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  • 251. Nilsson, Hanna
    et al.
    Stranne, Johan
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Nordin, Pär
    Incidence of groin hernia repair after radical prostatectomy: a population-based nationwide study.2014Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 259, nr 6, s. 1223-1227Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To assess the incidence of groin hernia repair after radical prostatectomy for prostate cancer compared with the incidence in a control population without prostate cancer in a nationwide, population-based study.

    BACKGROUND: Recent reports indicate an increase in the incidence of groin hernia repair after radical prostatectomy. Inadequate knowledge of the incidence of groin hernia in the general population makes this information hard to interpret.

    METHODS: Information was retrieved from the Prostate Cancer Database (PCBaSe) and Swedish Hernia Register for events between 1998 and 2010. The incidence of groin hernia surgery was calculated for a group of men treated with radical prostatectomy (open and minimally invasive) and for a group treated with radiation therapy, and these were compared with the incidence in a control cohort of men matched for age and county of residence. Multivariate analysis was used to assess the hazard ratio (HR) of groin hernia repair according to age, tumor risk category, and Charlson Comorbidity Index.

    RESULTS: A total of 28,608 cases and 105,422 controls were included in the study. Men treated with radical prostatectomy and radiation therapy had a significantly higher incidence of groin hernia repair than the control cohort: HR: 3.95 (95% confidence interval: 3.70-4.21) for retropubic prostatectomy, HR: 3.37 (95% confidence interval: 2.95-3.87) for minimally invasive prostatectomy, and HR: 1.84 (95% confidence interval: 1.66-2.04) for radiation therapy.

    CONCLUSIONS: An almost 4-fold increase in groin hernia repair was observed after radical prostatectomy compared with controls, and men who received radiation therapy had an almost 2-fold increase in incidence. As well as postoperative changes in the abdominal wall, increased vigilance for groin hernia seems to be important for the increased incidence of groin hernia repair seen after radical prostatectomy or radiation therapy for prostate cancer.

  • 252. Nilsson, Maria
    et al.
    Hägglöf, Christina
    Hammarsten, Peter
    Thysell, Elin
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ, Dept Surg & Perioperat Sci, Urol, Umea, Sweden.
    Egevad, Lars
    Granfors, Torvald
    Jernberg, Emma
    Wikstrom, Pernilla
    Halin Bergström, Sofia
    Bergh, Anders
    High Lysyl Oxidase (LOX) in the Non-Malignant Prostate Epithelium Predicts a Poor Outcome in Prostate Cancer Patient Managed by Watchful Waiting2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 10, artikkel-id e0140985Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Lysyl oxidase (LOX) has been shown to both promote and suppress tumor progression, but its role in prostate cancer is largely unknown. LOX immunoreactivity was scored in prostate tumor epithelium, tumor stroma and in the tumor-adjacent non-malignant prostate epithelium and stroma. LOX scores in tumor and non-malignant prostate tissues were then examined for possible associations with clinical characteristics and survival in a historical cohort of men that were diagnosed with prostate cancer at transurethral resection and followed by watchful waiting. Men with a low LOX score in the non-malignant prostate epithelium had significantly longer cancer specific survival than men with a high score. Furthermore, LOX score in non-malignant prostate epithelium remained prognostic in a multivariable analysis including Gleason score. LOX score in prostate tumor epithelium positively correlated to Gleason score and metastases but was not associated with cancer survival. LOX score in tumor and non-malignant prostate stroma appeared unrelated to these tumor characteristics. In radical prostatectomy specimens, LOX immune-staining corresponded to LOX in-situ hybridization and LOX mRNA levels were found to be similar between tumor and adjacent non-malignant areas, but significantly increased in bone metastases samples. LOX levels both in tumors and in the surrounding tumor-bearing organ are apparently related to prostate cancer aggressiveness.

  • 253.
    Nord, Helena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Segersten, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Sandgren, Johanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Wester, Kenneth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Busch, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Menzel, Uwe
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Komorowski, Jan
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för cell- och molekylärbiologi, Centrum för bioinformatik.
    Dumanski, Jan P.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    de Ståhl, Teresita Díaz
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Focal amplifications are associated with high grade and recurrences in stage Ta bladder carcinoma2010Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 126, nr 6, s. 1390-1402Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Urinary bladder cancer is a heterogeneous disease with tumors ranging from papillary noninvasive (stage Ta) to solid muscle infiltrating tumors (stage T2+). The risk of progression and death for the most frequent diagnosed type, Ta, is low, but the high incidence of recurrences has a significant effect on the patients' quality of life and poses substantial costs for health care systems. Consequently, the purpose of this study was to search for predictive factors of recurrence on the basis of genetic profiling. A clinically well characterized cohort of Ta bladder carcinomas, selected by the presence or absence of recurrences, was evaluated by an integrated analysis of DNA copy number changes and gene expression (clone-based 32K, respectively, U133Plus2.0 arrays). Only a few chromosomal aberrations have previously been defined in superficial bladder cancer. Surprisingly, the profiling of Ta tumors with a high-resolution array showed that DNA copy alterations are relatively common in this tumor type. Furthermore, we observed an overrepresentation of focal amplifications within high-grade and recurrent cases. Known (FGFR3, CCND1, MYC, MDM2) and novel candidate genes were identified within the loci. For example, MYBL2, a nuclear transcription factor involved in cell-cycle progression; YWHAB, an antiapoptotic protein; and SDC4, an important component of focal adhesions represent interesting candidates detected within two amplicons on chromosome 20, for which DNA amplification correlated with transcript up-regulation. The observed overrepresentation of amplicons within high-grade and recurrent cases may be clinically useful for the identification of patients who will benefit from a more aggressive therapy.

  • 254.
    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.

  • 255. O'Farrell, Sean
    et al.
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Adolfsson, Jan
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Van Hemelrijck, Mieke
    Risk and Timing of Cardiovascular Disease After Androgen-Deprivation Therapy in Men With Prostate Cancer2015Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 33, nr 11, s. 1243-1251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose Findings on the association between risk of cardiovascular disease (CVD) and the duration and type of androgen-deprivation therapy (ADT) in men with prostate cancer (PCa) are inconsistent.

    Methods By using data on filled drug prescriptions in Swedish national health care registers, we investigated the risk of CVD in a cohort of 41,362 men with PCa on ADT compared with an age-matched, PCa-free comparison cohort (n = 187,785) by use of multivariable Cox proportional hazards regression models.

    Results From 2006 to 2012, 10,656 men were on antiandrogens (AA), 26,959 were on gonadotropin-releasing hormone (GnRH) agonists, and 3,747 underwent surgical orchiectomy. CVD risk was increased in men on GnRH agonists compared with the comparison cohort (hazard ratio [HR] of incident CVD, 1.21; 95% CI, 1.18 to 1.25; and orchiectomy: HR, 1.16; 95% CI, 1.08 to 1.25). Men with PCa on AA were at decreased risk (HR of incident CVD, 0.87; 95% CI, 0.82 to 0.91). CVD risk was highest during the first 6 months of ADT in men who experienced two or more cardiovascular events before therapy, with an HR of CVD during the first 6 months of GnRH agonist therapy of 1.91 (95% CI, 1.66 to 2.20), an HR of CVD with AA of 1.60 (95% CI, 1.24 to 2.06), and an HR of CVD with orchiectomy of 1.79 (95% CI, 1.16 to 2.76) versus the comparison cohort.

    Conclusion Our results support that there should be a solid indication for ADT in men with PCa so that benefit outweighs potential harm; this is of particular importance among men with a recent history of CVD.

  • 256.
    O'Farrell, Sean
    et al.
    Kings Coll London, Canc Epidemiol Grp, Div Canc Studies, London, England; NIHR Guys & St Thomas NHS Fdn Trust, Kings Coll London, Comprehens Biomed Res Ctr, London, England.
    Sandström, Karin
    Kings Coll London, Canc Epidemiol Grp, Div Canc Studies, London, England.
    Garmo, Hans
    Kings Coll London, Canc Epidemiol Grp, Div Canc Studies, London, England; Uppsala Orebro, Reg Canc Ctr, Uppsala, 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.
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Kings Coll London, Canc Epidemiol Grp, Div Canc Studies, London, England; NIHR Guys & St Thomas NHS Fdn Trust, Kings Coll London, Comprehens Biomed Res Ctr, London, England; Uppsala Orebro, Reg Canc Ctr, Uppsala, Sweden.
    Adolfsson, Jan
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden; Swedish Council Hlth Technol Assessment, Stockholm, Sweden.
    Van Hemelrijck, Mieke
    Kings Coll London, Canc Epidemiol Grp, Div Canc Studies, London, England; NIHR Guys & St Thomas NHS Fdn Trust, Kings Coll London, Comprehens Biomed Res Ctr, London, England; Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Risk of thromboembolic disease in men with prostate cancer undergoing androgen deprivation2016Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 118, nr 3, s. 391-398Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To investigate the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) on androgen deprivation therapy (ADT) while accounting for known TED risk factors.

    MATERIALS AND METHODS: TED risk was assessed for 42,263 PCa men on ADT compared to a matched, PCa-free cohort of 190,930 men. Associations between ADT and deep venous thrombosis (DVT) or pulmonary embolism (PE) were analysed using multivariate Cox proportional hazard regression models. Previous PCa-related surgeries and the following proxies for disease progression: transurethral resection of the prostate, palliative radiotherapy and nephrostomy, were accounted for.

