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  • 301.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Quality Indicators For Global Benchmarking Of Localized Prostate Cancer Management Editorial Comment2018Ingår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 200, nr 2, s. 325-326Artikel i tidskrift (Övrigt vetenskapligt)
  • 302.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Svenska kvalitetsregister slår hål på larmrapporter - Register med stora studiepopulationer ger liten risk för fynd baserade på slump eller förväxling.2016Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, artikel-id DX9WArtikel i tidskrift (Refereegranskat)
  • 303.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden..
    Bratt, Ola
    Lund Univ, Div Urol Canc, Dept Translat Med Urol, Lund, Sweden.;Cambridge Univ Hosp, Dept Urol, CamPARI Clin, Cambridge, England..
    Reply to Glen Denmer Santok and Koon Ho Rha's Letter to the Editor re: Par Stattin, Fredrik Sandin, Frederik Birkebaek Thomsen, et al. Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.0232017Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 71, nr 4, s. E115-E116Artikel i tidskrift (Övrigt vetenskapligt)
  • 304.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Carlsson, Sigrid
    Jonsson, Håkan
    Response2014Ingår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 106, nr 10, artikel-id dju293Artikel i tidskrift (Refereegranskat)
  • 305. Stattin, Pär
    et al.
    Johansson, Robert
    Lodnert, Ronald
    Andrén, Ove
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Bratt, Ola
    Damber, Jan-Erik
    Hellström, Magnus
    Hugosson, Jonas
    Lundgren, Rolf
    Törnblom, Magnus
    Varenhorst, Eberhard
    Johansson, Jan-Erik
    Geographical variation in incidence of prostate cancer in Sweden.2005Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, nr 5, s. 372-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate the geographical variation in prostate cancer incidence in Sweden, in particular the incidences of screening-detected tumours and curative treatment of prostate cancer.

    MATERIAL AND METHODS: Data were retrieved from the National Prostate Cancer Register of Sweden for all cases of prostate cancer diagnosed in the year 2000-01. There were a total of 14 376 cases of prostate cancer and the mean total annual age-adjusted incidence was 197/100 000 men. There were 3318 cases in tumour category T1c, i.e. non-palpable tumours diagnosed during work-up for an elevated serum level of prostate-specific antigen, 1006 of which (30%) were asymptomatic and detected at a health check-up.

    RESULTS: The difference between the counties with the lowest and highest age-adjusted incidences per 100 000 men of total prostate cancer was almost twofold (128 vs 217). The corresponding variation in incidence of category T1c tumours was more than fourfold (13 vs 60); the difference in incidence of T1c tumours detected in asymptomatic men was up to 10-fold (2 vs 20); and there was more than a fourfold variation in incidence of curative treatment between counties (13 vs 67). Measured incidences were mostly highest in urban regions and in counties with university hospitals.

    CONCLUSION: There are large geographical variations in prostate cancer incidence and in the frequency of curative treatment for prostate cancer in Sweden and there appear to be large geographical variations in the uptake of prostate cancer screening.

  • 306.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Loeb, Stacy
    "To measure is to know. If you cannot measure it, you cannot improve it": Statistical modeling cannot compensate for unmeasured bias2014Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 65, nr 4, s. 701-703, artikel-id S0302-2838(13)00635-0Artikel i tidskrift (Refereegranskat)
  • 307.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, S-90185 Umea, Sweden..
    Robinson, David
    Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, S-90185 Umea, Sweden..
    Lambe, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Re: Giorgio Gandaglia, Freddie Bray, Matthew R. Cooperberg, et al. Prostate Cancer Registries: Current Status and Future Directions. Eur Urol 2015;68:e1102015Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 68, nr 5, s. E110-E110Artikel i tidskrift (Refereegranskat)
  • 308.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Sandin, Fredrik
    Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.
    Loeb, Stacy
    NYU, Dept Urol & Populat Hlth, New York, NY USA;Manhattan Vet Affairs, New York, NY USA.
    Robinson, David
    Ryhov Hosp, Dept Urol, Jonkoping, Sweden.
    Lissbrant, Ingela Franck
    Univ Goteborg, Dept Oncol, Inst Clin Sci, Sahlgrenska Acad, Gothenburg, Sweden.
    Lambe, Mats
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Public online reporting from a nationwide population-based clinical prostate cancer register2018Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 122, nr 1, s. 8-10Artikel i tidskrift (Övrigt vetenskapligt)
  • 309.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, SE-90185 Umea, Sweden..
    Sandin, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Sandback, Torsten
    Evry Consulting, Stockholm, Sweden..
    Damber, Jan-Erik
    Sahlgrens Acad, Dept Urol, Gothenburg, Sweden..
    Lissbrant, Ingela Franck
    Sahlgrens Acad, Dept Oncol, Gothenburg, Sweden..
    Robinson, David
    Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, SE-90185 Umea, Sweden.;Ryhov Cty Hosp, Dept Urol, Jonkoping, Sweden..
    Bratt, Ola
    Lund Univ, Dept Translat Med, Lund, Sweden..
    Lambe, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Dashboard report on performance on select quality indicators to cancer care providers2016Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 1, s. 21-28Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 310.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Sandin, Fredrik
    Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden..
    Thomsen, Frederik Birkebk
    Univ Copenhagen, Rigshosp, Dept Urol, Copenhagen Prostate Canc Ctr, Copenhagen, Denmark..
    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..
    Robinson, David
    Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.;Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Lissbrant, Ingela Franck
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
    Jonsson, Hakan
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Bratt, Ola
    Lund Univ, Div Urol Canc, Dept Translat Med, Lund, Sweden.;Cambridge Univ Hosp, Dept Urol, CamPARI Clin, Cambridge, England..
    Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study2017Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 72, nr 1, s. 125-134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance. Objective: To investigate the association between radical local treatment and mortality in men with very high-risk PCa. Design, setting, and participants: Semiecologic study of men aged < 80 yr within the Prostate Cancer data Base Sweden, diagnosed in 1998-2012 with very high-risk PCa (local clinical stage T4 and/or prostate-specific antigen [PSA] level 50-200 ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level < 50 ng/ml, any N, and M0) were used as positive controls. Intervention: Proportion of men who received prostatectomy or full-dose radiotherapy in 640 experimental units defined by county, diagnostic period, and age at diagnosis. Outcome measurements and statistical analysis: PCa and all-cause mortality rate ratios (MRRs). Results and limitations: Both PCa and all-cause mortality were half as high in units in the highest tertile of exposure to radical local treatment compared with units in the lowest tertile (PCa MRR: 0.51; 95% confidence interval [CI], 0.28-0.95; and all-cause MRR: 0.56; 95% CI, 0.33-0.92). The results observed for locally advanced PCa for highest versus lowest tertile of exposurewere in agreement with results fromrandomized trials (PCaMRR: 0.75; 95% CI, 0.60-0.94; and all-cause MRR: 0.85; 95% CI, 0.72-1.00). Although the semiecologic design minimized selection bias on an individual level, the effect of high therapeutic activity could not be separated from that of high diagnostic activity. Conclusions: The substantially lower mortality in units with the highest exposure to radical local treatment suggests that radical treatment decreases mortality even in men with very high-risk PCa for whom such treatment has been considered ineffective. Patient summary: Menwith very high-risk prostate cancer diagnosed and treated in units with the highest exposure to surgery or radiotherapy had a substantially lower mortality.

