Loeb, Stacy
    et al.
    NYU, Dept Urol & Populat Hlth, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
    Lambe, Mats
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, 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, S-90185 Umea, Sweden..
    Re: Editorial Comment on Use of Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction and Risk of Malignant Melanoma2016Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 195, nr 4, s. 1172-1173Artikkel i tidsskrift (Fagfellevurdert)
  • 202. Loeb, Stacy
    et al.
    Schlomm, Thorsten
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Associations Do Not Equal Causation: Clinical Relevance of Statistical Associations of Phosphodiesterase Type 5 Inhibitors with Prostate Cancer Progression and Melanoma.2015Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 68, nr 5, s. 754-755, artikkel-id S0302-2838(15)00668-5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A recent study reported a detrimental effect of phosphodiesterase type 5 inhibitors(PDE5-Is) on biochemical recurrence (BCR) after radical prostatectomy (RP) for prostatecancer (PCa). We tested the association between PDE5-I use, PDE5-I therapy scheme,number of PDE5-I pills taken, and BCR in 2579 patients treated with bilateral nerve-sparing RP for PCa between 2004 and 2013 at a single center. Patients were categorizedaccording to PDE5-I use within 2 yr after surgery ason demand, rehabilitation schedule(daily PDE5-I use for at least 3 mo), andno PDE5-I use. Multivariable (MVA) Coxregression models tested the association between PDE5-I and BCR. The same analyseswere repeated using the number of PDE5-I pills taken by each patient. Overall,674 patients (26.1%) received PDE5-Is. At MVA analysis, PDE5-I use, type of administra-tion schedule, and number of PDE5-I pills were not significantly associated with higherrisk of BCR (allp0.2) after accounting for multiple confounders including time from RPto PDE5-I use. While awaiting further studies, patients should not be denied PDE5-Itreatment after RP.Patient summary:Among patients treated with radical prostatectomy, phosphodies-terase type 5 inhibitor use was not associated with an increased risk of biochemicalrecurrence, regardless of the therapeutic regimen used.

  • 203.
    Loeb, Stacy
    et al.
    NYU, Dept Urol Populat Hlth, New York, NY 10003 USA.;NYU, Laura & Isaac Perlmutter Canc Ctr, New York, NY 10003 USA..
    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..
    Further Evidence against a Causal Association between Erectile Dysfunction Drugs and Melanoma2016Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 70, nr 5, s. 816-817Artikkel i tidsskrift (Annet vitenskapelig)
  • 204.
    Loeb, Stacy
    et al.
    NYU, Dept Urol, New York, NY USA.;NYU, New York, NY USA.;Manhattan VA, New York, NY USA..
    Ventimiglia, Eugenio
    IRCCS Osped San Raffaele, Div Expt Oncol, Unit Urol, URI, Milan, Italy.;Univ Vita Salute San Raffaele, Milan, Italy.;Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Salonia, Andrea
    IRCCS Osped San Raffaele, Div Expt Oncol, Unit Urol, URI, Milan, Italy.;Univ Vita Salute San Raffaele, Milan, Italy..
    Folkvaljon, Yasin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    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..
    Meta-Analysis of the Association Between Phosphodiesterase Inhibitors (PDE5Is) and Risk of Melanoma2017Inngår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 109, nr 8, artikkel-id djx086Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The US Food and Drug Administration recently announced the need to evaluate the association between PDE5is and melanoma. We performed a meta-analysis on the association between PDE5i and melanoma using random effects models and examined whether it met Hill's criteria for causality. A systematic search of Medline, EMBASE, and the Cochrane Library from 1998 to 2016 identified three case-control studies and two cohort studies, including a total of 866 049 men, of whom 41 874 were diagnosed with melanoma. We found a summary estimate indicating an increased risk of melanoma in PDE5i users (relative risk = 1.12, 95% confidence interval = 1.02 to 1.23). However, there was no difference in risk between men with low and high exposure to PDE5i, and risk was higher for in situ melanoma than localized and high-risk melanoma, suggesting a lack of dose response and biological gradient. PDE5i use was also associated with basal cell cancer, suggesting a lack of specificity and likely confounding by ultraviolet exposure. Thus, although this meta-analysis found a statistically significant association between PDE5i and melanoma, it did not satisfy Hill's criteria for causality.

  • 205.
    Lotan, Yair
    et al.
    Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA.
    Bivalacqua, Trinity J.
    Johns Hopkins Univ, James Buchanan Brady Urol Inst, Baltimore, MD USA.
    Downs, Tracy
    Univ Wisconsin, Dept Urol, Madison, WI USA.
    Huang, William
    Jones, Jeffrey
    Michael E DeBakey VA Med Ctr, Genitourinary Surg Sect, Houston, TX USA.
    Kamat, Ashish M.
    Univ Texas MD Anderson Canc Ctr, Dept Urol, Houston, TX 77030 USA.
    Konety, Badrinath
    Univ Minnesota, Dept Urol, Minneapolis, MN USA.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    McKiernan, James
    Columbia Univ, Med Ctr, Dept Urol, New York, NY USA.
    O'Donnell, Michael
    Univ Iowa, Dept Urol, Iowa City, IA 52242 USA.
    Patel, Sanjay
    Univ Oklahoma, Dept Urol, Oklahoma City, OK USA.
    Pohar, Kamal
    Ohio State Univ, Dept Urol, Columbus, OH 43210 USA.
    Resnick, Matthew
    Vanderbilt Univ, Dept Urol Surg, Nashville, TX USA.
    Sankin, Alexander
    Montefiore Med Ctr, Dept Urol, New York, NY USA.
    Smith, Angela
    Univ N Carolina, Dept Urol, Chapel Hill, NC 27515 USA.
    Steinberg, Gary
    Univ Chicago, Dept Urol, Chicago, IL 60637 USA.
    Trabulsi, Edouard
    Thomas Jefferson Univ, Sidney Kimmel Med Coll, Dept Urol, Philadelphia, PA 19107 USA.
    Woods, Michael
    Loyola Univ, Dept Urol, Chicago, IL 60611 USA.
    Daneshmand, Siamak
    Univ Southern Calif, Dept Urol, Los Angeles, CA USA.
    Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA - update 20182019Inngår i: Nature reviews. Urology, ISSN 1759-4812, E-ISSN 1759-4820, Vol. 16, nr 6, s. 377-386Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Blue light cystoscopy (BLC) with hexaminolevulinate (HAL) during transurethral resection of bladder cancer improves detection of non-muscle-invasive bladder cancer (NMIBC) and reduces recurrence rates. Flexible BLC was approved by the FDA in 2018 for use in the surveillance setting and was demonstrated to improve detection. Results of a phase III prospective multicentre study of blue light flexible cystoscopy (BLFC) in surveillance of intermediate-risk and high-risk NMIBC showed that 20.6% of malignancies were identified only by BLFC. Improved detection rates in the surveillance setting are anticipated to lead to improved clinical outcomes by reducing future recurrences and earlier identification of tumours that are unresponsive to therapy. Thus, BLFC has a role in surveillance cystoscopy, and determining which patients will benefit from BLFC and optimal and cost-effective ways of incorporating this technology into surveillance cystoscopy must be developed.