    RESULTS: Between 1997-2013, 11,242 PCa men received anti-androgen (AA) monotherapy, 26,959 gonadotropin-releasing hormone (GnRH) agonists, 1,091 combined androgen blockade, and 3,789 underwent orchiectomy. When accounting for previous surgeries and proxies of disease progression, GnRH agonist users and surgically castrated men were at increased TED risk versus the comparison cohort, HR: 1.67 (95% CI: 1.40-1.98) and 1.61 (95% CI: 1.15-2.28), respectively. Men on AA monotherapy were at decreased risk, HR for DVT: 0.49 (95% CI: 0.33-0.74). TED risk was highest among those who switched from AA to GnRH agonists, PE HR: 2.55 (95% CI: 1.76-3.70). This increased from 2.52 (95% CI: 1.54-4.12) in year one, to 4.05 (95% CI: 2.51-6.55) in year two.

    CONCLUSION: TED incidence among men on ADT increased with the duration of therapy and risk was highest for those who switched regimen, thus implicating roles for disease progression as well as ADT in propagating TED risk. Nonetheless, these findings support that only men with a relevant indication should receive systemic ADT.

  • 257. 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.

  • 258.
    Palou, J.
    et al.
    Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain.
    Pisano, F.
    Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain;Osped Citta Salute & Sci Molinette, Dept Urol, Corso Bramante 88, I-10126 Turin, Italy.
    Sylvester, R.
    EORTC Headquarters, Dept Biostat, Brussels, Belgium.
    Joniau, S.
    Univ Hosp Leuven, Oncol & Reconstruct Urol, Dept Urol, Louvain, Belgium.
    Serretta, V.
    Univ Palermo, Dept Surg Oncol & Stomatol Sci, Palermo, Italy.
    Larre, S.
    Univ Oxford, John Radcliffe Hosp, Dept Surg Sci, Oxford, England.
    Di Stasi, S.
    Policlin Tor Vergata Univ Rome, Rome, Italy.
    van Rhijn, B.
    Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands.
    Witjes, A. J.
    Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands.
    Grotenhuis, A.
    Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands.
    Colombo, R.
    Univ Vita Salute, Osped S Raffaele, Dipartimento Urol, Milan, Italy.
    Briganti, A.
    Univ Vita Salute, Osped S Raffaele, Dipartimento Urol, Milan, Italy.
    Babjuk, M.
    Univ Praha, Motol Hosp, Dept Urol, Prague, Czech Republic.
    Soukup, V.
    Univ Praha, Motol Hosp, Dept Urol, Prague, Czech Republic.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Irani, J.
    Univ Poitiers, Dept Urol, Ctr Hosp Univ Mil, Poitiers, France.
    Malats, N.
    Spanish Natl Canc Res Ctr CNIO, Genet & Mol Epidemiol Grp, Madrid, Spain.
    Baniel, J.
    Rabin Med Ctr, Dept Urol, Tel Aviv, Israel.
    Mano, R.
    Rabin Med Ctr, Dept Urol, Tel Aviv, Israel.
    Cai, T.
    Santa Chiara Hosp, Dept Urol, Trento, Italy.
    Cha, E. K.
    Cornell Univ, Weill Med Coll, Dept Urol, New York, NY 10021 USA.
    Ardelt, P.
    Chirurg Univ Klin, Facharzt Urol, Urol Abt, Freiburg, Germany.
    Varkarakis, J.
    Univ Athens, Sismanoglio Hosp, Dept Urol, Athens, Greece.
    Bartoletti, R.
    Univ Florence, Dept Expt & Clin Med, Florence, Italy.
    Dalbagni, G.
    Mem Sloan Kettering Canc Ctr, Dept Urol, 1275 York Ave, New York, NY 10021 USA.
    Shariat, S. F.
    Med Univ Vienna, Vienna, Austria.
    Xylinas, E.
    Cochin Hosp, Dept Urol, Paris, France.
    Karnes, R. J.
    Mayo Clin, Dept Urol, Rochester, MN USA.
    Gontero, P.
    Osped Citta Salute & Sci Molinette, Dept Urol, Corso Bramante 88, I-10126 Turin, Italy.
    Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought2018Inngår i: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726, Vol. 36, nr 10, s. 1621-1627Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis to adequately stage and treat the patient. Persistent disease after TUR is not uncommon and is why re-TUR is recommended in T1G3 patients. When there is T1 tumor in the re-TUR specimen, very high risks of progression (82%) have been reported. We analyze the risks of recurrence, progression to muscle-invasive disease and cancer-specific mortality (CSM) according to tumor stage at re-TUR in T1G3 patients treated with BCG.

    Methods: In our retrospective cohort of 2451 T1G3 patients, 934 patients (38.1%) underwent re-TUR. 667 patients had residual disease (71.4%): Ta in 378 (40.5%), T1 in 289 (30.9%) patients. Times to recurrence, progression and CSM in the three groups were estimated using cumulative incidence functions and compared using the Cox regression model.

    Results:During a median follow-up of 5.2years, 512 patients recurred. The recurrence rate was significantly higher in patients with a T1 at re-TUR (P<0.001). Progression rates differed according to the pathology at re-TUR, 25.3% in T1, 14.6% in Ta and 14.2% in case of no residual tumor (P<0.001). Similar trends were seen in both patients with and without muscle in the original TUR specimen.

    Conclusions: Patients with T1G3 tumors and no residual disease or Ta at re-TUR have better recurrence, progression and CSM rates than previously reported, with a CSM rate of 13.1 and a 25.3% progression rate in re-TUR T1 disease.

  • 259.
    Papadimitriou, Nikos
    et al.
    Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, Ioannina, Greece;Int Agcy Res Canc, Lyon, France.
    Muller, David
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, St Marys Campus, London W2 1PG, England.
    van den Brandt, Piet A.
    Maastricht Univ, CAPHRI, GROW Sch Oncol & Dev Biol, Dept Epidemiol, Maastricht, Netherlands.
    Geybels, Milan
    Maastricht Univ, CAPHRI, GROW Sch Oncol & Dev Biol, Dept Epidemiol, Maastricht, Netherlands.
    Patel, Chirag J.
    Harvard Med Sch, Dept Biomed Informat, Boston, MA 02115 USA.
    Gunter, Marc J.
    Int Agcy Res Canc, Lyon, France.
    Lopez, David S.
    UTMB Sch Med, Dept Prevent Med & Community Hlth, Galveston, TX USA;UTHealth McGovern Med Sch, Div Urol, Houston, TX USA.
    Key, Timothy J.
    Univ Oxford, Canc Epidemiol Unit, Nuffield Dept Populat Hlth, Oxford, England.
    Perez-Cornago, Aurora
    Univ Oxford, Canc Epidemiol Unit, Nuffield Dept Populat Hlth, Oxford, England.
    Ferrari, Pietro
    Int Agcy Res Canc, Lyon, France.
    Vineis, Paolo
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, St Marys Campus, London W2 1PG, England;IIGM, Turin, Italy.
    Weiderpass, Elisabete
    Int Agcy Res Canc, Lyon, France.
    Boeing, Heiner
    German Inst Human Nutr Potsdam Rehbrucke, Dept Epidemiol, Nuthetal, Germany.
    Agudo, Antonio
    Catalan Inst Oncol IDIBELL, Canc Epidemiol Res Program, Unit Nutr & Canc, Barcelona, Spain.
    Sanchez, Maria-Jose
    Escuela Andaluza Salud Publ, Granada, Spain;Univ Granada, Ibs GRANADA, Granada, Spain;CIBERESP, Madrid, Spain.
    Overvad, Kim
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark.
    Kuehn, Tilman
    German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany.
    Fortner, Renee T.
    German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany.
    Palli, Domenico
    ISPRO, Inst Canc Res Prevent & Clin Network, Canc Risk Factors & Life Style Epidemiol Unit, Florence, Italy.
    Drake, Isabel
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden.
    Bjartell, Anders
    Lund Univ, Dept Urol, Malmo, Sweden;Lund Univ, Dept Clin Sci, Malmo, Sweden.
    Santiuste, Carmen
    CIBERESP, Madrid, Spain;IMIB Arrixaca, Murcia Reg Hlth Council, Dept Epidemiol, Murcia, Spain.
    Bueno-de-Mesquita, Bas H.
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, St Marys Campus, London W2 1PG, England;Natl Inst Publ Hlth & Environm RIVM, Dept Determinants Chron Dis DCD, Bilthoven, Netherlands;Univ Med Ctr, Dept Gastroenterol & Hepatol, Utrecht, Netherlands;Univ Malaya, Fac Med, Dept Social & Prevent Med, Kuala Lumpur, Malaysia.
    Krogh, Vittorio
    Ist Nazl Tumori Milano, Fdn IRCCS, Epidemiol & Prevent Unit, Milan, Italy.
    Tjonneland, Anne
    Danish Canc Soc, Res Ctr, Diet Genes & Environm, Copenhagen, Denmark;Univ Copenhagen, Fac Hlth & Med Sci, Dept Publ Hlth, Copenhagen, Denmark.
    Lauritzen, Dorthe Furstrand
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Publ Hlth, Copenhagen, Denmark.
    Gurrea, Aurelio Barricarte
    CIBERESP, Madrid, Spain;Navarra Publ Hlth Inst, Pamplona, Spain;Navarra Inst Hlth Res IdiSNA, Pamplona, Spain.
    Quiros, Jose Ramon
    Publ Hlth Directorate, Asturias, Spain.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Trichopoulou, Antonia
    Hellen Hlth Fdn, Athens, Greece; Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Unit Nutrit Epidemiol & Nutr Publ Hlth, Dept Hyg Epidemiol & Med Stat, Sch Med, Athens, Greece.
    Martimianaki, Georgia
    Hellen Hlth Fdn, Athens, Greece.
    Karakatsani, Anna
    Hellen Hlth Fdn, Athens, Greece;Univ Athens, ATTIKON Univ Hosp, Pulm Med Dept 2, Sch Med, Haidari, Greece.
    Thysell, Elin
    Umea Univ, Dept Biobank Res, Dept Med Biosci, Pathol, Umea, Sweden.
    Johansson, Ingegerd
    Umea Univ, Biobank Res Publ Hlth & Clin Med, Dept Odontol, Cardiol Sect, Umea, Sweden.
    Ricceri, Fulvio
    Univ Turin, Dept Clin & Biol Sci, Orbassano, Italy.
    Tumino, Rosario
    MP Arezzo Hosp, Canc Registry & Histopathol Unit, Ragusa, Italy.
    Larranaga, Nerea
    Basque Reg Hlth Dept, Publ Hlth Div Gipuzkoa, Epidemiol & Hlth Informat, San Sebastian, Spain.
    Khaw, Kay Tee
    Univ Cambridge, Addenbrookes Hosp, Sch Clin Med, Clin Gerontol Unit, Cambridge, England.
    Riboli, Elio
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, St Marys Campus, London W2 1PG, England.
    Tzoulaki, Ioanna
    Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, Ioannina, Greece;Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, St Marys Campus, London W2 1PG, England.
    Tsilidis, Konstantinos K.
    Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, Ioannina, Greece;Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, St Marys Campus, London W2 1PG, England.
    A nutrient-wide association study for risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition and the Netherlands Cohort Study2019Inngår i: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The evidence from the literature regarding the association of dietary factors and risk of prostate cancer is inconclusive.