  • 311.
    Stattin, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Vickers, Andrew J
    Sjoberg, Daniel D
    Johansson, Robert
    Granfors, Torvald
    Johansson, Mattias
    Pettersson, Kim
    Scardino, Peter T
    Hallmans, Göran
    Lilja, Hans
    Improving the Specificity of Screening for Lethal Prostate Cancer Using Prostate-specific Antigen and a Panel of Kallikrein Markers: A Nested Case-Control Study2015Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 68, nr 2, s. 207-213, artikel-id S0302-2838(15)00024-XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A disadvantage of prostate-specific antigen (PSA) for the early detection of prostate cancer (PCa) is that many men must be screened, biopsied, and diagnosed to prevent one death.

    OBJECTIVE: To increase the specificity of screening for lethal PCa at an early stage.

    DESIGN, SETTING, AND PARTICIPANTS: We conducted a case-control study nested within a population-based cohort. PSA and three additional kallikreins were measured in cryopreserved blood from a population-based cohort in Västerbotten, Sweden. Of 40379 men providing blood at ages 40, 50, and 60 yr from 1986 to 2009, 12542 men were followed for >15 yr. From this cohort, the Swedish Cancer Registry identified 1423 incident PCa cases, 235 with distant metastasis.

    OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Risk of distant metastasis for different PSA levels and a prespecified statistical model based on the four kallikrein markers.

    RESULTS AND LIMITATIONS: Most metastatic cases occurred in men with PSA in the top quartile at age 50 yr (69%) or 60 yr (74%), whereas 20-yr risk of metastasis for men with PSA below median was low (≤0.6%). Among men with PSA >2 ng/ml, a prespecified model based on four kallikrein markers significantly enhanced the prediction of metastasis compared with PSA alone. About half of all men with PSA >2 ng/ml were defined as low risk by this model and had a ≤1% 15-yr risk of metastasis.

    CONCLUSIONS: Screening at ages 50-60 yr should focus on men with PSA in the top quartile. A marker panel can aid biopsy decision making.

    PATIENT SUMMARY: For men in their fifties, screening should focus on those in the top 10% to 25% of PSA values because the majority of subsequent cases of distant metastasis are found among these men. Testing of four kallikrein markers in men with an elevated PSA could aid biopsy decision making.

  • 312. Sternberg, Cora N.
    et al.
    Donat, S. Machele
    Bellmunt, Joaquim
    Millikan, Randall E.
    Stadler, Walter
    De Mulder, Pieter
    Sherif, Amir
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    von der Maase, Hans
    Tsukamoto, Taiji
    Soloway, Mark S.
    Chemotherapy for bladder cancer: Treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer2007Ingår i: Urology, ISSN 0090-4295, E-ISSN 1527-9995, Vol. 69, s. 62-79Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    To determine the optimal use of chemotherapy in the neoadjuvant, adjuvant, and metastatic setting in patients with advanced urothelial cell carcinoma, a consensus conference was convened by the World Health Organization (WHO) and the Societe Internationale d'Urologie (SIU) to critically review the published literature on chemotherapy for patients with locally advanced bladder cancer. This article reports the development of international guidelines for the treatment of patients with locally advanced bladder cancer with neoadjuvant and adjuvant chemotherapy. Bladder preservation is also discussed, as is chemotherapy for patients with metastatic urothelial cancer. The conference panel consisted of TO medical oncologists and urologists from 3 continents who are experts in this field and who reviewed the English-language literature through October 2004. Relevant English-language literature was identified with the use of Medline; additional cited works not detected on the initial search regarding neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and chemotherapy for patients with metastatic urothelial cancer were reviewed. Evidence-based recommendations for diagnosis and management of the disease were made with reference to a 4-point scale. Results of the authors' deliberations are presented as a consensus document. Meta-analysis of randomized trials on cisplatin-containing combination neoadjuvant chemotherapy revealed a 5% difference in favor of neoadjuvant chemotherapy. No randomized trials have yet compared survival with transurethral resection of bladder tumor alone versus cystectomy for the management of patients with muscle-invasive disease. Collaborative international adjuvant chemotherapy trials are needed to assist researchers in assessing the true value of adjuvant chemotherapy. Systemic cisplatin-based combination chemotherapy is the only current modality that has been shown in phase 3 trials to improve survival in responsive patients with advanced urothelial cancer. A panel of international experts has formulated grade A through D recommendations for the management of patients with locally advanced and metastatic urothelial cancer on the basis of level I to 3 evidence and the findings of phase 2 trials, prospective randomized clinical trials, and meta-analyses.

  • 313. Stocks, Tanja
    et al.
    Bjørge, Tone
    Ulmer, Hanno
    Manjer, Jonas
    Häggström, Christel
    Nagel, Gabriele
    Engeland, Anders
    Johansen, Dorthe
    Hallmans, Göran
    Selmer, Randi
    Concin, Hans
    Tretli, Steinar
    Jonsson, Håkan
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Metabolic risk score and cancer risk: pooled analysis of seven cohorts2015Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, nr 4, s. 1353-1363Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There are few data on the joint influence of metabolic factors on risk of separate cancers.

    METHODS: We analysed data on body mass index, blood pressure and plasma levels of glucose, total cholesterol and triglycerides from seven European cohorts comprising 564 596 men and women with a mean age of 44 years. We weighted those factors equally into a standardized metabolic risk score [MRS, mean = 0, standard deviation (SD) = 1], with an individual's level indicated as SDs from the sex- and cohort-specific means. Cancer hazard ratios were calculated by Cox regression with age as timescale and with relevant adjustments including smoking status. All statistical tests were two-sided.

    RESULTS: During a mean follow-up of 12 years, 21 593 men and 14 348 women were diagnosed with cancer. MRS was linearly and positively associated with incident cancer in total and at sites (P < 0.05). In men, risk per SD MRS was increased by 43% (95% confidence interval: 27-61) for renal cell cancer, 43% (16-76) for liver cancer, 29% (20-38) for colon cancer, 27% (5-54) for oesophageal cancer, 20% (9-31) for rectal cancer, 19% (4-37) for leukaemias, 15% (1-30) for oral cancer and 10% (2-19) for bladder cancer. In women, risk increases per SD MRS were 56% (42-70) for endometrial cancer, 53% (29-81) for pancreatic cancer, 40% (16-67) for renal cell cancer, 27% (9-47) for cervical cancer and 17% (3-32) for rectal cancer.