  • 206. Lumme, Sonja
    et al.
    Tenkanen, Leena
    Langseth, Hilde
    Gislefoss, Randi
    Hakama, Matti
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Hallmans, Göran
    Adlercreutz, Herman
    Saikku, Pekka
    Stenman, Ulf-Håkan
    Tuohimaa, Pentti
    Luostarinen, Tapio
    Dillner, Joakim
    Longitudinal biobanks-based study on the joint effects of infections, nutrition and hormones on risk of prostate cancer.2016Inngår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, nr 7, s. 839-45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background To evaluate the individual and combined effects of enterolactone, vitamin D, free testosterone, Chlamydia trachomatis and HPV-18 on the risk of prostate cancer in a large population-based biochemical material that combined three Nordic serum sample banks. Material and methods A joint cohort of 209 000 healthy men was followed using cancer registry linkages. From this cohort altogether 699 incident cases of prostate cancer were identified. Four controls were selected by incidence density sampling and matching for country, age and date of the blood sampling. Complete data for all investigated exposures was available for 483 eligible cases and 1055 eligible controls. Multivariate regression analyses were performed to investigate the solitary and combined effects. Results The solitary effects were small. Significantly increased risk [rate ratio 1.6 (95% CI 1.0-2.5)] was found in those seronegative for C. trachomatis infection. The joint effect in risk levels of enterolactone and vitamin D was antagonistic [observed rate ratio (RR) 1.4 (1.0-2.1), expected RR 2.0 (1.0-4.1)] as well as that of HPV-18 and C. trachomatis [observed RR 1.9 (0.8-4.5), expected RR 9.9 (1.1-87.0)]. Conclusion A large follow-up study combining data from several previously investigated exposures to investigate joint effects found no evidence that exposure to two risk factors would increase the risk of prostate cancer from that expected on basis of exposure to one risk factor. If anything, the results were consistent with antagonistic interactions.

  • 207. Lundholm, Marie
    et al.
    Hägglöf, Christina
    Wikberg, Maria L
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umeå, Sweden.
    Egevad, Lars
    Bergh, Anders
    Wikström, Pernilla
    Palmqvist, Richard
    Edin, Sofia
    Secreted Factors from Colorectal and Prostate Cancer Cells Skew the Immune Response in Opposite Directions.2015Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, artikkel-id 15651Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Macrophage infiltration has been associated with an improved prognosis in patients with colorectal cancer (CRC), but a poor prognosis in prostate cancer (PC) patients. In this study, the distribution and prognostic value of proinflammatory M1 macrophages (NOS2(+)) and immunosuppressive M2 macrophages (CD163(+)) was evaluated in a cohort of 234 PC patients. We found that macrophages infiltrating PC were mainly of an M2 type and correlated with a more aggressive tumor and poor patient prognosis. Furthermore, the M1/M2 ratio was significantly decreased in PC compared to CRC. Using in vitro cell culture experiments, we could show that factors secreted from CRC and PC cells induced macrophages of a proinflammatory or immunosuppressive phenotype, respectively. These macrophages differentially affected autologous T lymphocyte proliferation and activation. Consistent with this, CRC specimens were found to have higher degrees of infiltrating T-helper 1 cells and active cytotoxic T lymphocytes, while PC specimens displayed functionally inactive T cells. In conclusion, our results imply that tumour-secreted factors from cancers of different origin can drive macrophage differentiation in opposite directions and thereby regulate the organization of the anti-tumour immune response. Our findings suggest that reprogramming of macrophages could be an important tool in the development of new immunotherapeutic strategies.

  • 208. Lundstrom, Karl-Johan
    et al.
    Drevin, Linda
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Carlsson, Stefan
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Loeb, Stacy
    Stattin, Par
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Nationwide Population Based Study of Infections after Transrectal Ultrasound Guided Prostate Biopsy2014Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 192, nr 4, s. 1116-1122Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Transrectal ultrasound guided biopsy is the gold standard for detecting prostate cancer but international reports suggest that increasing risks are associated with the procedure. We estimated incidence and risk factors for infection after prostate biopsy as well as 90-day mortality using a nationwide Swedish sample.

    Material and Methods: We performed a population based study of 51,321 men from PCBaSe between 2006 and 2011. Primary outcome measures were dispensed prescriptions of antibiotics for urinary tract infection and hospitalization with a discharge diagnosis of urinary tract infection. Multivariable logistic regression was used to examine risk factors for infection in men who underwent prostate biopsy.