    Methods: A nutrient-wide association study was conducted to systematically and comprehensively evaluate the associations between 92 foods or nutrients and risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cox proportional hazard regression models adjusted for total energy intake, smoking status, body mass index, physical activity, diabetes and education were used to estimate hazard ratios and 95% confidence intervals for standardized dietary intakes. As in genome-wide association studies, correction for multiple comparisons was applied using the false discovery rate (FDR < 5%) method and suggested results were replicated in an independent cohort, the Netherlands Cohort Study (NLCS).

    Results: A total of 5916 and 3842 incident cases of prostate cancer were diagnosed during a mean follow-up of 14 and 20 years in EPIC and NLCS, respectively. None of the dietary factors was associated with the risk of total prostate cancer in EPIC (minimum FDR-corrected P, 0.37). Null associations were also observed by disease stage, grade and fatality, except for positive associations observed for intake of dry cakes/biscuits with low-grade and butter with aggressive prostate cancer, respectively, out of which the intake of dry cakes/biscuits was replicated in the NLCS.

    Conclusions: Our findings provide little support for an association for the majority of the 92 examined dietary factors and risk of prostate cancer. The association of dry cakes/biscuits with low-grade prostate cancer warrants further replication given the scarcity in the literature.

     

  • 260.
    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.

  • 261. 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.

  • 262.
    Perez-Cornago, Aurora
    et al.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Richard Doll Bldg,Roosevelt Dr, Oxford OX3 7LF, England.
    Appleby, Paul N.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Richard Doll Bldg,Roosevelt Dr, Oxford OX3 7LF, England.
    Boeing, Heiner
    German Inst Human Nutr Potsdam Rehbrucke, Dept Epidemiol, Nuthetal, Germany.
    Gil, Leire
    Basque Reg Hlth Dept, Publ Hlth Div Gipuzkoa BIODONOSTIA, San Sebastian, Spain;CIBER Epidemiol & Publ Hlth, Madrid, Spain.
    Kyro, Cecilie
    Danish Canc Soc Res Ctr, Strandblvd 49, Copenhagen, Denmark.
    Ricceri, Fulvio
    Univ Turin, Dept Clin & Biol Sci, Turin, Italy;Reg Hlth Serv ASL TO3, Epidemiol Unit, Grugliasco, Italy.
    Murphy, Neil
    Int Agcy Res Canc, Sect Nutr & Metab, Lyon, France.
    Trichopoulou, Antonia
    Hellen Hlth Fdn, Athens, Greece.
    Tsilidis, Konstantinos K.
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England;Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, Ioannina, Greece.
    Khaw, Kay-Tee
    Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England.
    Luben, Robert N.
    Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England.
    Gislefoss, Randi E.
    Canc Registry Norway, Dept Res, Oslo, Norway.
    Langseth, Hilde
    Canc Registry Norway, Dept Res, Oslo, Norway.
    Drake, Isabel
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden.
    Sonestedt, Emily
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden.
    Wallström, Peter
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden;Skane Univ Hosp, Clin Res Ctr, Malmo, Sweden.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Johansson, Anders
    Umea Univ, Nutr Res & Mol Periodontol, Umea, Sweden.
    Landberg, Rikard
    Chalmers Univ Technol, Dept Biol & Biol Engn Food & Nutr Sci, Gothenburg, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Nutr Res, Umea, Sweden.
    Nilsson, Lena Maria
    Umea Univ, Dept Publ Hlth & Clin Med, Nutr Res, Umea, Sweden;Umea Univ, Arctic Res Ctr, Umea, Sweden.
    Ozasa, Kotaro
    Radiat Effects Res Fdn, Dept Epidemiol, Minami Ku, Hiroshima, Japan.
    Tamakoshi, Akiko
    Hokkaido Univ, Grad Sch Med, Dept Publ Hlth, Kita Ku, Sapporo, Hokkaido, Japan.
    Mikami, Kazuya
    Kyoto Prefectural Univ Med, Grad Sch Med Sci, Dept Urol, Kamikgyo Ku, Kyoto, Japan.
    Kubo, Tatsuhiko
    Univ Occupat & Environm Hlth, Dept Prevent Med & Community Hlth, Yahatanishi Ku, Kitakyushu, Fukuoka, Japan.
    Sawada, Norie
    Natl Canc Ctr, Ctr Publ Hlth Sci, Epidemiol & Prevent Grp, Tokyo, Japan.
    Tsugane, Shoichiro
    Natl Canc Ctr, Ctr Publ Hlth Sci, Epidemiol & Prevent Grp, Tokyo, Japan.
    Key, Timothy J.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Richard Doll Bldg,Roosevelt Dr, Oxford OX3 7LF, England.
    Allen, Naomi E.
    Univ Oxford, Big Data Inst, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England;Univ Oxford, Big Data Inst, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England.
    Travis, Ruth C.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Richard Doll Bldg,Roosevelt Dr, Oxford OX3 7LF, England.
    Circulating isoflavone and lignan concentrations and prostate cancer risk: a meta-analysis of individual participant data from seven prospective studies including 2,828 cases and 5,593 controls2018Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, nr 11, s. 2677-2686Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Phytoestrogens may influence prostate cancer development. This study aimed to examine the association between prediagnostic circulating concentrations of isoflavones (genistein, daidzein, equol) and lignans (enterolactone and enterodiol) and the risk of prostate cancer. Individual participant data were available from seven prospective studies (two studies from Japan with 241 cases and 503 controls and five studies from Europe with 2,828 cases and 5,593 controls). Because of the large difference in circulating isoflavone concentrations between Japan and Europe, analyses of the associations of isoflavone concentrations and prostate cancer risk were evaluated separately. Prostate cancer risk by study-specific fourths of circulating concentrations of each phytoestrogen was estimated using multivariable-adjusted conditional logistic regression. In men from Japan, those with high compared to low circulating equol concentrations had a lower risk of prostate cancer (multivariable-adjusted OR for upper quartile [Q4] vs. Q1 = 0.61, 95% confidence interval [CI] = 0.39-0.97), although there was no significant trend (OR per 75 percentile increase = 0.69, 95 CI = 0.46-1.05, p(trend) = 0.085); Genistein and daidzein concentrations were not significantly associated with risk (ORs for Q4 vs. Q1 = 0.70, 0.45-1.10 and 0.71, 0.45-1.12, respectively). In men from Europe, circulating concentrations of genistein, daidzein and equol were not associated with risk. Circulating lignan concentrations were not associated with the risk of prostate cancer, overall or by disease aggressiveness or time to diagnosis. There was no strong evidence that prediagnostic circulating concentrations of isoflavones or lignans are associated with prostate cancer risk, although further research is warranted in populations where isoflavone intakes are high.

  • 263. Perez-Cornago, Aurora
    et al.
    Appleby, Paul N
    Pischon, Tobias
    Tsilidis, Konstantinos K
    Tjønneland, Anne
    Olsen, Anja
    Overvad, Kim
    Kaaks, Rudolf
    Kühn, Tilman
    Boeing, Heiner
    Steffen, Annika
    Trichopoulou, Antonia
    Lagiou, Pagona
    Kritikou, Maria
    Krogh, Vittorio
    Palli, Domenico
    Sacerdote, Carlotta
    Tumino, Rosario
    Bueno-de-Mesquita, H Bas
    Agudo, Antonio
    Larrañaga, Nerea
    Molina-Portillo, Elena
    Barricarte, Aurelio
    Chirlaque, Maria-Dolores
    Quirós, J Ramón
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Häggström, Christel
    Wareham, Nick
    Khaw, Kay-Tee
    Schmidt, Julie A
    Gunter, Marc
    Freisling, Heinz
    Aune, Dagfinn
    Ward, Heather
    Riboli, Elio
    Key, Timothy J
    Travis, Ruth C
    Tall height and obesity are associated with an increased risk of aggressive prostate cancer: results from the EPIC cohort study2017Inngår i: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 15, nr 1, artikkel-id 115Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The relationship between body size and prostate cancer risk, and in particular risk by tumour characteristics, is not clear because most studies have not differentiated between high-grade or advanced stage tumours, but rather have assessed risk with a combined category of aggressive disease. We investigated the association of height and adiposity with incidence of and death from prostate cancer in 141,896 men in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

    METHODS: Multivariable-adjusted Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average of 13.9 years of follow-up, there were 7024 incident prostate cancers and 934 prostate cancer deaths.