    CONCLUSION: This largest study to date on the joint influence of metabolic factors on risk of separate cancers showed increased risks for several cancers, in particular renal cell and liver cancer in men and endometrial and pancreatic cancer in women.

  • 314.
    Stranne, J.
    et al.
    Univ Gothenburg, Dept Urol, Inst Clin Sci, Sahlgrenska Acad, Gothenburg, Sweden.
    Brasso, K.
    Rigshosp Copenhagen, Copenhagen Prostate Canc Ctr, Copenhagen, Denmark; Rigshosp Copenhagen, Dept Urol, Copenhagen, Denmark.
    Brennhovd, B.
    Oslo Univ Hosp HF, Dept Urooncol, Radiumhosp, Oslo, Norway.
    Johansson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Jäderling, F.
    Univ Hosp, Karolinska Inst, Dept Radiol, Stockholm, Sweden.
    Kouri, M.
    Helsinki Univ Hosp, Dept Oncol, Helsinki, Finland.
    Lilleby, W.
    Oslo Univ Hosp HF, Dept Urooncol, Radiumhosp, Oslo, Norway.
    Petersen, P. Meidahl
    Copenhagen Univ Hosp, Dept Oncol, Finsen Ctr, Copenhagen, Denmark.
    Mirtti, T.
    Univ Helsinki, Inst Mol Med Finland FIMM, Helsinki, Finland.
    Pettersson, A.
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden.
    Rannikko, A.
    Helsinki Univ Hosp, Dept Urol, Helsinki, Finland.
    Thellenberg, C.
    Norrlands Univ Hosp, Cancerctr, Umeå, Sweden.
    Akre, O.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    SPCG-15: a prospective randomized study comparing primary radical prostatectomy and primary radiotherapy plus androgen deprivation therapy for locally advanced prostate cancer2018Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 5-6, s. 313-320Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 315. Stranne, Johan
    et al.
    Johansson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Nilsson, Andreas
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Carlsson, Stefan
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Johansson, Jan-Erik
    Nyberg, Tommy
    Ruutu, Mirja
    Wiklund, N. Peter
    Steineck, Gunnar
    Inguinal Hernia After Radical Prostatectomy for Prostate Cancer: Results From a Randomized Setting and a Nonrandomized Setting2010Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 58, nr 5, s. 719-726Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Observational data indicate that retropubic radical prostatectomy (RRP) for prostate cancer (PCa) may induce inguinal hernia (IH) formation. Little is known about the influence of robot-assisted radical prostatectomy (RALP) on IH risk. Objective: To compare the incidence of IH after RRP and RALP to that of nonoperated patients with PCa and to a population control. Design, setting, and participants: We studied two groups. All 376 men included in the Scandinavian Prostate Cancer Group Study Number 4 constitute study group 1. Patients were randomly assigned RRP or watchful waiting (WW). The 1411 consecutive patients who underwent RRP or RALP at Karolinska University Hospital constitute study group 2. Men without PCa, matched for age and residence to each study group, constitute controls. Measurements: Postoperative IH incidence was detected through a validated questionnaire. The participation rates were 82.7% and 88.4% for study groups 1 and 2, respectively. Results and limitations: The Kaplan-Meier cumulative occurrence of IH development after 48 mo in study group 1 was 9.3%, 2.4%, and 0.9% for the RRP, the WW, and the control groups, respectively. There were statistically significant differences between the RRP group and the WW and control groups, but not between the last two. In study group 2 the cumulative risk of IH development at 48 mo was 12.2%, 5.8%, and 2.6% for the RRP, the RALP, and the control group, respectively. There were statistically significant differences between the RRP group and the RALP and control groups, but not between the last two. Conclusions: RRP for PCa leads to an increased risk of IH development. RALP may lower the risk as compared to open surgery.

  • 316.
    Styrke, Johan
    et al.
    Umea Univ, Sundsvall Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Henriksson, Helene
    Umea Univ, Sundsvall Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Ljungberg, Borje
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Hasan, Mudhar
    Danderyd Hosp, Dept Urol, Danderyd, Sweden..
    Silfverberg, Ingrid
    Enkoping Hosp, Dept Urol, Enkoping, Sweden..
    Einarsson, Roland
    IDL Biotech AB, Stockholm, Sweden..
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Sherif, Amir
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Evaluation of the diagnostic accuracy of UBC® Rapid in bladder cancer: a Swedish multicentre study2017Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 4, s. 293-300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 317.
    Sverrisson, Ingvar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Folkvaljon, Folke
    Chabok, Abbas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Smedh, Kennet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Nikberg, Maziar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancerManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: There are little data on the post-operative outcome of anterior resection (AR) for rectal cancer in men who had received radiotherapy for prostate cancer previously. The aim of this study was to assess the rate of anastomotic leakage (AL) after AR in these patients.

    Methods: All men who underwent bowel resection because of rectal cancer between 2000 and 2016 and had been diagnosed previously with prostate cancer were identified by linking the Swedish Colorectal Cancer Registry with the National Prostate Cancer Register. The medical records of men who underwent AR and had previously received radiotherapy for prostate cancer were reviewed.

    Results: In total, 13299 men had undergone a bowel resection for rectal cancer, 188 of whom had previously received radiotherapy for prostate cancer. Among those who had received radiation therapy, 59 men (31%) had an AR: 50 men (85%) received a diverting ileostomy, 42 men (71%) had an American Society of Anesthesiologists score of 1–2 and 36 men (61%) had tumour stage 1–2. AL was found in 12/59 men (20%), one of whom had a re-laparotomy. There was no 90-day mortality.

    Conclusions: In the combined national population-based registries, a minority of patients with rectal cancer had an AR after previous radiotherapy for prostate cancer. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than that reported previously.

  • 318.
    Sverrisson, Ingvar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Folkvaljon, Folke
    Uppsala universitet.
    Chabok, Abbas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Smedh, Kennet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Nikberg, Maziar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer2019Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, nr 3, s. 341-346Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction:

    There are little data on the post-operative outcome of anterior resection (AR) for rectal cancer in men who had received radiotherapy for prostate cancer previously. The aim of this study was to assess the rate of anastomotic leakage (AL) after AR in these patients.

    Methods:

    All men who underwent bowel resection because of rectal cancer between 2000 and 2016 and had been diagnosed previously with prostate cancer were identified by linking the Swedish Colorectal Cancer Registry with the National Prostate Cancer Register. The medical records of men who underwent AR and had previously received radiotherapy for prostate cancer were reviewed.