    Results: During the 6 months before biopsy the background incidence of urinary tract infection was approximately 2%. Within 30 days after biopsy 6% of the men had a dispensed prescription for urinary tract antibiotics and 1% were hospitalized with infection. The strongest risk factors for an antibiotic prescription were prior infection (OR 1.59, 95% CI 1.45-1.73), high Charlson comorbidity index (OR 1.25, 95% CI 1.11-1.41) and diabetes (OR 1.32, 95% CI 1.17-1.49). Risk of an antibiotic prescription after biopsy decreased from 2006 to 2011 (OR 0.79, 95% CI 0.70-0.90) but the risk of hospital admission increased (OR 2.14, 95% CI 1.58-2.94). No significant increase was observed in 90-day mortality.

    Conclusions: Severe infections with hospitalization after prostate biopsy are increasing in Sweden. The risk of post-biopsy infection is highest in men with a history of urinary tract infection and those with significant comorbidities.

  • 209.
    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.

  • 210.
    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.

  • 211.
    Lycken, Magdalena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Living and dying with prostate cancer: Population-based register studies2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Tailored treatment with adequate timing is essential for the quality of prostate cancer care at all stages. Overtreatment should be avoided due to the side effects, but undertreatment may on the other hand lead to progression and death. This thesis aims to describe the patterns of use for non-curative treatments of prostate cancer, alongside the time trends of disease characteristics of men who die from prostate cancer. The work was based on the National Prostate Cancer Register of Sweden (NPCR).

    The first study included 45 147 men. The cumulative incidence of castration was 11.6% at ten years after diagnosis, while it was 10.8% for antiandrogen monotherapy. Estimated median durations of castration ranged from four years in the deferred treatment high-risk group to seventeen years in the prostatectomy low-risk group. The second study included 114 cases and 1140 controls. Four men out of ten received androgen deprivation therapy although they had prostate-specific antigen doubling time ≥12 months and biopsy Gleason score ≤7, which was defined as non-adherence to the guidelines of the European Association of Urology. Most of these men had low-risk features at diagnosis. The third study included 8326 men. During the last year before death from prostate cancer, use of opioids increased from 30% to 72%. Men without close relatives and older men had lower probability to receive opioids. The fourth study included 45 850 men. During the study period of 1992 to 2012, the time trend showed a stage shift towards lower risk group at diagnosis, longer disease duration, and higher age at death among men who died from prostate cancer.

    The first two studies indicate that overtreatment with androgen deprivation therapy is common after curative treatment, why interventions to improve adherence to guidelines are needed.  The third study indicates that men without close relatives and older men are disadvantaged with respect to treatment of cancer pain, why they need closer attention from health care providers. The findings in the fourth study may reflect the synergetic effects of prolonged lead time, increased life expectancy, and improvements in the management of prostate cancer during the last two decades.

    Delarbeid
    1. Patterns of androgen deprivation therapies among men diagnosed with localised prostate cancer: A population-based study
    Åpne denne publikasjonen i ny fane eller vindu >>Patterns of androgen deprivation therapies among men diagnosed with localised prostate cancer: A population-based study
    Vise andre…
    2014 (engelsk)Inngår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, nr 10, s. 1789-1798Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Aim: Many men diagnosed with localised prostate cancer will eventually be treated with androgen deprivation therapy (ADT). ADT is associated with adverse effects and its timing is controversial. Data on patterns of use are scarce. We describe patterns of ADT use, defined as castration (medical and surgical) or antiandrogen monotherapy initiated after primary treatment, in a population-based cohort. Methods and materials: Data were extracted from the population-based Prostate Cancer data Base Sweden (PCBaSe). Totally 45,147 men diagnosed between 1997 and 2009 with clinical stage T1-2, N0-NX, M0-MX and prostate specific antigen (PSA) <50 ng/ml without primary ADT were included. Outcomes in the period 2006 through 2010 were analysed using a period analysis approach. Results: The cumulative incidence of castration at 10 years after diagnosis was 11.6% (95% confidence interval (CI), 11.0-12.2%). The corresponding proportion of antiandrogen monotherapy was 10.8% (95% CI, 10.2-11.4%). Castration was the dominant therapy among men on deferred treatment. The probability of receiving castration rather than antiandrogen monotherapy increased with age. Estimated median durations of castration ranged from 4 years in the deferred treatment high-risk group to 17 years in the prostatectomy low-risk group. The main limitation was the lack of information on progression to metastatic disease and PSA at the time for initiation of ADT. Conclusion: When initiated early after curative treatment, the duration of castration can be decades. The findings indicate that more accurate tools are necessary to guide which men should be selected for ADT as secondary treatment. 

    Emneord
    Androgen deprivation therapy, Antiandrogen monotherapy, Castration, Deferred treatment, Prostate cancer
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-228967 (URN)10.1016/j.ejca.2014.03.279 (DOI)000337875800012 ()
    Tilgjengelig fra: 2014-07-25 Laget: 2014-07-24 Sist oppdatert: 2018-06-20bibliografisk kontrollert
    2. Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study
    Åpne denne publikasjonen i ny fane eller vindu >>Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study
    Vise andre…
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: Androgen deprivation therapy (ADT) is a non-curative but essential treatment of prostate cancer with severe side effects. Therefore, both over- and underuse should be avoided. Our aim was to investigate adherence to guidelines for ADT following radical prostatectomy through Swedish population-based data. 

    Methods: We used the database PSA Uppsala/Örebro to study men with localised or locally advanced prostate cancer at diagnosis (clinical stage T1-T3, N0-NX, M0-MX, and prostate-specific antigen (PSA) <50 ng/ml) who underwent radical prostatectomy 1997-2012. Totally 114 men were treated with ADT and selected as cases; 1140 men with no ADT at the index date were selected as controls within four-year strata of time of radical prostatectomy. All men with a PSA doubling time <12 months and/or a biopsy Gleason score of 8-10 were considered to have an indication for ADT according to the European Association of Urology (EAU) guidelines. 