    RESULTS: Height was not associated with total prostate cancer risk. Subgroup analyses showed heterogeneity in the association with height by tumour grade (P heterogeneity = 0.002), with a positive association with risk for high-grade but not low-intermediate-grade disease (HR for high-grade disease tallest versus shortest fifth of height, 1.54; 95% CI, 1.18-2.03). Greater height was also associated with a higher risk for prostate cancer death (HR = 1.43, 1.14-1.80). Body mass index (BMI) was significantly inversely associated with total prostate cancer, but there was evidence of heterogeneity by tumour grade (P heterogeneity = 0.01; HR = 0.89, 0.79-0.99 for low-intermediate grade and HR = 1.32, 1.01-1.72 for high-grade prostate cancer) and stage (P heterogeneity = 0.01; HR = 0.86, 0.75-0.99 for localised stage and HR = 1.11, 0.92-1.33 for advanced stage). BMI was positively associated with prostate cancer death (HR = 1.35, 1.09-1.68). The results for waist circumference were generally similar to those for BMI, but the associations were slightly stronger for high-grade (HR = 1.43, 1.07-1.92) and fatal prostate cancer (HR = 1.55, 1.23-1.96).

    CONCLUSIONS: The findings from this large prospective study show that men who are taller and who have greater adiposity have an elevated risk of high-grade prostate cancer and prostate cancer death.

  • 264.
    Perez-Cornago, Aurora
    et al.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England..
    Travis, Ruth C.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England..
    Appleby, Paul N.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England..
    Tsilidis, Konstantinos K.
    Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, Ioannina, Greece.;Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England..
    Tjonneland, Anne
    Danish Canc Soc Res Ctr, Copenhagen, Denmark..
    Olsen, Anja
    Danish Canc Soc Res Ctr, Copenhagen, Denmark..
    Overvad, Kim
    Aarhus Univ, Sect Epidemiol, Dept Publ Hlth, Aarhus C, Denmark..
    Katzke, Verena
    German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany..
    Kuehn, Tilman
    German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany..
    Trichopoulou, Antonia
    Hellen Hlth Fdn, Athens, Greece.;Univ Athens, Med Sch, Unit Nutr Epidemiol & Nutr Publ Hlth,WHO, Collaborating Ctr Nutr & Hlth,Dept Hyg Epidemiol, Athens, Greece..
    Peppa, Eleni
    Hellen Hlth Fdn, Athens, Greece..
    Kritikou, Maria
    Hellen Hlth Fdn, Athens, Greece..
    Sieri, Sabina
    Fdn IRCCS Ist Nazl Tumori, Epidemiol & Prevent Unit, Milan, Italy..
    Palli, Domenico
    Canc Res & Prevent Inst ISPO, Canc Risk Factors & Life Style Epidemiol Unit, Florence, Italy..
    Sacerdote, Carlotta
    Univ Turin, AO Citta Salute & Sci, Unit Canc Epidemiol, Turin, Italy.;Ctr Canc Prevent CPO Piemonte, Turin, Italy..
    Tumino, Rosario
    Civ MP Arezzo Hosp ASP Ragusa, Canc Registry & Histopathol Unit, Ragusa, Italy..
    Bueno-de-Mesquita, H. B. (as)
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England.;Natl Inst Publ Hlth & Environm RIVM, Dept Determinants Chron Dis DCD, Bilthoven, Netherlands.;Univ Malaya, Fac Med, Dept Social & Prevent Med, Kuala Lumpur, Malaysia..
    Agudo, Antonio
    Catalan Inst Oncol IDIBELL, Canc Epidemiol Res Program, Unit Nutr & Canc, Barcelona, Spain..
    Larranaga, Nerea
    Reg Govt Basque Country, Publ Hlth Div Gipuzkoa, Vitoria, Spain.;CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain..
    Molina-Portillo, Elena
    CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain.;Univ Granada, Hosp Univ Granada, GRANADA, Escuela Andaluza Salud Publ,Inst Invest Biosanita, Granada, Spain..
    Ardanaz, Eva
    CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain.;Navarra Publ Hlth Inst, Pamplona, Spain.;Navarra Inst Hlth Res IdiSNA Pamplona, Pamplona, Spain..
    Chirlaque, Maria-Dolores
    CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain.;IMIB Arrixaca, Reg Hlth Council, Dept Epidemiol, Murcia, Spain.;Univ Murcia, Dept Hlth & Social Sci, Murcia, Spain..
    Lasheras, Cristina
    Univ Oviedo, Fac Med, Dept Funct Biol, Asturias, Spain..
    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..
    Wennberg, Maria
    Umea Univ, Nutr Res, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Drake, Isabel
    Lund Univ, Dept Clin Sci Malmo, Diabet & Cardiovasc Dis Genet Epidemiol, Lund, Sweden..
    Malm, Johan
    Lund Univ, Skane Univ Hosp, Dept Translat Med Clin Chem, Malmo, Sweden..
    Schmidt, Julie A.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England..
    Khaw, Kay-Tee
    Univ Cambridge, Sch Clin Med, Cambridge, England..
    Gunter, Marc
    Int Agcy Res Canc, Sect Nutr & Metab, Lyon, France..
    Freisling, Heinz
    Int Agcy Res Canc, Sect Nutr & Metab, Lyon, France..
    Huybrechts, Inge
    Int Agcy Res Canc, Sect Nutr & Metab, Lyon, France..
    Aune, Dagfinn
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England..
    Cross, Amanda J.
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England..
    Riboli, Elio
    Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England..
    Key, Timothy J.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England..
    Fruit and vegetable intake and prostate cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)2017Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 141, nr 2, s. 287-297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Several dietary factors have been studied in relation to prostate cancer; however, most studies have not reported on subtypes of fruit and vegetables or tumor characteristics, and results obtained so far are inconclusive. This study aimed to examine the prospective association of total and subtypes of fruit and vegetable intake with the incidence of prostate cancer overall, by grade and stage of disease, and prostate cancer death. Lifestyle information for 142,239 men participating in the European Prospective Investigation into Cancer and Nutrition from 8 European countries was collected at baseline. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average follow-up time of 13.9 years, 7,036 prostate cancer cases were identified. Compared with the lowest fifth, those in the highest fifth of total fruit intake had a significantly reduced prostate cancer risk (HR = 0.91; 95% CI = 0.83-0.99; p-trend = 0.01). No associations between fruit subtypes and prostate cancer risk were observed, except for citrus fruits, where a significant trend was found (HR = 0.94; 95% CI = 0.86-1.02; p-trend = 0.01). No associations between total and subtypes of vegetables and prostate cancer risk were observed. We found no evidence of heterogeneity in these associations by tumor grade and stage, with the exception of significant heterogeneity by tumor grade (pheterogeneity<0.001) for leafy vegetables. No significant associations with prostate cancer death were observed. The main finding of this prospective study was that a higher fruit intake was associated with a small reduction in prostate cancer risk. Whether this association is causal remains unclear. What's new? The role of diet in prostate-cancer etiology is uncertain, and associations may vary by tumor characteristics. In this prospective, longitudinal study, the authors examined the association of total and subtypes of fruit and vegetable intake with the overall incidence of prostate cancer. They then analyzed incidence by grade, stage of disease, and prostate-cancer death. They found that higher fruit intake was associated with a small reduction in prostate cancer risk, and that this association did not differ by tumor characteristics.

  • 265.
    Persson, Mikael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Gedda, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Lundqvist, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Tolmachev, Vladimir
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Nordgren, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Carlsson, Jörgen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    [Lu-177]pertuzumab: Experimental therapy of HER-2-expressing xenografts2007Inngår i: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 67, nr 1, s. 326-331Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pertuzumab (Omnitarg) is a novel antibody against HER-2, domain II. HER-2 is a tyrosine kinase receptor that is overexpressed in several carcinomas, especially breast cancer. Pertuzumab, labeled with the low-energy beta emitter Lu-177, might be a candidate for targeted radiotherapy of disseminated HER-2-positive micrometastases. The radiolabeled antibody [Lu-177]pertuzumab showed favorable targeting properties in BALB/c (nu/nu) mice with HER-2-overexpressing xenografts. The absorbed dose in tumors was more than five times higher than the absorbed dose in blood and more than seven times the absorbed dose in any other normal organ. Experimental therapy showed that [Lu-177]pertuzumab delayed tumor progression compared with controls (no treatment, P < 0.0001; nonlabeled pertuzumab antibody, P < 0.0001; and Lu-177-labeled irrelevant antibody, P < 0.01). No adverse side effects of the treatment could be detected. Thus, the experimental results support the planning of clinical studies applying [Lu-177]pertuzumab for therapy.

  • 266.
    Persson, Mikael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Sivaev, Igor
    Winberg, Karl-Johan
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Kemiska sektionen, Kemiska institutionen.
    Gedda, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Tolmachev, Vladimir
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi.
    In vitro evaluation of two polyhedral boron anion derivatives as linkers for attachment of radioiodine to the anti-HER2 monoclonal antibody trastuzumab2007Inngår i: Cancer Biotherapy and Radiopharmaceuticals, ISSN 1084-9785, E-ISSN 1557-8852, Vol. 22, nr 5, s. 585-596Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Improving intracellular retention is important for the use of radiohalogens in radionuclide therapy usinginternalizing antibodies. Two putative linkers for residualization of radioiodine labels, 7-(4-isothiocyanato-phenyl)undecahydro-7,8-dicarba-nido-undecaborate(1Ϫ) ion (NBI) and (4-isothiocyanato-benzylammo-nio)undecahydro-closo-dodecaborate(1Ϫ) (DABI), were analyzed. The anti-HER-2 antibody, trastuzumab,was labeled with iodine-125 using NBI and DABI linkers, and, for comparison, with the para-[125I]iodoben-zoate (PIB), and Chloramine-T (CAT) methods. The different labels were tested for residualizing prop-erties using the HER-2 overexpressing SKBR-3 cells. The cellular radioactivity retention showed thatDABI provided a 55% better retention than CAT and was 42% better than PIB after 20 hours. NBI didnot improve retention. Accumulation tests up to 21 hours showed that the HER-2-specific accumulationof radioactivity delivered with DABI was, on average, 33% higher than with the use of PIB. These DABI-dependent improvements could, with high probability, be attributed to the good residualizing propertiesof DABI. The affinity of DABI-labeled trastuzumab to SKBR-3 cells was not better than the affinity of thePIB labeled (3.2 Ϯ 1.9 nM and 0.77 Ϯ 0.39 nM, respectively). In conclusion, the use of the DABI linkerimproved intracellular retention in vitro in comparison with the other labeling methods.