    Results:

    In total, 13299 men had undergone a bowel resection for rectal cancer, 188 of whom had previously received radiotherapy for prostate cancer. Among those who had received radiation therapy, 59 men (31%) had an AR: 50 men (85%) received a diverting ileostomy, 42 men (71%) had an American Society of Anesthesiologists score of 1-2 and 36 men (61%) had tumour stage 1-2. AL was found in 12/59 men (20%), one of whom had a re-laparotomy. There was no 90-day mortality.

    Conclusions:

    In the combined national population-based registries, a minority of patients with rectal cancer had an AR after previous radiotherapy for prostate cancer. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than that reported previously.

  • 319.
    Tammela, T L
    et al.
    Tampere Univ Hosp, Dept Urol, Tampere, Finland.; Univ Tampere, Tampere, Finland.
    Häggman, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Ladjevardi, Sam
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Taari, K
    Helsinki Univ Hosp, Helsinki, Finland.
    Isotalo, T
    Paijiat Hame Cent Hosp, Lahti, Finland.
    Lennernäs, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaci.
    Weis, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    von Below, Catrin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Wassberg, Cecilia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Lennernäs, B
    Univ Orebro, Dept Oncol, Orebro, Sweden.
    Tolf, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Klinisk och experimentell patologi.
    Axén, N
    LIDDS AB, Uppsala, Sweden.
    Gölander, C-G
    LIDDS AB, Uppsala, Sweden.
    Ahlström, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    An Intraprostatic Modified Release Formulation of Antiandrogen 2-Hydroxyflutamide for Localized Prostate Cancer2017Ingår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 198, nr 6, s. 1333-1339Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To investigate tolerability, safety and antitumor effects of a novel intra-prostatic depot formulation of antiandrogen 2-hydroxyflutamide (2-HOF in NanoZolid(®)) in men with localized prostate cancer (PCa).

    MATERIALS AND METHODS: Two clinical trials, LPC-002 and LPC-003, were conducted on a total of 47 men. The formulation was injected transrectally into the prostate with ultrasound guidance. In LPC-002 the effects on prostate specific antigen (PSA) and prostate volume (PV) were measured over 6 months on 24 patients. In LPC-003, antitumor effects were evaluated with histopathology, magnetic resonance imaging (MRI) including spectroscopy (MRS) during 6 or 8 weeks on 23 patients. In both studies, testosterone and 2-HOF in plasma were measured, as well as quality-of-life parameters.

    RESULTS: In LPC-002 (mean dose 690 mg) a reduction in PSA and PV was observed. The nadir values for PSA and PV were on average 24.9 % and 14.0 % below baseline, respectively. When increasing the dose in LPC-003 (920 mg and 1740 mg), the average PSA dropped 16 % and 23 %, respectively, after 6 and 8 weeks. MRI/MRS showed morphological changes and a global drop in metabolite concentrations following treatment indicating an antitumor response. The injections did not result in hormone related side effects. In total, three serious adverse events were reported, all resolved by oral antibiotic treatment.

    CONCLUSIONS: The intraprostatic injections of 2-HOF depot formulations indicated anti-tumor effects and proved safe and tolerable. However, for better anti-cancer effects higher doses and better dose distribution are suggested.

  • 320.
    Teleka, Stanley
    et al.
    Lund Univ, Dept Clin Sci Malmo, Lund, Sweden.
    Häggström, Christel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Umea Univ, Dept Biobank Res, Umea, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Nutr Res, Umea, Sweden.
    Nagel, Gabriele
    Univ Ulm, Inst Epidemiol & Med Biometry, Ulm, Germany;Vorarlberg Canc Registry, Agcy Prevent & Social Med, Bregenz, Aks, Austria.
    Bjorge, Tone
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway;Canc Registry Norway, Oslo, Norway.
    Manjer, Jonas
    Lund Univ, Skane Univ Hosp, Dept Surg, Malmo, Sweden.
    Ulmer, Hanno
    Innsbruck Med Univ, Dept Med Stat Informat & Hlth Econ, Innsbruck, Austria.
    Liedberg, Fredrik
    Lund Univ, Inst Translat Med, Div Urol Res, Malmo, Sweden.
    Ghaderi, Sara
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway.
    Lang, Alois
    Vorarlberg Canc Registry, Agcy Prevent & Social Med, Bregenz, Aks, Austria.
    Jonsson, Hakan
    Umea Univ, Dept Radiat Sci, Umea, Sweden.
    Jahnson, Staffan
    Linkoping Univ, Dept Urol, Linkoping, Sweden;Linkoping Univ, IKE, Linkoping, Sweden.
    Orho-Melander, Marju
    Lund Univ, Dept Clin Sci Malmo, Lund, Sweden.
    Tretli, Steinar
    Canc Registry Norway, Oslo, Norway.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Stocks, Tanja
    Lund Univ, Dept Clin Sci Malmo, Lund, Sweden.
    Risk of bladder cancer by disease severity in relation to metabolic factors and smoking: A prospective pooled cohort study of 800,000 men and women2018Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, nr 12, s. 3071-3082Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Previous studies on metabolic factors and bladder cancer (BC) risk have shown inconsistent results and have commonly not investigated associations separately by sex, smoking, and tumor invasiveness. Among 811,633 participants in six European cohorts, we investigated sex-specific associations between body mass index (BMI), mid-blood pressure (BP, [systolic + diastolic]/2), plasma glucose, triglycerides, total cholesterol and risk of BC overall, non-muscle invasive BC (NMIBC) and muscle invasive BC (MIBC). Among men, we additionally assessed additive interactions between metabolic factors and smoking on BC risk. During follow-up, 2,983 men and 754 women were diagnosed with BC. Among men, triglycerides and BP were positively associated with BC risk overall (hazard ratio [HR] per standard deviation [SD]: 1.17 [95% confidence interval (CI) 1.06-1.27] and 1.09 [1.02-1.17], respectively), and among women, BMI was inversely associated with risk (HR: 0.90 [0.82-0.99]). The associations for BMI and BP differed between men and women (p(interaction) <= 0.005). Among men, BMI, cholesterol and triglycerides were positively associated with risk for NMIBC (HRs: 1.09 [95% CI 1.01-1.18], 1.14 [1.02-1.25], and 1.30 [1.12-1.48] respectively), and BP was positively associated with MIBC (HR: 1.23 [1.02-1.49]). Among women, glucose was positively associated with MIBC (HR: 1.99 [1.04-3.81]). Apart from cholesterol, HRs for metabolic factors did not significantly differ between MIBC and NMIBC, and there were no interactions between smoking and metabolic factors on BC. Our study supports an involvement of metabolic aberrations in BC risk. Whilst some associations were significant only in certain sub-groups, there were generally no significant differences in associations by smoking or tumor invasiveness.