    Results: No indication for ADT was found in 39% of the cases. Among these men, 89% had tumour stage (T-stage) 1-2 at diagnosis, 58% had a biopsy Gleason score 2-6, 98% had an expected remaining lifetime over ten years, 16% received castration, and 84% received antiandrogen monotherapy. Among the controls 5% were found to have an indication for ADT, and 98% of these men had an expected remaining lifetime over ten years.

    Conclusion: Our results indicate that overtreatment with ADT after radical prostatectomyis common, whereas undertreatment is unusual. Interventions to improve adherence to guidelines are needed to avoid unnecessary side-effects and long treatment durations with ADT.

    Emneord
    Androgen deprivation therapy, Guidelines, Population-based study; Prostate cancer; Radical prostatectomy.
    HSV kategori
    Forskningsprogram
    Urologi
    Identifikatorer
    urn:nbn:se:uu:diva-354467 (URN)
    Forskningsfinansiär
    Swedish Cancer Society, CAN 2008/598
    Tilgjengelig fra: 2018-06-20 Laget: 2018-06-20 Sist oppdatert: 2018-06-25bibliografisk kontrollert
    3. The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.
    Åpne denne publikasjonen i ny fane eller vindu >>The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.
    Vise andre…
    2017 (engelsk)Inngår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 88, s. 101-108Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: Symptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.

    METHODS: This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.

    RESULTS: We included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47-0.66 for >85 years versus <70 years) and (OR 0.78, 95% CI: 0.66-0.92 for unmarried without children versus married with children).

    CONCLUSION: Our results represent robust epidemiological data from Sweden for comparison of palliative care quality between countries. The findings indicate that men without close relatives and older men are disadvantaged with respect to the treatment of cancer pain and need closer attention from health care providers and highlight the importance to identify psychological distress in terminal prostate cancer.

    Emneord
    Anxiety, Cancer pain, Castration, Depression, Fatigue, Observational study, Opioids, Palliative medicine, Prostate cancer, Sleep disorders
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-336227 (URN)10.1016/j.ejca.2017.10.023 (DOI)000418290800012 ()29216521 (PubMedID)
    Forskningsfinansiär
    Swedish Cancer Society, CAN 2008/598:1Swedish Research Council, 2012-5047
    Tilgjengelig fra: 2017-12-13 Laget: 2017-12-13 Sist oppdatert: 2019-12-06bibliografisk kontrollert
    4. Nationwide study of time trends in prostate cancer death over two decades
    Åpne denne publikasjonen i ny fane eller vindu >>Nationwide study of time trends in prostate cancer death over two decades
    Vise andre…
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: 

    Limited data is available to describe the men who die from prostate cancer. Our aim with this study was to describe the time trends for disease characteristics at date of diagnosis, disease duration and age at death for all Swedish men who died from prostate cancer in the period of 1992-2012. 

     

    Methods:

    We included all men who died with prostate cancer as the underlying cause of death from 1992 to 2012 according to the Swedish Cause of Death Register. Information on disease characteristics at diagnosis was collected by links to other nation-wide registries through the unique personal identity number. Information on missing data on risk categories for men with an early date of diagnosis was imputed according to the method of chained equations by using R commander. 

     

    Results: 

    Totally 45 850 men were included. Increased prevalence and decreased age-standardised mortality from prostate cancer was observed during the study period. The proportion of men with localised and locally advanced disease at diagnosis increased from 33% to 46%, while distant metastases decreased from 54% to 42%. Median disease duration increased from 3.1 years (Percentile (P)0.25-P0.75: 1.4-6.0 years) to 5.6 years (P0.25-P0.75: 2.5-9.8 years), and median age at death from prostate cancer increased from 78.3 years (P0.25-P0.75: 72.2-83.4 years) to 81.9 years (P0.25-P0.75: 75.2-87.2 years). The proportion of distant metastases at diagnosis was highest among the youngest men.  

     

    Conclusion: 

    The longer disease duration and higher age at death may reflect the synergetic effects of prolonged lead time, increased life expectancy, and improvements in the management of prostate cancer during the last two decades. 

    HSV kategori
    Forskningsprogram
    Urologi
    Identifikatorer
    urn:nbn:se:uu:diva-354469 (URN)
    Forskningsfinansiär
    Swedish Cancer Society, no. CAN 2008/598
    Tilgjengelig fra: 2018-06-20 Laget: 2018-06-20 Sist oppdatert: 2018-06-28bibliografisk kontrollert
  • 212.
    Lycken, Magdalena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Drevin, Linda
    Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.
    Garmo, Hans
    Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.; King’s College London, School of Medicine, Division of Cancer Studies, London, UK..
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Andrén, Ove
    Department of Urology, Örebro University Hospital, Örebro, Sweden..
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. King’s College London, School of Medicine, Division of Cancer Studies, London, UK..
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based studyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: Androgen deprivation therapy (ADT) is a non-curative but essential treatment of prostate cancer with severe side effects. Therefore, both over- and underuse should be avoided. Our aim was to investigate adherence to guidelines for ADT following radical prostatectomy through Swedish population-based data. 

    Methods: We used the database PSA Uppsala/Örebro to study men with localised or locally advanced prostate cancer at diagnosis (clinical stage T1-T3, N0-NX, M0-MX, and prostate-specific antigen (PSA) <50 ng/ml) who underwent radical prostatectomy 1997-2012. Totally 114 men were treated with ADT and selected as cases; 1140 men with no ADT at the index date were selected as controls within four-year strata of time of radical prostatectomy. All men with a PSA doubling time <12 months and/or a biopsy Gleason score of 8-10 were considered to have an indication for ADT according to the European Association of Urology (EAU) guidelines. 

    Results: No indication for ADT was found in 39% of the cases. Among these men, 89% had tumour stage (T-stage) 1-2 at diagnosis, 58% had a biopsy Gleason score 2-6, 98% had an expected remaining lifetime over ten years, 16% received castration, and 84% received antiandrogen monotherapy. Among the controls 5% were found to have an indication for ADT, and 98% of these men had an expected remaining lifetime over ten years.