  • 267.
    Pettersson, A
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Robinson, D
    Department of Urology, Ryhov Hospital, Jönköping, Sweden.
    Garmo, H
    Division of Cancer Studies, Faculty of Life Sciences and Medicine, King’s College London, London, UK; Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Swede.
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Division of Cancer Studies, Faculty of Life Sciences and Medicine, King’s College London, London, UK;.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Age at diagnosis and prostate cancer treatment and prognosis: a population-based cohort study2018Inngår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 29, nr 2, s. 377-385Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Old age at prostate cancer diagnosis has been associated with poor prognosis in several studies. We aimed to investigate the association between age at diagnosis and prognosis, and if it is independent of tumor characteristics, primary treatment, year of diagnosis, mode of detection and comorbidity.

    Patients and methods: We conducted a nation-wide cohort study including 121,392 Swedish men aged 55-95 years in Prostate Cancer data Base Sweden (PCBaSe) 3.0 diagnosed with prostate cancer in 1998-2012 and followed for prostate cancer death through 2014. Data were available on age, stage, grade, PSA-level, mode of detection, comorbidity, educational level and primary treatment. We used Cox regression to calculate hazard ratios (HR) and 95% confidence intervals (CIs).

    Results: With increasing age at diagnosis, men had more comorbidity, fewer PSA detected cancers, more advanced cancers and were less often treated with curative intent. Among men with high-risk or regionally metastatic disease, the proportion of men with unknown M stage was higher among old men versus young men. During a follow-up of 751,000 person-years, 23,649 men died of prostate cancer. In multivariable Cox-regression analyses stratified by treatment, old age at diagnosis was associated with poorer prognosis among men treated with deferred treatment (HRage 85+ vs. 60-64: 7.19; 95% CI: 5.61-9.20), androgen deprivation therapy (HRage 85+ vs. 60-64: 1.72; 95% CI: 1.61-1.84) or radical prostatectomy (HRage 75+ vs. 60-64: 2.20; 95% CI: 1.01-4.77), but not radiotherapy (HRage 75+ vs. 60-64: 1.08; 95% CI: 0.76-1.53).

    Conclusion: Our findings argue against a strong inherent effect of age on risk of prostate cancer death, but indicate that in current clinical practice, old men with prostate cancer receive insufficient diagnostic work-up and subsequent curative treatment.

  • 268.
    Pettersson, A.
    et al.
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden.
    Robinson, D.
    Ryhov Hosp, Dept Urol, Jonkoping, Sweden.
    Garmo, Hans
    Univ Uppsala Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden;Kings Coll London, Fac Life Sci & Med, Div Canc Studies, London, England.
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Kings Coll London, Fac Life Sci & Med, Div Canc Studies, London, England.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Reply to the letter to the editor 'Age at diagnosis and prognosis among prostate cancer patients treated with radiotherapy: evidenced from three independent cohort studies' by X. Dong, G. Ma and F. Chen2018Inngår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 29, nr 9, s. 2020-2021Artikkel i tidsskrift (Annet vitenskapelig)
  • 269. Pili, Roberto
    et al.
    Häggman, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Stadler, Walter M.
    Gingrich, Jeffrey R.
    Assikis, Vasileios J.
    Bjork, Anders
    Nordle, Orjan
    Forsberg, Goran
    Carducci, Michael A.
    Armstrong, Andrew J.
    Phase II Randomized, Double-Blind, Placebo-Controlled Study of Tasquinimod in Men With Minimally Symptomatic Metastatic Castrate-Resistant Prostate Cancer2011Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 29, nr 30, s. 4022-4028Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The activity of the novel antitumor agent tasquinimod (TASQ) with S100A9 as a molecular target was investigated in men with metastatic castration-resistant prostate cancer (CRPC) and minimal symptoms.

    Patients and Methods: We conducted a randomized, double-blind, placebo-controlled phase II trial in men assigned (at a ratio of two to one) to either oral once-daily TASQ 0.25 mg/d escalating to 1.0 mg/d over 4 weeks or placebo. The primary end point was the proportion of patients without disease progression at 6 months, defined by Response Evaluation Criteria in Solid Tumors Group, Prostate Cancer Working Group (PCWG2), or pain criteria, excluding prostate-specific antigen.

    Results: Two hundred one men (134 assigned to TASQ; 67 to placebo) were evaluable, and baseline characteristics were well balanced. Six-month progression-free proportions for TASQ and placebo groups were 69% and 37%, respectively (P < .001), and median progression-free survival (PFS) was 7.6 versus 3.3 months (P = .0042). In PCWG2 CRPC clinical subgroups, PFS in months was as follows: nodal metastases, 6.1 versus 3.1; bone metastases, 8.8 versus 3.4; and visceral metastases, 6.0 versus 3.0 for patients receiving TASQ versus placebo, respectively. Bone alkaline phosphatase levels were stabilized in the TASQ group, whereas the impact on PSA kinetics was less pronounced. Adverse events (AEs) occurring more frequently in the TASQ arm included GI disorders, fatigue, musculoskeletal pains, and elevations of pancreatic and inflammatory biomarkers. Grade 3 to 4 AEs, including asymptomatic elevations of laboratory parameters, were reported in 40% of patients receiving TASQ versus 10% receiving placebo; deep vein thrombosis (4% v 0%) was more common in the TASQ arm.

    Conclusion: TASQ significantly slowed progression and improved PFS in patients with metastatic CRPC with an acceptable AE profile.

  • 270.
    Plym, Anna
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, POB 281, S-17177 Stockholm, Sweden..
    Chiesa, Flaminia
    Karolinska Inst, Dept Med Epidemiol & Biostat, POB 281, S-17177 Stockholm, Sweden..
    Voss, Margaretha
    Swedish Social Insurance Agcy, Dept Anal & Forecast, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden..
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Kings Coll London, Sch Med, Div Canc Studies, Canc Epidemiol Grp, London WC2R 2LS, England..
    Johansson, Eva
    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..
    Lambe, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Karolinska Inst, Dept Med Epidemiol & Biostat, POB 281, S-17177 Stockholm, Sweden..
    Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study2016Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 70, nr 1, s. 64-71Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Robot-assisted radical prostatectomy (RARP) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy (RRP), but it is unclear whether these differences translate into shorter absence from work. Objective: To investigate short-and long-term rates of work disability following RARP and RRP. Design, setting, and participants: We conducted a nationwide population-based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden. Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012. Outcome measurements and statistical analysis: We used Cox regression to calculate time to return to work (RTW, or duration of sick leave) after surgery and used generalised estimating equations to analyse days lost from work (because of sick leave and disability pension) after RTW. Results and limitations: Men treated with RARP returned to work after a median of 35 d, whereas the corresponding time for RRP was 48 d (p < 0.001). The difference was seen early; within the first month, men treated with RARP returned to work nearly four times faster than men treated with RRP (adjusted relative RTW rate 3.76; 95% confidence interval [CI], 3.04-4.66). During a median of 3.6 yr after return to work, men treated with RARP lost fewer days from work per person-year than men treated with RRP-12 d versus 15 d-but the association was not statistically significant (p = 0.10). The adjusted rate ratio was 1.08 (95% CI, 0.82-1.42). One limitation is the nonrandomised design of this study. Conclusions: RARP was associated with a faster RTW compared with RRP, but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW. Patient summary: We compared disease-related absence from work between two surgical methods for the removal of the prostate. Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective.

  • 271. Plym, Anna
    et al.
    Folkvaljon, Yasin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Johansson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Fransson, Per
    Stattin, Par
    Lambe, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Drug Prescription for Erectile Dysfunction Before and After Diagnosis of Localized Prostate Cancer2014Inngår i: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 11, nr 8, s. 2100-2108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction. Despite the high prevalence of erectile dysfunction (ED) in men with prostate cancer, little is known about the use of ED drugs. Also, the possible influence of socioeconomic factors on ED drug use has not been studied previously. Aim. The aim of this study was to examine determinants and patterns of ED drug use before and after diagnosis in men with localized prostate cancer. Methods. Using a nationwide population-based cohort, 25,390 men with localized prostate cancer diagnosed between 2006 and 2009 and 126,944 control men were identified and followed for filled ED drug prescriptions over a 3-year period, ranging from 1 year before and up to 2 years after diagnosis. Main Outcome Measures. The main outcome measure was the proportion of men with at least one filled ED drug prescription after diagnosis. Results. The number of men using ED drugs increased markedly following diagnosis. Men who underwent radical prostatectomy had the strongest increase, with a cumulative proportion of 74% for at least one filled prescription within the first 2 years after diagnosis. The corresponding proportion was 33% in men treated with radiotherapy, 21% in men on active surveillance, 10% in men on watchful waiting, and 8% in control men. Among men who underwent prostatectomy, usage attenuated over time. Determinants of postdiagnostic use were young age at diagnosis, high income, high education, and a low- or intermediate-risk cancer. Conclusion. Although drugs for ED are commonly prescribed after diagnosis, use among most men is transient and influenced by socioeconomic status. Posttreatment counseling and affordable ED drugs are likely to reduce treatment dropout and disparities in use and help improve sexual health and quality of life in men with prostate cancer.