  • 321.
    Thomsen, Frederik B.
    et al.
    Univ Copenhagen, Rigshosp, Copenhagen Prostate Canc Ctr, Copenhagen, Denmark.;Univ Copenhagen, Rigshosp, Dept Urol, Copenhagen, Denmark..
    Folkvaljon, Yasin
    Univ Uppsala Hosp, Reg Canc Ctr, Uppsala, Sweden..
    Brasso, Klaus
    Univ Copenhagen, Rigshosp, Copenhagen Prostate Canc Ctr, Copenhagen, Denmark.;Univ Copenhagen, Rigshosp, Dept Urol, Copenhagen, Denmark..
    Loeb, Stacy
    NYU, Dept Urol, Populat Hlth, New York, NY USA.;NYU, Laura & Isaac Perlmutter Canc Inst, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
    Robinson, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Egevad, Lars
    Karolinska Inst, Karolinska Univ Hosp, Dept Oncol Pathol, 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..
    Prognostic Implications of 2005 Gleason Grade Modification. Population-Based Study of Biochemical Recurrence Following Radical Prostatectomy2016Ingår i: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 114, nr 6, s. 664-670Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To assess the impact of the 2005 modification of the Gleason classification on risk of biochemical recurrence (BCR) after radical prostatectomy (RP). Patients and Methods: In the Prostate Cancer data Base Sweden (PCBaSe), 2,574 men assessed with the original Gleason classification and 1,890 men assessed with the modified Gleason classification, diagnosed between 2003 and 2007, underwent primary RP. Histopathology was reported according to the Gleason Grading Groups (GGG): GGG1 = Gleason score (GS) 6, GGG2 = GS 7(3+4), GGG3 = GS 7(4+3), GGG4 = GS 8 and GGG5 = GS 9-10. Cumulative incidence and multivariable Cox proportional hazards regression models were used to assess difference in BCR. Results: The cumulative incidence of BCR was lower using the modified compared to the original classification: GGG2 (16% vs. 23%), GGG3 (21% vs. 35%) and GGG4 (18% vs. 34%), respectively. Risk of BCR was lower for modified versus original classification, GGG2 Hazard ratio (HR) 0.66, (95% CI 0.49-0.88), GGG3 HR 0.57 (95% CI 0.38-0.88) and GGG4 HR 0.53 (95% CI 0.29-0.94). Conclusion: Due to grade migration following the 2005 Gleason modification, outcome after RP are more favourable. Consequently, outcomes from historical studies cannot directly be applied to a contemporary setting.

  • 322.
    Thomsen, Frederik B.
    et al.
    Bispebjerg & Frederiksberg Hosp, Dept Urol, DK-2000 Frederiksberg, Denmark..
    Folkvaljon, Yasin
    Uppsala universitet.
    Garmo, Hans
    Kings Coll London, Sch Med, Div Canc Studies, Canc Epidemiol Grp, London WC2R 2LS, England..
    Robinson, David
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.;Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Loeb, Stacy
    NYU, Dept Urol, Populat Hlth, New York, NY USA.;NYU, Laura & Isaac Perlmutter Canc Inst, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
    Ingvar, Christian
    Lund Univ, Dept Surg, Clin Sci, Skane Univ Hosp, Lund, Sweden..
    Lambe, Mats
    Uppsala universitet. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Risk of malignant melanoma in men with prostate cancer: Nationwide, population-based cohort study2016Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 138, nr 9, s. 2154-2160Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An increased risk of malignant melanoma has been observed in men with prostate cancer. To assess potential shared risk factors and confounding factors, we analysed risk of melanoma in men with prostate cancer including information on tumor characteristics and demographics including socioeconomic status. In The Prostate Cancer data Base Sweden, risk of melanoma was assessed in a cohort of men with prostate cancer and in a comparison cohort of prostate-cancer free men. Data on prostate cancer risk category, melanoma stage, basal cell carcinoma, location of residency, and socioeconomic status were obtained from nationwide registers. Melanoma was diagnosed in 830/108,145 (0.78%) men with prostate cancer and in 3,699/556,792 (0.66%) prostate cancer-free men. In multivariable Cox regression models, men with prostate cancer had a significantly increased risk of melanoma (HR 1.18, 95% CI 1.09-1.27), and so had married men, men with high education and income, and men residing in southern Sweden. The strongest associations were observed for stage 0 melanoma in men with low-risk prostate cancer (HR 1.45, 1.14-1.86), high education (HR 1.87, 1.60-2.18) and top income (HR 1.61, 1.34-1.93), respectively, whereas there was no association between these factors and late-stage melanoma. Men with prostate cancer also had an increased risk of basal cell carcinoma (HR 1.18, 1.15-1.22). In conclusion, men with low-risk prostate cancer, high education, high income and residency in southern Sweden had an increased risk of early-stage melanoma. What's new? Men with a history of prostate cancer are at increased risk of melanoma, an association suspected of arising from a common mechanism of androgen exposure. Other factors, however, including tumor characteristics and socioeconomic factors, may also play a role. In this population-based study in Sweden, among men with prostate cancer, melanoma risk was found to be greatest for low-risk prostate tumors. The association was exclusive to early-stage melanoma. Risk of basal cell carcinoma was also elevated among men with prostate cancer. The findings throw new light on potential shared risk factors between prostate cancer and skin malignancies.

  • 323.
    Thomsen, Frederik B.
    et al.
    Bispebjerg & Frederiksberg Hosp, Dept Urol, Frederiksberg, Denmark.;Univ Copenhagen, Rigshosp, Copenhagen Prostate Canc Ctr, Dept Urol, Copenhagen, Denmark..
    Mikkelsen, Marta K.
    Bispebjerg & Frederiksberg Hosp, Dept Urol, Frederiksberg, Denmark..
    Hansen, Rikke B.
    Bispebjerg & Frederiksberg Hosp, Dept Urol, Frederiksberg, Denmark..
    Krug, Andrea H.
    Univ Copenhagen, Rigshosp, Copenhagen Prostate Canc Ctr, Dept Urol, Copenhagen, Denmark..
    Glenthoj, Anders
    Univ Copenhagen, Rigshosp, Dept Pathol, Copenhagen, Denmark..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, Umea, Sweden..
    Brasso, Klaus
    Univ Copenhagen, Rigshosp, Copenhagen Prostate Canc Ctr, Dept Urol, Copenhagen, Denmark..
    Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2007 and 2013: status from a Danish primary referral center2016Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, nr 12, s. 1456-1460Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Danish Cancer Registry holds information on all prostate cancers (PCa) cases, including diagnostic TNM. However, stratification according to contemporary risk classification is not possible because histopathological grading and prostate-specific antigen (PSA) level are not registered. The objective of the study was to report clinical characteristics and primary management of men diagnosed with PCa from a primary referral center in Denmark. Material and methods: Records on all men diagnosed with PCa at the Department of Urology, Frederiksberg Hospital, 1 January 2007 - 31 December 2013, were reviewed. Clinical characteristics and primary treatment were recorded. The National Comprehensive Cancer Network risk group classification was used. Results: A total of 1934 men with a median age of 69 years (interquartile range 65-75) were diagnosed with PCa in the study period resulting in an incidence rate (World Standard Population) of 84/100 000. Overall, 18% were classified as low-risk, 34% as intermediate-risk, 23% as high-risk, 8% as very high-risk and 17% had metastatic disease at diagnosis. Among men age <65 years 70% had low-or intermediate-risk disease, while this was the case for 58% of men aged 65-75 and 22% of men aged >75. Metastatic disease was found in 11% of men <65 years, 17% of men 65-75 years and 23% of men >75 years. In total 73% of men with low-risk PCa were managed on watchful waiting or active surveillance. Curatively intended treatment was performed in 56% of men with intermediate-risk and 61% of men with high-risk PCa, while hormonal therapy was used in 90% of men with very high-risk and 98% of men with metastatic PCa. Conclusion: In a population without systematic PSA testing we found a large proportion of patients presenting with advanced PCa at diagnosis. Elderly patients presented with more advanced disease. Curative treatment was primarily used in younger men with clinically localized PCa.