    Conclusion: Our results indicate that overtreatment with ADT after radical prostatectomyis common, whereas undertreatment is unusual. Interventions to improve adherence to guidelines are needed to avoid unnecessary side-effects and long treatment durations with ADT.

  • 213.
    Lycken, Magdalena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Drevin, Linda
    Reg Canc Ctr Uppsala Orebro Reg, Uppsala, Sweden.
    Garmo, Hans
    Reg Canc Ctr Uppsala Orebro Reg, 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. Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden.
    Adolfsson, Jan
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Lissbrant, Ingela Franck
    Univ Gothenburg, Sahlgrenska 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 Orebro Reg, 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.
    The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.2017Inngår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 88, s. 101-108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Symptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.

    METHODS: This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.

    RESULTS: We included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47-0.66 for >85 years versus <70 years) and (OR 0.78, 95% CI: 0.66-0.92 for unmarried without children versus married with children).

    CONCLUSION: Our results represent robust epidemiological data from Sweden for comparison of palliative care quality between countries. The findings indicate that men without close relatives and older men are disadvantaged with respect to the treatment of cancer pain and need closer attention from health care providers and highlight the importance to identify psychological distress in terminal prostate cancer.

  • 214.
    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)
  • 215.
    Lycken, Magdalena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Adolfsson, Jan
    Stattin, Par
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Patterns of androgen deprivation therapies among men diagnosed with localised prostate cancer: A population-based study2014Inngår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, nr 10, s. 1789-1798Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: Many men diagnosed with localised prostate cancer will eventually be treated with androgen deprivation therapy (ADT). ADT is associated with adverse effects and its timing is controversial. Data on patterns of use are scarce. We describe patterns of ADT use, defined as castration (medical and surgical) or antiandrogen monotherapy initiated after primary treatment, in a population-based cohort. Methods and materials: Data were extracted from the population-based Prostate Cancer data Base Sweden (PCBaSe). Totally 45,147 men diagnosed between 1997 and 2009 with clinical stage T1-2, N0-NX, M0-MX and prostate specific antigen (PSA) <50 ng/ml without primary ADT were included. Outcomes in the period 2006 through 2010 were analysed using a period analysis approach. Results: The cumulative incidence of castration at 10 years after diagnosis was 11.6% (95% confidence interval (CI), 11.0-12.2%). The corresponding proportion of antiandrogen monotherapy was 10.8% (95% CI, 10.2-11.4%). Castration was the dominant therapy among men on deferred treatment. The probability of receiving castration rather than antiandrogen monotherapy increased with age. Estimated median durations of castration ranged from 4 years in the deferred treatment high-risk group to 17 years in the prostatectomy low-risk group. The main limitation was the lack of information on progression to metastatic disease and PSA at the time for initiation of ADT. Conclusion: When initiated early after curative treatment, the duration of castration can be decades. The findings indicate that more accurate tools are necessary to guide which men should be selected for ADT as secondary treatment. 

  • 216.
    Lycken, Magdalena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Garmo, Hans
    Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.; King’s College London, School of Medicine, Division of Cancer Studies, London, UK..
    Westerberg, Marcus
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Matematiska institutionen.
    Axen, Elin
    Department of Urology at Institute of Clinical Sciences, Sahlgrenska University Hospital, Sweden.
    Stranne, Johan
    Department of Urology at Institute of Clinical Sciences, Sahlgrenska University Hospital, Sweden.
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. King’s College London, School of Medicine, Division of Cancer Studies, London, UK..
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Nationwide study of time trends in prostate cancer death over two decadesManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: 

    Limited data is available to describe the men who die from prostate cancer. Our aim with this study was to describe the time trends for disease characteristics at date of diagnosis, disease duration and age at death for all Swedish men who died from prostate cancer in the period of 1992-2012. 

     

    Methods:

    We included all men who died with prostate cancer as the underlying cause of death from 1992 to 2012 according to the Swedish Cause of Death Register. Information on disease characteristics at diagnosis was collected by links to other nation-wide registries through the unique personal identity number. Information on missing data on risk categories for men with an early date of diagnosis was imputed according to the method of chained equations by using R commander. 

     

    Results: 

    Totally 45 850 men were included. Increased prevalence and decreased age-standardised mortality from prostate cancer was observed during the study period. The proportion of men with localised and locally advanced disease at diagnosis increased from 33% to 46%, while distant metastases decreased from 54% to 42%. Median disease duration increased from 3.1 years (Percentile (P)0.25-P0.75: 1.4-6.0 years) to 5.6 years (P0.25-P0.75: 2.5-9.8 years), and median age at death from prostate cancer increased from 78.3 years (P0.25-P0.75: 72.2-83.4 years) to 81.9 years (P0.25-P0.75: 75.2-87.2 years). The proportion of distant metastases at diagnosis was highest among the youngest men.  

     

    Conclusion: 

    The longer disease duration and higher age at death may reflect the synergetic effects of prolonged lead time, increased life expectancy, and improvements in the management of prostate cancer during the last two decades. 