  • 272.
    Plym, Anna
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, POB 281, SE-17177 Stockholm, Sweden..
    Voss, Margaretha
    Swedish Social Insurance Agcy, Dept Anal & Forecast, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, 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..
    Lambe, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Karolinska Inst, Dept Med Epidemiol & Biostat, POB 281, SE-17177 Stockholm, Sweden..
    Reply from Authors re: Matthew T. Gettman. Assessing Work Disability After Radical Prostatectomy. Eur Urol 2016;70:72-3 The Challenge of Assessing Work Disability2016Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 70, nr 1, s. 73-74Artikkel i tidsskrift (Annet vitenskapelig)
  • 273. Price, Alison J
    et al.
    Travis, Ruth C
    Appleby, Paul N
    Albanes, Demetrius
    Barricarte Gurrea, Aurelio
    Bjørge, Tone
    Bueno-de-Mesquita, H Bas
    Chen, Chu
    Donovan, Jenny
    Gislefoss, Randi
    Goodman, Gary
    Gunter, Marc
    Hamdy, Freddie C
    Johansson, Mattias
    King, Irena B
    Kühn, Tilman
    Männistö, Satu
    Martin, Richard M
    Meyer, Klaus
    Neal, David E
    Neuhouser, Marian L
    Nygård, Ottar
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Tell, Grethe S
    Trichopoulou, Antonia
    Tumino, Rosario
    Ueland, Per Magne
    Ulvik, Arve
    de Vogel, Stefan
    Vollset, Stein Emil
    Weinstein, Stephanie J
    Key, Timothy J
    Allen, Naomi E
    Circulating Folate and Vitamin B12 and Risk of Prostate Cancer: A Collaborative Analysis of Individual Participant Data from Six Cohorts Including 6875 Cases and 8104 Controls.2016Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 70, nr 6, s. 941-951, artikkel-id S0302-2838(16)00379-1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Folate and vitamin B12 are essential for maintaining DNA integrity and may influence prostate cancer (PCa) risk, but the association with clinically relevant, advanced stage, and high-grade disease is unclear.

    OBJECTIVE: To investigate the associations between circulating folate and vitamin B12 concentrations and risk of PCa overall and by disease stage and grade.

    DESIGN, SETTING, AND PARTICIPANTS: A study was performed with a nested case-control design based on individual participant data from six cohort studies including 6875 cases and 8104 controls; blood collection from 1981 to 2008, and an average follow-up of 8.9 yr (standard deviation 7.3). Odds ratios (ORs) of incident PCa by study-specific fifths of circulating folate and vitamin B12 were calculated using multivariable adjusted conditional logistic regression.

    OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Incident PCa and subtype by stage and grade.

    RESULTS AND LIMITATIONS: Higher folate and vitamin B12 concentrations were associated with a small increase in risk of PCa (ORs for the top vs bottom fifths were 1.13 [95% confidence interval (CI), 1.02-1.26], ptrend=0.018, for folate and 1.12 [95% CI, 1.01-1.25], ptrend=0.017, for vitamin B12), with no evidence of heterogeneity between studies. The association with folate varied by tumour grade (pheterogeneity<0.001); higher folate concentration was associated with an elevated risk of high-grade disease (OR for the top vs bottom fifth: 2.30 [95% CI, 1.28-4.12]; ptrend=0.001), with no association for low-grade disease. There was no evidence of heterogeneity in the association of folate with risk by stage or of vitamin B12 with risk by stage or grade of disease (pheterogeneity>0.05). Use of single blood-sample measurements of folate and B12 concentrations is a limitation.

    CONCLUSIONS: The association between higher folate concentration and risk of high-grade disease, not evident for low-grade disease, suggests a possible role for folate in the progression of clinically relevant PCa and warrants further investigation.

    PATIENT SUMMARY: Folate, a vitamin obtained from foods and supplements, is important for maintaining cell health. In this study, however, men with higher blood folate levels were at greater risk of high-grade (more aggressive) prostate cancer compared with men with lower folate levels. Further research is needed to investigate the possible role of folate in the progression of this disease.

  • 274.
    Radecka, Eva
    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.
    Juhlin, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Nilsson, L
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Thoraxkirurgi.
    Sundin, Anders
    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.
    An unusual case of tumor thrombus in the inferior vena cava: A case report2003Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 44, nr 2, s. 160-161Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Adrenal cortical carcinoma (ACC) is a rare malignancy. Patients present either with a functional tumor or secondary to mass effect. In non-functioning tumors, the tumor size often exceeds 5 cm by the time of diagnosis, and tumor thrombus can occur. We report on a case of a small non-functioning ACC causing a large tumor thrombus in the inferior vena cava.

  • 275.
    Regula, Naresh
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Häggman, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Johansson, Silvia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Sörensen, Jens
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Malignant lipogenesis defined by 11C-acetate PET/CT predicts prostate cancer-specific survival in patients with biochemical relapse after prostatectomy2016Inngår i: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 43, nr 12, s. 2131-2138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Malignant de novo lipogenesis is strongly linked to the aggressiveness of prostate cancer (PCa) under experimental conditions. C-11-Acetate PET/CT is a potential noninvasive biomarker of malignant lipogenesis in PCa, but its prognostic value is not known. The objective of this study was to analyse C-11-acetate PET/CT image metrics in relation to survival. All patients undergoing C-11-acetate PET/CT in one university hospital from 2005 to 2011 due to PSA relapse after previous prostatectomy were retrospectively evaluated. Two groups of patients were compared: those who died from PCa and those who were censored. All previously reported findings of local recurrence, regional or distal lymph node metastases and bone metastases were counted and evaluated regarding C-11-acetate uptake intensity (SUVmax) and tumour volume. Total tumour volume and total lipogenic activity (TLA, summed SUVmax x TV) were calculated. Survival analysis in the entire study population was followed by Cox proportional hazards ratio (HR) analysis. A total of 121 patients were included, and 22 PCa-specific deaths were recorded. The mean PSA level at the time of PET was 2.69 +/- 4.35 ng/mL. The median follow-up of the study population was 79 +/- 28 months. PET identified at least one PCa lesion in 53 % of patients. Five-year PCa-specific survival after PET was 80 % and 100 % in patients with a positive and a negative PET scan, respectively (p < 0.001). Time-to-death was linearly correlated with highest SUVmax (r = -0.55, p = 0.01) and nonlinearly with TLA (r = -0.75, p < 0.001). Multivariate analysis showed statistical significance for number of bone metastases (HR 1.74, p = 0.01), tertile of TLA (HR 5.63, p = 0.029) and postoperative Gleason score (HR 1.84, p = 0.045). Malignant C-11-acetate accumulation measured with PET/CT is a strong predictor of survival in the setting of PSA relapse after prostatectomy. The study provides further evidence for a quantitative relationship between malignant de novo lipogenesis and early death. C-11-Acetate PET/CT might be useful for identifying a high-risk population of relapsing patients in which therapies targeting malignant lipogenesis might be of particular benefit.

  • 276.
    Regula, Naresh Kumar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Lubberink, Mark
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Jorulf, Håkan
    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. Uppsala Univ, Urol, Uppsala, Sweden..
    Häggman, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Sörensen, Jens
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Dynamic Imaging of Prostate Cancer with 11C-acetate PET/CT2017Inngår i: Journal of Nuclear Medicine, ISSN 0161-5505, E-ISSN 1535-5667, Vol. 58, nr S1, artikkel-id 662Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Objectives: Dynamic 11C-acetate PET/CT can be used to study tissue perfusion and carbon flux simultaneously, but studies in cancer are limited. We investigated the kinetics of 11C-acetate in prostate cancer subjects using parametric images with an image-derived input function (IDIF).

    Methods: Twenty-one patients with newly diagnosed low-moderate risk prostate cancer were studied. All underwent pelvic MRI. Dynamic 11C-acetate (5 MBq/kg) PET/CT of the pelvis was acquired for 32 minutes with 32 time frames. An IDIF was acquired from iliac vessels with multiple small regions of interest (ROIs) and a standardized metabolite correction. Parametric images of K1 (extraction), k2 (oxidative metabolism) and Vd (=K1/k2, anabolic metabolism defined as carbon retention) were constructed using a one-tissue compartment model. ROIs of the largest cancer region in each patient and normal prostate tissue were drawn using information from MRI (T2 and DWI images) and from post-surgical histopathology of whole prostate sections (n=7).

    Results: Mean PSA was 8.3±3.9. Median Gleason Sum was 6 (range 5-7). K1, Vd and SUVs were higher in cancerous regions compared to normal prostate for all patients (p<0.001). PSA correlated to early SUV (r=0.50, p=0.02) and K1 (r=0.48, p=0.03). Early and late SUVs were correlated to Vd (r>0.76, p<0.001) and K1 (r>0.61, p<0.005).