  • 324.
    Thomsen, Frederik B.
    et al.
    Rigshosp, Copenhagen Prostate Canc Ctr, Dept Urol, Copenhagen, Denmark..
    Sandin, Fredrik
    Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden..
    Garmo, Hans
    Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.;Kings Coll London, Sch Med, Canc Epidemiol Grp, Div Canc Studies, London, England..
    Lissbrant, Ingela F.
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
    Ahlgren, Goran
    SUS Malmo, Dept Urol, Malmo, Sweden..
    Van Hemelrijck, Mieke
    Kings Coll London, Sch Med, Canc Epidemiol Grp, Div Canc Studies, London, England.;Karolinska Inst, Epidemiol Unit, Inst Environm Med, Stockholm, Sweden..
    Adolfsson, Jan
    Karolinska Inst, CLINTEC Dept, Stockholm, Sweden..
    Robinson, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Ume, Sweden..
    No difference in risk of cardiovascular disease in men with prostate cancer treated with GnRH agonists or orchiectomy: semi-ecologic, nationwide, population-based study2017Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr SI 220, s. 16-16Artikel i tidskrift (Övrigt vetenskapligt)
  • 325.
    Thomsen, Frederik Birkebaek
    et al.
    Univ Copenhagen, Rigshosp, Dept Urol, Copenhagen Prostate Canc Ctr, Ole Maaloes Vej 24,Afs 7521, DK-2200 Copenhagen, Denmark.
    Bosco, Cecilia
    Kings Coll London, TOUR, Sch Canc & Pharmaceut Sci, London, England.
    Garmo, Hans
    Kings Coll London, TOUR, Sch Canc & Pharmaceut Sci, London, England;Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.
    Adolfsson, Jan
    Karolinska Inst, CLINTEC Dept, Stockholm, Sweden.
    Hammar, Niklas
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, Stockholm, Sweden;AstraZeneca, Global Med Dev, Med Evidence & Observat Res, Stockholm, Sweden.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Van Hemelrijck, Mieke
    Kings Coll London, TOUR, Sch Canc & Pharmaceut Sci, London, England;Karolinska Inst, Inst Environm Med, Unit Epidemiol, Stockholm, Sweden.
    Anti-androgen monotherapy versus gonadotropin-releasing hormone agonists in men with advanced, non-metastatic prostate cancer: a register-based, observational study2019Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 58, nr 1, s. 110-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    In randomised controlled trials, men with advanced, non-metastatic prostate cancer (PCa) treated with anti-androgen monotherapy (AA) had similar all-cause mortality as men treated with gonadotropin-releasing hormone (GnRH) agonists. Using real-world evidence (i.e., observational data), we aimed to further assess the difference in mortality between these two drug categories.

    Material and Methods:

    We emulated a trial using data from Prostate Cancer data Base Sweden 3.0. We specifically focused on men diagnosed in 2006-2012 with high-risk PCa who had no distant metastasis. They either received primary hormonal therapy with AA (n=2078) or GnRH agonists (n=4878) who were followed for a median time of 5 years. Risk of death from PCa and other causes was assessed using competing risk analyses and Cox proportional hazards regression analyses, including propensity score matching.

    Results:

    The cumulative 5-year PCa mortality was lower for men treated with AA (16% [95% confidence interval, CI, 15-18%]) than men treated with GnRH agonists (22% [95% CI 21-24%]). The 5-year other cause mortality was also lower for men on AA (17% [95% CI 15-19%] compared to men on GnRH agonists (27% [95% CI 25-28%]). In regression analyses, the risk of PCa death was similar, GnRH agonists versus AA (reference), hazard ratio (HR) 1.08 (95% CI 0.95-1.23), but the risk of death from all causes was higher for men on GnRH agonists, HR 1.23 (95% CI 1.13-1.34). Consistent results were seen in the propensity score-matched cohort.

    Conclusion:

    Our results indicate that the use of AA as primary hormonal therapy in men with high-risk non-metastatic PCa does not increase PCa-specific mortality compared to GnRH. Using AA instead of GnRH agonists may result in shorter time on/exposure to GnRH-treatment, which may reduce the risk of adverse events associated with this treatment.

  • 326.
    Thomsen, Frederik Birkebæk
    et al.
    Univ Copenhagen, Rigshosp, Dept Urol, Copenhagen Prostate Canc Ctr, Copenhagen, Denmark.
    Sandin, Fredrik
    Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden.
    Garmo, Hans
    Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden.; Kings Coll London, Div Canc Studies, Sch Med, Canc Epidemiol Grp, London, England.
    Lissbrant, Ingela Franck
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden.
    Ahlgren, Göran
    SUS Malmo, Dept Urol, Malmo, Sweden.
    Van Hemelrijck, Mieke
    Kings Coll London, Div Canc Studies, Sch Med, Canc Epidemiol Grp, London, England.; Karolinska Inst, Inst Environm Med, Epidemiol Unit, Stockholm, Sweden.
    Adolfsson, Jan
    Karolinska Inst, CLINTEC Dept, 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. Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.
    Gonadotropin-releasing Hormone Agonists, Orchiectomy, and Risk of Cardiovascular Disease: Semi-ecologic, Nationwide, Population-based Study2017Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 72, nr 6, s. 920-928, artikel-id S0302-2838(17)30536-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In observational studies, men with prostate cancer treated with gonadotropin-releasing hormone (GnRH) agonists had a higher risk of cardiovascular disease (CVD) compared to men who had undergone orchiectomy. However, selection bias may have influenced the difference in risk.