  • 217.
    Magnusson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Geterud, Kjell
    Brekkan, Einar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Lindqvist, Klas
    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.
    Nilsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Nyman, Ulf
    Hellström, Mikael
    Ultraljud vs DT vid uretärsten: svenska rutiner gäller2014Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, nr 49-50, s. 2236-2237Artikkel i tidsskrift (Annet vitenskapelig)
  • 218.
    Magnusson, Anders
    et al.
    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.
    Ahlström, Håkan
    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.
    Förändrad teknik förbättrar behandlingen med prostataspiral1991Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 88, nr 16, s. 1485-Artikkel i tidsskrift (Fagfellevurdert)
  • 219.
    Magnusson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Wallgren, AnnaCarin
    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.
    Karlsson-Parra, Alex
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Klinisk immunologi.
    Laurell, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Klinisk immunologi.
    Long-term survival in unfavorable-risk mRCC patients after intratumoral administration of a cell-based allogeneic vaccine adjuvant.2015Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 33, nr 15Artikkel i tidsskrift (Annet vitenskapelig)
  • 220.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Bladder tumours: time for a paradigm shift?2011Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 107, nr 10, s. 1543-1545Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    The results for many types of cancers have improved during later decades but not so for bladder cancer. Most patients with muscle-invasive tumors will still succumb to the disease and a high recurrence rate characterises non-muscle invasive tumors.The objective is to critically review the present model of bladder cancer based on newly acquired biological data. The definition of bladder cancer has extended with the introduction of the WHO classification. The corresponding loss of distinction between benign tumor and cancer has not been rewarding and should be reintroduced to facilitate exploration of new molecular findings. The common endpoints recurrence and progression should be redefined or replaced by more appropriate endpoints. The concept of surgery only for locally advanced cancers has proven unsuccessful and has to be complemented with early administered systemic treatment.

  • 221.
    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)
  • 222.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Editorial2013Inngår i: Scandinavian journal of urology, ISSN 2168-1813, Vol. 47, nr 1, s. 3-3Artikkel i tidsskrift (Fagfellevurdert)
  • 223.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Editorial2012Inngår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 46, nr 1, s. 4-4Artikkel i tidsskrift (Fagfellevurdert)
  • 224.
    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)
  • 225.
    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)
  • 226.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Kejsarens nya kläder eller nödvändig medicinsk teknik?2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 19-20, s. 1280-1280Artikkel i tidsskrift (Fagfellevurdert)
  • 227.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Prognostic markers for urothelial cancer: Obstacles and opportunities introduction2012Inngår i: Urologic Oncology, ISSN 1078-1439, E-ISSN 1873-2496, Vol. 30, nr 4, s. 516-517Artikkel i tidsskrift (Annet vitenskapelig)
  • 228.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Re: Randomized Phase III Trial on Gemcitabine Versus Mytomicin in Recurrent Superficial Bladder Cancer: Evaluation of Efficacy and Tolerance2010Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 58, nr 1, s. 178-Artikkel i tidsskrift (Fagfellevurdert)
  • 229.
    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)
  • 230.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    "To Improve Is To Change; To Be Perfect Is To Change Often"2014Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 65, nr 2, s. 358-359Artikkel i tidsskrift (Annet vitenskapelig)
  • 231.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Why has the survival of patients with bladder cancer not improved?2008Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 101, nr 3, s. 267-9Artikkel i tidsskrift (Fagfellevurdert)
  • 232.
    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.

  • 233.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Grabe, Magnus
    Haug, Erik Skaaheim
    Hellström, Pekka
    Hermann, Gregers G
    Mogensen, Karin
    Raitanen, Mika
    Wahlqvist, Rolf
    Role of hexaminolevulinate-guided fluorescence cystoscopy in bladder cancer: critical analysis of the latest data and European guidance2012Inngår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 46, nr 2, s. 108-116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective.

    Hexaminolevulinate (HAL) is an optical imaging agent used with fluorescence cystoscopy (FC) for the detection of non-muscle-invasive bladder cancer (NMIBC). Guidelines from the European Association of Urology (EAU) and a recent, more detailed European expert consensus statement agree that HAL-FC has a role in improving detection of NMIBC and provide recommendations on situations for its use. Since the publication of the EAU guidelines and the European consensus statement, new evidence on the efficacy of HAL-FC in reducing recurrence of NMIBC, compared with white light cystoscopy (WLC), have been published.

    Material and methods.

    To consider whether these new trials have an impact on the expert guidelines and on clinical practice (e.g. supporting existing recommendations or providing evidence for a change or expansion of practice), a group of bladder cancer experts from Denmark, Finland, Norway and Sweden met to address the following questions: What is the relevance of the new data on HAL-FC for clinical practice in managing NMIBC? What impact do the new data have on European guidelines? How could HAL-FC be used in clinical practice? and What further information on HAL-FC is required to optimize the management of NMIBC?

    Results and conclusions.

    This article reports the outcomes of the discussion at the Nordic expert panel meeting, concluding that, in line with European guidance, HAL-FC has an important role in the initial detection of NMIBC and for follow-up of patients to assess tumour recurrence after WLC. It provides practical advice, with an algorithm on the use of this diagnostic procedure for urologists managing NMIBC.

  • 234.
    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.

  • 235.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Hedelin, Hans
    Thomas, Yngvil Kloster
    Thompson, Gwilym J.
    Durrant, Helen
    Furniss, Jim
    Fluorescence-guided transurethral resection of bladder cancer using hexaminolevulinate: analysis of health economic impact in Sweden2009Inngår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 43, nr 3, s. 192-198Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: A decision analytic model was established to estimate the budget impact on the Swedish health service of using hexaminolevulinate (HAL) in conjunction with white light cystoscopy (WLC) in the management of bladder cancer for 1 year following initial diagnosis. MATERIAL AND METHODS: Flowcharts were developed to represent the diagnostic and treatment pathways for each of four risk groups for non-muscle-invasive bladder cancer (NMIBC), as defined by risk of tumour recurrence and progression. Flowcharts were based on European Association of Urology Guidelines and adjusted to current Swedish clinical practice. The model covers the use of HAL cystoscopy in the operating room to guide transurethral resection of the bladder (TURB) in all patients. HAL cystoscopy as an adjunct to WLC allows for more accurate and complete resection of tumours compared with WLC alone, and the model assumed a consequent reduction in recurrence of 40%. RESULTS: The model projects that compared with WLC alone, use of HAL cystoscopy in the first TURB of all patients and for all TURBs due to recurrence in the first year after diagnosis, leads to a reduction of 23 cystectomies and 180 TURBs in a population of 2032 newly diagnosed bladder cancer patients. Avoidance of these procedures would result in a saving of SEK1 321 716 to the Swedish health service. CONCLUSION: HAL cystoscopy, used as an adjunct to white light in guiding TURB in NMIBC patients, may result in reduction of invasive, time-intensive and high-cost procedures such as cystectomy and TURB, compared with WLC alone.