    Conclusion: Parametric images could be used to visualize the 11C-acetate kinetics of the prostate. In this cohort of relatively low-risk cancers, PSA values were related to cancer perfusion. SUV of cancerous regions at any time point is primarily associated with anabolic metabolism. Research Support: Swedish Cancer Foundation (Cancerfonden)

  • 277.
    Robertson, Stephanie
    et al.
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Lab, Dept Clin Pathol & Cytol, Solna, Sweden..
    Adolfsson, Jan
    Swedish Agcy Hlth Technol Assessment & Assessment, Karolinska Inst, CLINTEC Dept, Stockholm, 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..
    Sjövall, Annika
    Karolinska Univ Hosp, Div Coloproctol, Ctr Digest Dis, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Winnersjö, Rocio
    Natl Board Hlth & Welf, Stockholm, Sweden..
    Hanning, Marianne
    Natl Board Hlth & Welf, Stockholm, Sweden..
    Sandelin, Kerstin
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Breast & Endocrine Surg, P9 3, SE-11776 Stockholm, Sweden..
    Waiting times for cancer patients in Sweden: A nationwide population-based study2017Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, nr 3, s. 230-237Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: The reported long waiting times for cancer patients have mostly been related to prognostic outcome and less to patient-related experience to outcome. We assessed waiting times for patients with cancer of the breast, prostate, colon or rectum in Sweden.

    Methods: The median time from referral to start of treatment was assessed using data from clinical cancer registers for patients who received curative treatment during 2011, 2012 and 2013.

    Results: The median overall waiting time in different counties ranged from 7 to 28 days for breast cancer, from 117 to 280 days for prostate cancer, from 27 to 64 days for colon cancer and from 48 to 80 days for rectal cancer. For the entire nation, the median time from referral to start of treatment remained unchanged from 2011 to 2013 for each cancer diagnosis.

    Conclusions: Large variations were found in waiting times between different counties in Sweden and between different types of cancer. The long waiting times identified in this study emphasize the need to improve national programmes for more rapid diagnosis and treatment.

  • 278. Robinson, David
    et al.
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Mucci, Lorelei
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Stattin, Par
    Use of 5 alpha-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study2013Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, s. f3406-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To assess the association between 5 alpha-reductase inhibitor (5-ARI) use in men with lower urinary tract symptoms and prostate cancer risk. Design Nationwide, population based case-control study for men diagnosed with prostate cancer in 2007-09 within the Prostate Cancer data Base Sweden 2.0. Setting The National Prostate Cancer Register, National Patient Register, census, and Prescribed Drug Register in Sweden, from which we obtained data on 5-ARI use before date of prostate cancer diagnosis. Participants 26 735 cases and 133 671 matched controls; five controls per case were randomly selected from matched men in the background population. 7815 men (1499 cases and 6316 controls) had been exposed to 5-ARI. 412 men had been exposed to 5-ARI before the diagnosis of a cancer with Gleason score 8-10. Main outcome measures Risk of prostate cancer calculated as odds ratios and 95% confidence intervals by conditional logistic regression analyses. Results Risk of prostate cancer overall decreased with an increasing duration of exposure; men on 5-ARI treatment for more than three years had an odds ratio of 0.72 (95% confidence interval 0.59 to 0.89; P<0.001 for trend). The same pattern was seen for cancers with Gleason scores 2-6 and score 7 (both P<0.001 for trend). By contrast, the risk of tumours with Gleason scores 8-10 did not decrease with increasing exposure time to 5-ARI (for 0-1 year of exposure, odds ratio 0.96 (95% confidence interval 0.83 to 1.11); for 1-2 years, 1.07 (0.88 to 1.31); for 2-3 years, 0.96 (0.72 to 1.27); for >3 years, 1.23 (0.90 to 1.68); P=0.46 for trend). Conclusions Men treated with 5-ARI for lower urinary tract symptoms had a decreased risk of cancer with Gleason scores 2-7, and showed no evidence of an increased risk of cancer with Gleason scores 8-10 after up to four years' treatment.

  • 279. Robinson, David
    et al.
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    5-alpha reductase inhibitors, benign prostatic hyperplasia, and risk of male breast cancer2015Inngår i: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 26, nr 9, s. 1289-1297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    5-alpha reductase inhibitors (5-ARI) have been suggested to increase the risk of male breast cancer. The aim of this study was to study the risk of breast cancer in men on 5-ARI, in men with benign prostatic hyperplasia (BPH) not on 5-ARI, and in men without BPH. We performed a population-based cohort study in Sweden with data from The Prescribed Drug Register, The Patient Register, and The Cancer Register. Men on 5-ARI, men on alpha-blockers, or men who had undergone a transurethral resection of the prostate (TUR-P) prior to or during 2006-2008 were included as exposed to BPH and a specific treatment thereof. For each exposed man, five unexposed men were selected. Risk of breast cancer was calculated in Cox proportional hazard models. There were 124,183 exposed men and 545,293 unexposed men, and during follow-up (median 6 years), 99 men with breast cancer were diagnosed. Compared to unexposed men, men on 5-ARI had a hazard ratio (HR) of breast cancer of 0.74 (95 % confidence interval (CI) 0.27-2.03), men on alpha-blockers had HR 1.47 (95 % CI 0.73-2.95), and men with a TUR-P had HR 1.99 (95 % CI 1.05-3.75). No increased risk of breast cancer was observed for men on 5-ARI. However, the increased risk of breast cancer among men who had undergone a TUR-P, a strong indicator of BPH, suggests that the endocrine milieu conducive to BPH is associated with male breast cancer.

  • 280.
    Robinson, David
    et al.
    Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Garmo, Hans
    Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.;Kings Coll London, Sch Med, Div Canc Studies, Canc Epidemiol Grp, London, England..
    Lissbrant, Ingela Franck
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
    Widmark, Anders
    Umea Univ, Dept Radiat Sci, Oncol, Umea, Sweden..
    Pettersson, Andreas
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden..
    Gunnlaugsson, Adalsteinn
    Lund Univ, Skane Univ Hosp, Dept Oncol & Radiat Phys, Lund, Sweden..
    Adolfsson, Jan
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden..
    Bratt, Ola
    Lund Univ, Dept Translat Med, Div Urol Canc, Lund, Sweden.;Cambridge Univ Hosp, CamPARI Clin, Dept Urol, Cambridge, England..
    Nilsson, Per
    Lund Univ, Skane Univ Hosp, Dept Oncol & Radiat Phys, Lund, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Prostate Cancer Death After Radiotherapy or Radical Prostatectomy: A Nationwide Population-based Observational Study2018Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 73, nr 4, s. 502-511Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.

    Objective: To compare the risk of prostate cancer death after RT versus RP.

    Design, setting, and participants: Nationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.

    Outcome measurements and statistical analysis: Prostate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.

    Results and limitations: Primary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT-low-and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53-2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33-1.85). After full adjustment in period analysis, this difference between the treatments was attenuated-low-and intermediate-risk cancer, HR 1.24 (95% CI: 0.97-1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81-1.31). Confounding remained due to nonrandom allocation to treatment.

    Conclusions: In comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.

    Patient summary: The difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.

  • 281. Robinson, David
    et al.
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Risk of Fractures and Falls during and after 5-α Reductase Inhibitor Use: A Nationwide Cohort Study2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 10, artikkel-id e0140598Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Lower urinary tract symptoms are common among older men and 5-α reductase inhibitors (5-ARI) are a group of drugs recommended in treating these symptoms. The effect on prostate volume is mediated by a reduction in dihydrotestosterone; however, this reduction is counterbalanced by a 25% rise in serum testosterone levels. Therefore, 5-ARI use might have systemic effects and differentially affect bone mineral density, muscular mass and strength, as well as falls, all of which are major determinants of fractures in older men.

    METHODS: We conducted a nationwide cohort study of all Swedish men who used 5-ARI by comparing their risk of hip fracture, any type of fracture and of falls with matched control men randomly selected from the population and unexposed to 5-ARI.

    RESULTS: During 1 417 673 person-years of follow-up, 10 418 men had a hip fracture, 19 570 any type of fracture and 46 755 a fall requiring hospital care. Compared with unexposed men, current users of 5-ARI had an adjusted hazard ratio (HR) of 0.96 (95% CI 0.91-1.02) for hip fracture, an HR of 0.94 (95% CI 0.90-0.98) for all fracture and an HR of 0.99 (95% CI 0.96-1.02) for falls. Former users had an increased risk of hip fractures (HR 1.10, 95% CI 1.01-1.19).

    CONCLUSION: 5-ARI is safe from a bone health perspective with an unaltered risk of fractures and falls during periods of use. After discontinuation of 5-ARI, there is a modest increase in the rate of fractures and falls.

  • 282.
    Robinson, David
    et al.
    Ryhov Hosp, Dept Urol, Jonkoping, Sweden.
    Garmo, Hans
    Regional Cancer Centre Uppsala Örebro, Uppsala university hospital, Sweden;Kings Coll London, TOUR, Sch Canc & Pharmaceut Sci, London, England.
    Van Hemelrijck, Mieke
    Kings Coll London, TOUR, Sch Canc & Pharmaceut Sci, London, England.
    Damber, Jan-Erik
    Univ Gothenburg, Sahlgrenska Acad, Dept Urol, Gothenburg, Sweden.
    Bratt, Ola
    Univ Gothenburg, Sahlgrenska Acad, Dept Urol, Gothenburg, Sweden.
    Holmberg, Lars
    Kings Coll London, TOUR, Sch Canc & Pharmaceut Sci, London, England.
    Wahlund, Lars-Olof
    Karolinska Inst, Karolinska Univ Hosp, NVS Dept, Sect Clin Geriatr, Huddinge, Sweden.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Adolfsson, Jan
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.
    Androgen deprivation therapy for prostate cancer and risk of dementia2019Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 124, nr 1, s. 87-92Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    To study whether androgen deprivation therapy (ADT), the mainstay treatment for advanced and disseminated prostate cancer, is associated with risk of dementia.

    Methods

    Risk of dementia in men with prostate cancer primarily managed with ADT or watchful waiting (WW) in the Prostate Cancer Database Sweden, PCBaSe, was compared with that in prostate cancer-free men, matched on birth year and county of residency. We used Cox regression to calculate the hazard ratios (HRs) for Alzheimer's and non-Alzheimer's dementia (vascular dementia, dementia secondary to other diseases or unspecified dementias) for different types and duration of ADT and oral antiandrogens (AAs) as well as for men managed with WW.