    OBJECTIVE: To investigate the association of type of androgen deprivation therapy (ADT) with risk of CVD while minimising selection bias.

    DESIGN, SETTING, AND PARTICIPANTS: Semi-ecologic study of 6556 men who received GnRH agonists and 3330 men who underwent orchiectomy as primary treatment during 1992-1999 in the Prostate Cancer Database Sweden 3.0.

    OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We measured the proportion of men who received GnRH agonists as primary treatment in 580 experimental units defined by healthcare provider, diagnostic time period, and age at diagnosis. Incident or fatal CVD events in units with high and units with low use of GnRH agonists were compared. Net and crude probabilities were also analysed.

    RESULTS AND LIMITATIONS: The risk of CVD was similar between units with the highest and units with the lowest proportion of GnRH agonist use (relative risk 1.01, 95% confidence interval [CI] 0.93-1.11). Accordingly, there was no difference in the net probability of CVD after GnRH agonist compared to orchiectomy (hazard ratio 1.02, 95% CI 0.96-1.09). The 10-yr crude probability of CVD was 0.56 (95% CI 0.55-0.57) for men on GnRH agonists and 0.52 (95% CI 0.50-0.54) for men treated with orchiectomy. The main limitation was the nonrandom allocation to treatment, with younger men with lower comorbidity and less advanced cancer more likely to receive GnRH agonists.

    CONCLUSION: Our data do not support previous observations that GnRH agonists increase the risk of CVD in comparison to orchiectomy.

    PATIENT SUMMARY: We found a similar risk of cardiovascular disease between medical and surgical treatment as androgen deprivation therapy for prostate cancer.

  • 327. Thorstenson, Andreas
    et al.
    Bratt, Ola
    Akre, Olof
    Hellborg, Henrik
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Lambe, Mats
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Stattin, Paer
    Adolfsson, Jan
    Incidence of fractures causing hospitalisation in prostate cancer patients: Results from the population-based PCBaSe Sweden2012Ingår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, nr 11, s. 1672-1681Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Prostate cancer patients have an increased risk of fractures as a consequence of skeletal metastases and osteoporosis induced by endocrine treatment. Data on incidence of fractures and risks in subgroups of men with prostate cancer are sparse. Our aim with this study is to report the risk of fractures among men with prostate cancer in a nationwide population-based study. Patients and methods: We identified 76,600 Swedish men diagnosed with prostate cancer 1997-2006 in the Prostate Cancer Data Base (PCBaSe) Sweden and compared the occurrence of fractures requiring hospitalisation with the Swedish male population. Results: Only men treated with gonadotropin releasing-hormone (GnRH) agonists or orchiectomy had increased incidence and increased relative risk of fractures requiring hospitalisation. Men treated with GnRH agonists had 9.8 and 6.3/1000 person-years higher incidence of any fracture and hip fracture requiring hospitalisation than the general population. The corresponding increases in incidence for men treated with orchiectomy were 16 and 12/1000 person-years, respectively. Men treated with orchiectomy, GnRH agonists, and antiandrogen monotherapy, had SIR for hip fracture of 2.0 (95% Confidence Interval 1.8-2.2), 1.6 (95% CI 1.5-1.8) and 0.9 (95% CI 0.7-1.1), respectively. Men treated with a curative intent (radical prostatectomy or radiotherapy) or managed with surveillance had no increased risk of fractures. Older men had the highest incidence of fractures while younger men had the highest relative risk. Conclusion: Prostate cancer patients treated with GnRH agonists or orchiectomy have significantly increased risk of fractures requiring hospitalisation while patients treated with antiandrogen monotherapy had no increase in such fractures. In absolute terms the excess risk in men treated with GnRH agonists corresponded to almost 10 extra fractures leading to hospitalisation per 1000 patient-years. Effects on bone density should be considered for men on long-term endocrine treatment. Unwarranted use of orchiectomy and GnRH agonists should be avoided. 

  • 328.
    Thorstenson, Andreas
    et al.
    Karolinska Inst, Urol Sect, Dept Mol Med & Surg, Stockholm, Sweden.;Capio St Gorans Hosp, Dept Surg, Urol Sect, Sankt Goransplan 1, Stockholm, Sweden..
    Hagberg, Oskar
    Lund Univ, Reg Canc Ctr, Lund, Sweden..
    Ljungberg, Borje
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Liedberg, Fredrik
    Lund Univ, SUS, Dept Urol, Malmo, Sweden..
    Jancke, Georg
    Linkoping Univ, Univ Hosp, Dept Urol, Linkoping, Sweden..
    Holmang, Sten
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden..
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Hosseini, Abolfazl
    Karolinska Inst, Urol Sect, Dept Mol Med & Surg, Stockholm, Sweden..
    Jahnson, Staffan
    Linkoping Univ, Univ Hosp, Dept Urol, Linkoping, Sweden..
    Gender-related differences in urothelial carcinoma of the bladder: a population-based study from the Swedish National Registry of Urinary Bladder Cancer2016Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 4, s. 292-297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 329.
    Thorstenson, Andreas
    et al.
    Umeå Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umeå, Sweden; Karolinska Inst, Urol Sect, Dept Mol Med & Surg, Stockholm, Sweden; Univ Oxford, Nuffield Dept Surg Sci, Surg Intervent Trials Unit, Oxford, England.
    Harmenberg, Ulrika
    Karolinska Univ Hosp, Dept Oncol, Stockholm, Sweden.
    Lindblad, Per
    Univ Örebro, Fac Med & Hlth, Dept Urol, Örebro, Sweden.
    Holmström, Benny
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. ..
    Lundstam, Sven
    Sahlgrens Univ Hosp, Dept Urol, Gothenburg, Sweden.
    Ljungberg, Börje
    Umeå Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umeå, Sweden..
    Cancer Characteristics and Current Treatments of Patients with Renal Cell Carcinoma in Sweden2015Ingår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, artikel-id 456040Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Methodology: Since the start in 2005 virtually all patients with newly diagnosed renal cell carcinoma (RCC) in Sweden are reported to the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence, and survival.

    Results: A total of 8556 patients with newly diagnosed RCC were registered in the NSKCR from 2005 to 2013 resulting in a coverage of 99% as compared to the Swedish Cancer Registry. The mean tumor size at detection decreased from 70 mm in 2005 to 64 mm in 2010. The proportion of patients who were incidentally detected increased. The proportion of patients with tumor stage T1a who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2012. Similarly, the proportion of laparoscopically performed radical nephrectomies increased from 6% in 2005 to 17% in 2010. During the five years of follow-up 20% of the patients had a recurrence.