  • 236.
    Malmström, Per-Uno
    et al.
    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.
    Segersten, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Validation of the ezrin, CK20, and Ki-67 as potential predictive markers for BCG instillation therapy of non-muscle-invasive bladder cancer2017Inngår i: Urologic Oncology, ISSN 1078-1439, E-ISSN 1873-2496, Vol. 35, nr 8, s. 532.e1-532.e6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of our study was to try to validate 3 promising predictive biomarkers in a database based on prospective trials comparing bacillus Calmette-Guerin(BCG) with mitomycin-C and a combination of epirubicin and interferon, respectively.

    Background: The most common form of bladder cancer is non-muscle-invasive tumors treated initially with transurethral resection. Unfortunately more than half recur and some also progress. Consequently, an attempt to prevent poor outcome is frequently made by intravesical instillations either by chemo-orimmuno therapy. The response to such treatment is unpredictable, which is why markers predicting outcome would be valuable.

    Patients and methods: Immunohistochemical expression of ezrin, CK20, and Ki-67 was evaluated in a tumort issue micro array based on 2 nordic multicenter trials comparing treatment with BCG vs. other intravesical adjuvant therapies. Kaplan- Meieranalysis, log-ranktest, and Cox regression were used toe valuate the effect of the biomarkers on recurrence-,progression-,and treatment failure- freesurvival.

    Results: Of the 294 available patients immunoreactivity could be assessed in 285 patients for ezrin (97%), 285 patients for CK20 (97%), and 294 patient's forKi- 67 (100%). The 3 biomarkers did not predict time to any of the end points. Multi focality was the only predictive factor for time to recurrence (P=0.029) and progression (P=0.031). Ezrinwas, however, predictive for treatment failure (P=0.029) in a subgroup (BCG treated in one of the trials). In a multivariate analysis among BCG treated, none of the variables correlated to recurrence and only multifocality correlated top rogression. Limitations in our study are the retrospective design and those inherentto immunohistochemistry. Conclusions: The negative results from this validation study question the ability of the tested biomarkers to predict therapy effect.

  • 237.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Loskog, Angelica S. I.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för klinisk immunologi.
    Lindqvist, Camilla A.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för klinisk immunologi.
    Mangsbo, Sara M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för klinisk immunologi.
    Fransson, Moa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för klinisk immunologi.
    Wanders, Alkwin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Gårdmark, Truls
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Tötterman, Thomas H.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för klinisk immunologi.
    AdCD40L Immunogene Therapy for Bladder Carcinoma: The First Phase I/IIa Trial2010Inngår i: Clinical Cancer Research, ISSN 1078-0432, E-ISSN 1557-3265, Vol. 16, nr 12, s. 3279-3287Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Immunotherapy with bacillus Calmette-Guérin (BCG) instillation is recommended for high-risk non-muscle invasive bladder cancer. BCG is not effective in advanced tumors, and better alternatives are warranted. Immunostimulating gene therapy with adenoviral vectors expressing CD40L (AdCD40L) has shown efficacy in tumor models. CD40L stimulates systemic immunity and may be effective in local and invasive human disease. EXPERIMENTAL DESIGN: Patients with invasive bladder cancer scheduled for cystectomy or patients with Ta tumors were enrolled in a Phase I/IIa trial. Patients were treated with three cycles of intra-bladder Clorpactin WCS-90 prewash followed by AdCD40L instillation one week apart. Safety, gene transfer, immune effects and anti-tumor responses were monitored. RESULTS: All eight recruited patients were treated as scheduled, and therapy was well tolerated. The main adverse effect was transient local pain during prewash. Postoperatively, urinary tract infections and one case of late septicemia with elevated potassium were reported. No adverse events were ascribed to vector therapy. Gene transfer was detected in biopsies and bladders were heavily infiltrated with T-cells. The effector marker IFNg increased in biopsies while levels of circulating T regulatory cells were reduced. Histological evaluation indicated that AdCD40L therapy reduced the load of malignant cells. CONCLUSION: To our knowledge, this is the first report on immunogene therapy in bladder cancer and the first utilizing AdCD40L in vivo. Local AdCD40L gene therapy was safe, boosted immune activation and should be further evaluated as single or adjuvant therapy for urothelial malignancies.

  • 238.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Ojdeby, Gunilla
    Varför negligeras smärta vid provtagning i prostata?2008Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 26-27, s. 1955-Artikkel i tidsskrift (Fagfellevurdert)
  • 239.
    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.

     

  • 240.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Sylvester, Richard J.
    Crawford, David E.
    Friedrich, Martin
    Krege, Susanne
    Rintala, Erkki
    Solsona, Eduardo
    Di Stasi, Savino M.
    Witjes, J. Alfred
    An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guérin for non-muscle-invasive bladder cancer2009Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 56, nr 2, s. 247-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Patients with non-muscle-invasive bladder cancer with an intermediate or high risk need adjuvant intravesical therapy after surgery. Based largely on meta-analyses of previously published results, guidelines recommend using either bacillus Calmette-Guérin (BCG) or mitomycin C (MMC) in these patients. Individual patient data (IPD) meta-analyses, however, are the gold standard. OBJECTIVE: To compare the efficacy of BCG and MMC based on an IPD meta-analysis of randomised trials. DESIGN, SETTING, AND PARTICIPANTS: Trials were searched through Medline and review articles. The relevant trial investigators were contacted to provide IPD. MEASUREMENTS: The drugs were compared with respect to time to recurrence, progression, and overall and cancer-specific death. RESULTS AND LIMITATIONS: Nine trials that included 2820 patients were identified, and IPD were obtained from all of them. Patient characteristics were 71% primary, 54% Ta, 43% T1, 25% G1, 58% G2, and 16% G3, and 7% had prior intravesical chemotherapy. Based on a median follow-up of 4.4 yr, 43% recurred. Overall, there was no difference in the time to first recurrence (p=0.09) between BCG and MMC. In the trials with BCG maintenance, a 32% reduction in risk of recurrence on BCG compared to MMC was found (p<0.0001), while there was a 28% risk increase (p=0.006) for BCG in the trials without maintenance. BCG with maintenance was more effective than MMC in both patients previously treated and those not previously treated with chemotherapy. In the subset of 1880 patients for whom data on progression, survival, and cause of death were available, 12% progressed and 24% died, and, of those, 30% of the deaths were due to bladder cancer. No statistically significant differences were found for these long-term end points. CONCLUSIONS: For prophylaxis of recurrence, maintenance BCG is required to demonstrate superiority to MMC. Prior intravesical chemotherapy was not a confounder. There were no statistically significant differences regarding progression, overall survival, and cancer-specific survival between the two treatments.