    Results

    A total of 25 967 men with prostate cancer and 121 018 prostate cancer-free men were followed for a median of 4 years. In both groups 6% of the men were diagnosed with dementia. In men with prostate cancer, gonadotropin-releasing hormone agonist treatment ( HR 1.15, 95% confidence interval [CI] 1.07-1.23) and orchiectomy (HR 1.60, 95% CI 1.32-1.93) were associated with an increased risk of dementia, as compared to no treatment in prostate cancer-free men; however, this increase in risk was only observed for non-Alzheimer's dementia and occurred from year 1-4 after start of ADT. No increase in risk for any type of dementia was observed for men treated with AAs or for men on WW.

    Conclusion

    This population-based cohort study does not support previous observations of an increased risk of Alzheimer's dementia for men on ADT; however, there was a small increase in risk of non-Alzheimer's dementia.

  • 283. Rose, James B
    et al.
    Armstrong, Shannon
    Hermann, Gregers G
    Kjellberg, Jakob
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Budget impact of incorporating one instillation of hexaminolevulinate hydrochloride blue-light cytoscopy in transurethral bladder tumour resection for patients with non-muscle-invasive bladder cancer in Sweden.2016Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 117, nr 6B, s. E102-E113Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To explore the cost impact on Swedish healthcare of incorporating one instillation of hexaminolevulinate hydrochloride (HAL) blue-light cystoscopy into transurethral resection of bladder tumour (TURBT) in patients with suspected new or recurrent non-muscle-invasive bladder cancer (NMIBC).

    MATERIALS AND METHODS: A decision tree model was built based on European Association of Urology guidelines for the treatment and management of NMIBC. Input data were compiled from two recent studies comparing recurrence rates of bladder cancer in patients undergoing TURBT with either the current standard of care (SOC) of white-light cystoscopy, or with the SOC and HAL blue-light cystoscopy. Using these published data with clinical cost data for surgical and outpatient procedures and pharmaceutical costs, the model reported on the clinical and economic differences associated with the two treatment options.

    RESULTS: This model demonstrates the significant clinical benefits likely to be observed through the incorporation of HAL blue-light cystoscopy for TURBT in terms of reductions in recurrences of bladder cancer. Analysis of economic outputs of the model found that the use of one instillation of HAL for TURBT in all Swedish patients with NMIBC is likely to be cost-neutral or cost-saving over 5 years relative to the current SOC of white-light cystoscopy.

    CONCLUSIONS: The results of this analysis provide additional health economic rationale for the incorporation of a single instillation of HAL blue-light cystoscopy for TURBT in the treatment of patients with NMIBC in Sweden.

  • 284.
    Rosenblatt, Robert
    et al.
    Karolinska Inst, Stockholm South Gen Hosp, Dept Urol, Stockholm, Sweden;Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, S-90185 Umea, Sweden.
    Johansson, Markus
    Sundsvall Hosp, Dept Urol, Sundsvall, Sweden.
    Alamdari, 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.
    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
    Karolinska Inst, Dept Med, Unit Immunol & Allergy, Stockholm, Sweden.
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, S-90185 Umea, Sweden.
    Sentinel node detection in muscle-invasive urothelial bladder cancer is feasible after neoadjuvant chemotherapy in all pT stages: a prospective multicenter report2017Inngår i: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726, Vol. 35, nr 6, s. 921-927Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0. Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility. Additionally, SNd in MIBC requests further evaluations as a method for nodal staging. Ninety-nine patients with suspected urothelial MIBC were prospectively selected from six urological centers. After TUR-B and primary staging, 65 MIBC patients qualified for radical cystectomy. Precystectomy staging was cT2a-T4aN0M0, including 47 NAC patients and 18 chemo-na < ve patients. All 65 patients underwent intraoperative SNd by peritumoral injection of 80 Mbq Technetium and Geiger probe detection. Postcystectomy staging was pT0-T4aN0-N2M0. SNs were defined by two calculations, SNdef1 and SNdef2. Totally 1063 lymph nodes were removed (total SNs; 222-227). NAC patients with pT0 (n = 24) displayed a true positive detection in 91.7 % by either SNdef, with a median of 3.0 SNs. NACpT > 0 patients had a true positive detection in 87 % (SNdef1) and 91.3 % (SNdef2). In a univariate analysis, patient group neither NAC nor tumor downstaging influenced detection rates, regardless of SN definition. In total eight patients, 4/22 metastatic nodes were SNs while 18/22 were non-SNs. Sentinel node detection in MIBC is feasible also in NAC patients, regardless of pT stage. SNd played no role in nodal staging.

  • 285. Rosenblatt, Robert
    et al.
    Sherif, Amir
    Rintala, Erkki
    Wahlqvist, Rolf
    Ullén, Anders
    Nilsson, Sten
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Pathologic Downstaging Is a Surrogate Marker for Efficacy and Increased Survival Following Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-Invasive Urothelial Bladder Cancer2012Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 61, nr 6, s. 1229-1238Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Characterising responders to neoadjuvant chemotherapy (NAC) is important to minimise overtreatment and the unnecessary delay of definitive treatment of urothelial urinary bladder cancer.

    OBJECTIVE: To assess the effect of NAC on tumour downstaging and overall survival.

    DESIGN, SETTING, AND PARTICIPANTS: A total of 449 patients from the randomised prospective Nordic Cystectomy Trials 1 and 2 were analysed retrospectively. Eligible patients were defined as T2-T4aNXM0 preoperatively and pT0-pT4aN0-N+M0 postoperatively. The median follow-up time was 5 yr.

    INTERVENTION: The experimental arm consisted of cisplatin-based NAC; the control arm consisted of cystectomy only.

    MEASUREMENTS: The primary outcome was tumour downstaging defined as pathologic TNM less than clinical TNM. Different downstaging thresholds were applied: complete downstaging (CD) (pT0N0), noninvasive downstaging (NID) (pT0/pTis/pTaN0), and organ confinement (OC) (≤pT3aN0). Downstaging rates and nodal status were compared between the study arms using the chi-square test. Secondary outcome was overall survival (OS) stratified by treatment arm, downstaging categories, and clinical stages, analysed by the Kaplan-Meier method. The following covariates were tested as prognostic factors in univariate and multivariate analyses using the Cox regression method: age, sex, clinical stage, pN status, NAC, CD, NID, and OC.

    RESULTS AND LIMITATIONS: Downstaging rates increased significantly in the NAC arm independent of the downstaging threshold. The impact was more prominent in clinical T3 tumours, with a near threefold increase in CD tumours. The combination of CD and NAC showed an absolute risk reduction of 31.1% in OS at 5 yr compared with CD controls. The combination of NAC and CD revealed a hazard ratio of 0.32 compared with 1.0 for the combination of no NAC and no CD. Limitations were the retrospective approach and uncertain clinical TNM staging.

    CONCLUSIONS: Survival benefits of NAC are reflected in downstaging of the primary tumour. Chemo-induced downstaging might be a potential surrogate marker for OS.

  • 286.
    Roupret, Morgan
    et al.
    Sorbonne Univ, ONCOTYPE URO, Hop Pitie Salpetriere, Paris, France.
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Black, Peter
    Univ British Columbia, Urol Sci, Vancouver, BC, Canada.
    Recurrent Ta Low-grade Non-muscle-invasive Bladder Cancer: What Are the Options?2019Inngår i: EUROPEAN UROLOGY ONCOLOGY, ISSN 2588-9311, Vol. 2, nr 6, s. 723-729Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recurrent low-grade Ta tumours, classified as intermediate-risk non-muscle-invasive bladder cancer (NMIBC), have a high risk of recurrence but a low risk of progression. This case presents a 60-yr-old female with intermediate-risk NMIBC who has been treated with sequential courses of mitomycin C followed by bacillus Calmette-Guerin (BCG). She continued to develop multiple episodes of recurrence. The discussion addresses whether the best course is repeat transurethral resection of the bladder with continued monitoring, more of the same intravesical treatments, new methods of applying these treatments, or novel treatments that might involve enrolling the patient in a clinical trial. The biggest unmet need in the field comes from the lack of a molecular marker that could help select patients for aggressive strategies. Patient summary: Following treatment of intermediate-risk non-muscle-invasive bladder cancer with a fairly standard course of intravesical drug therapy, the patient, a relatively young woman, continued to develop recurrences of the bladder cancer. The authors discuss whether the best next course is "more of the same", device-assisted application of these treatments, or perhaps one of the new, still investigatory treatment approaches. Radical surgery (removal of the bladder) should not be necessary unless the recurrences show signs of disease progression. .

  • 287.
    Russell, Beth
    et al.
    Kings Coll London, Div Canc Studies Translat Oncol & Urol Res TOUR, London, England..
    Garmo, Hans
    Kings Coll London, Div Canc Studies Translat Oncol & Urol Res TOUR, London, England.;Reg Canc Ctr, Uppsala, Sweden..
    Beckmann, Kerri
    Kings Coll London, Div Canc Studies Translat Oncol & Urol Res TOUR, London, England.;Univ South Australia, Ctr Populat Hlth Res, Adelaide, SA, Australia..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Adolfsson, Jan
    Karolinska Inst, CLINTEC Dept, Stockholm, Sweden..
    Van Hemelrijck, Mieke
    Kings Coll London, Div Canc Studies Translat Oncol & Urol Res TOUR, London, England..
    A case-control study of lower urinary-tract infections, associated antibiotics and the risk of developing prostate cancer using PCBaSe 3.02018Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 4, artikkel-id e0195690Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]