  • 241.
    Malmström, Per-Uno
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Trock, Bruce J.
    Johns Hopkins Med Inst, Div Epidemiol, Baltimore, MD 21205 USA.
    Re: Richard J. Sylvester, Willem Oosterlinck, Sten Holmang, et al. Systematic Review and Individual Patient Data Meta-analysis of Randomized Trials Comparing a Single Immediate Instillation of Chemotherapy After Transurethral Resection with Transurethral Resection Alone in Patients with Stage pTa-pT1 Urothelial Carcinoma of the Bladder: Which Patients Benefit from the Instillation? Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2015.05.0502015Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 69, nr 1, s. E10-E11Artikkel i tidsskrift (Fagfellevurdert)
  • 242. Markt, Sarah C
    et al.
    Grotta, Alessandra
    Nyren, Olof
    Adami, Hans-Olov
    Mucci, Lorelei A
    Valdimarsdottir, Unnur A
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Bellocco, Rino
    Lagerros, Ylva Trolle
    Insufficient Sleep and Risk of Prostate Cancer in a Large Swedish Cohort.2015Inngår i: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 38, nr 9, s. 1405-10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY OBJECTIVE: There are some data to suggest that insufficient sleep, including short sleep duration and sleep disruption, may be associated with an increased risk of cancer. We investigated the association between sleep duration and sleep disruption and risk of prostate cancer.

    DESIGN: Prospective cohort study.

    SETTING: Sweden.

    PARTICIPANTS: A total of 14,041 men in the Swedish National March Cohort.

    INTERVENTIONS: None.

    MEASUREMENTS AND RESULTS: Habitual sleep duration and sleep disruption were self-reported in 1997. Prostate cancer diagnoses, including lethal (metastases at diagnosis or death from prostate cancer) and advanced (stage T4, N1, or M1 at diagnosis or death from prostate cancer), were determined from linkage to nationwide cancer registries through 2010. We conducted Cox proportional hazards regression adjusted for potential confounding variables. During 13 years of follow-up, we identified 785 cases of incident prostate cancer, including 118 lethal and 127 advanced cases. Four percent of men reported sleeping 5 h or less a night, and 2% reported sleeping 9 h or more per night. We found no association between sleep duration and risk of prostate cancer overall or for advanced/lethal disease. We also did not find an association between prostate cancer and sleep disruption, as defined by difficulty falling asleep, difficulty maintaining sleep, sleep quality, and restorative power of sleep.

    CONCLUSIONS: In this large prospective study from Sweden, we found no association between habitual sleep duration or sleep disruption and risk of prostate cancer.

  • 243. Markt, Sarah C
    et al.
    Shui, Irene M
    Unger, Robert H
    Urun, Yuksel
    Berg, Christine D
    Black, Amanda
    Brennan, Paul
    Bueno-de-Mesquita, H Bas
    Gapstur, Susan M
    Giovannucci, Edward
    Haiman, Christopher
    Henderson, Brian
    Hoover, Robert N
    Hunter, David J
    Key, Timothy J
    Khaw, Kay-Tee
    Canzian, Federico
    Larranga, Nerea
    Le Marchand, Loic
    Ma, Jing
    Naccarati, Alessio
    Siddiq, Afshan
    Stampfer, Meir J
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Stevens, Victoria L
    Stram, Daniel O
    Tjønneland, Anne
    Travis, Ruth C
    Trichopoulos, Dimitrios
    Ziegler, Regina G
    Lindstrom, Sara
    Kraft, Peter
    Mucci, Lorelei A
    Choueiri, Toni K
    Wilson, Kathryn M
    ABO blood group alleles and prostate cancer risk: Results from the breast and prostate cancer cohort consortium (BPC3)2015Inngår i: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 75, nr 15, s. 1677-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: ABO blood group has been associated with risk of cancers of the pancreas, stomach, ovary, kidney, and skin, but has not been evaluated in relation to risk of aggressive prostate cancer.

    METHODS: We used three single nucleotide polymorphisms (SNPs) (rs8176746, rs505922, and rs8176704) to determine ABO genotype in 2,774 aggressive prostate cancer cases and 4,443 controls from the Breast and Prostate Cancer Cohort Consortium (BPC3). Unconditional logistic regression was used to calculate age and study-adjusted odds ratios and 95% confidence intervals for the association between blood type, genotype, and risk of aggressive prostate cancer (Gleason score ≥8 or locally advanced/metastatic disease (stage T3/T4/N1/M1).

    RESULTS: We found no association between ABO blood type and risk of aggressive prostate cancer (Type A: OR = 0.97, 95%CI = 0.87-1.08; Type B: OR = 0.92, 95%CI =n0.77-1.09; Type AB: OR = 1.25, 95%CI = 0.98-1.59, compared to Type O, respectively). Similarly, there was no association between "dose" of A or B alleles and aggressive prostate cancer risk.

    CONCLUSIONS: ABO blood type was not associated with risk of aggressive prostate cancer.

  • 244. Martin, Neil E
    et al.