    Conclusion: Over the last decade there has been a trend of earlier detection and less advanced tumors at detection in patients with RCC. An increasing proportion of the patients undergo laparoscopic and nephron-sparing procedures.

  • 330. Thulin, Helena
    et al.
    Kreicbergs, Ulrika
    Onelöv, Erik
    Ahlstrand, Christer
    Carringer, Malcolm
    Holmäng, Sten
    Ljungberg, Börje
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Robinsson, David
    Wijkström, Hans
    Wiklund, N Peter
    Steineck, Gunnar
    Henningsohn, Lars
    Defecation disturbances after cystectomy for urinary bladder cancer2011Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 108, nr 2, s. 196-203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Type - Preference (prospective cohort)
Level of Evidence 4 OBJECTIVES: To describe and compare long-term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non-continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions. PATIENTS AND METHODS: During their follow-up we attempted to contact all men and women aged 30-80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study-specific questionnaire together with free-hand comments. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval. RESULTS: The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). A sense of decreased straining capacity was reported by 20% of the men and women with non-continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively. CONCLUSIONS: Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool-emptying problems, and asking about them after surgery.

  • 331. Thulin, Helena
    et al.
    Steineck, Gunnar
    Kreicbergs, Ulrika
    Onelöv, Erik
    Ahlstrand, Christer
    Carringer, Malcolm
    Holmäng, Sten
    Ljungberg, Börje
    Malmström, Per-Uno
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Robinsson, David
    Wijkström, Hans
    Wiklund, N Peter
    Henningsohn, Lars
    Hygiene and urinary tract infections after cystectomy in 452 Swedish survivors of bladder cancer2009Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 105, nr 8, s. 1107-1117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES To determine whether or not an improved hygiene can lessen the incidence of symptomatic urinary tract infections (UTIs) in patients treated by cystectomy for urinary bladder cancer. PATIENTS AND METHODS We attempted to contact during their follow-up all men and women aged 30-80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified hygienic measures and included them in a study-specific questionnaire. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results presented as relative risks (RR) with 95% confidence interval. RESULTS We received the questionnaire from 452 (92%) of 491 identified patients. The proportion of patients who had a symptomatic UTI in the previous year was 22% for orthotopic neobladder and cutaneous continent reservoir, and 23% for non-continent urostomy diversion. The RR for a UTI was 1.1 (0.5-2.5) for 'never washing hands' before handling with catheters or ostomy material. Patients with diabetes mellitus had a RR of 2.1 (1.4-3.2) for having a symptomatic UTI. CONCLUSIONS We could not confirm lack of hygiene measures as a cause of UTI for men and women who had a cystectomy with urinary diversion. Patients with diabetes mellitus have a greater risk of contracting a UTI.

  • 332.
    Thysell, Elin
    et al.
    Umea Univ, Dept Med Biosci, Pathol, SE-90185 Umea, Sweden.
    Vidman, Linda
    Umea Univ, Dept Math & Math Stat, Umea, Sweden.
    Ylitalo, Erik Bovinder
    Umea Univ, Dept Med Biosci, Pathol, SE-90185 Umea, Sweden.
    Jernberg, Emma
    Umea Univ, Dept Med Biosci, Pathol, SE-90185 Umea, Sweden.
    Crnalic, Sead
    Umea Univ, Dept Surg & Perioperat Sci, Orthopaed, Umea, Sweden.
    Iglesias-Gato, Diego
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Drug Design & Pharmacol, Copenhagen, Denmark.
    Flores-Morales, Amilcar
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Drug Design & Pharmacol, Copenhagen, Denmark.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Egevad, Lars
    Karolinska Univ Hosp, Dept Pathol & Cytol, Stockholm, Sweden.
    Widmark, Anders
    Umea Univ, Dept Radiat Sci, Oncol, Umea, Sweden.
    Ryden, Patrik
    Umea Univ, Dept Math & Math Stat, Umea, Sweden.
    Bergh, Anders
    Umea Univ, Dept Med Biosci, Pathol, SE-90185 Umea, Sweden.
    Wikstrom, Pernilla
    Umea Univ, Dept Med Biosci, Pathol, SE-90185 Umea, Sweden.
    Gene expression profiles define molecular subtypes of prostate cancer bone metastases with different outcomes and morphology traceable back to the primary tumor2019Ingår i: Molecular Oncology, ISSN 1574-7891, E-ISSN 1878-0261, Vol. 13, nr 8, s. 1763-1777Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Bone metastasis is the lethal end-stage of prostate cancer (PC), but the biology of bone metastases is poorly understood. The overall aim of this study was therefore to explore molecular variability in PC bone metastases of potential importance for therapy. Specifically, genome-wide expression profiles of bone metastases from untreated patients (n = 12) and patients treated with androgen-deprivation therapy (ADT, n = 60) were analyzed in relation to patient outcome and to morphological characteristics in metastases and paired primary tumors. Principal component analysis and unsupervised classification were used to identify sample clusters based on mRNA profiles. Clusters were characterized by gene set enrichment analysis and related to histological and clinical parameters using univariate and multivariate statistics. Selected proteins were analyzed by immunohistochemistry in metastases and matched primary tumors (n = 52) and in transurethral resected prostate (TUR-P) tissue of a separate cohort (n = 59). Three molecular subtypes of bone metastases (MetA-C) characterized by differences in gene expression pattern, morphology, and clinical behavior were identified. MetA (71% of the cases) showed increased expression of androgen receptor-regulated genes, including prostate-specific antigen (PSA), and glandular structures indicating a luminal cell phenotype. MetB (17%) showed expression profiles related to cell cycle activity and DNA damage, and a pronounced cellular atypia. MetC (12%) exhibited enriched stroma-epithelial cell interactions. MetB patients had the lowest serum PSA levels and the poorest prognosis after ADT. Combined analysis of PSA and Ki67 immunoreactivity (proliferation) in bone metastases, paired primary tumors, and TUR-P samples was able to differentiate MetA-like (high PSA, low Ki67) from MetB-like (low PSA, high Ki67) tumors and demonstrate their different prognosis. In conclusion, bone metastases from PC patients are separated based on gene expression profiles into molecular subtypes with different morphology, biology, and clinical outcome. These findings deserve further exploration with the purpose of improving treatment of metastatic PC.

  • 333. Tidehag, Viktor
    et al.
    Hammarsten, Peter
    Egevad, Lars
    Granfors, Torvald
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Leanderson, Tomas
    Wikström, Pernilla
    Josefsson, Andreas
    Hägglöf, Christina
    Bergh, Anders
    High density of S100A9 positive inflammatory cells in prostate cancer stroma is associated with poor outcome.2014Ingår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, nr 10, s. 1829-1835, artikel-id S0959-8049(14)00550-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To elucidate if the density of inflammatory cells expressing S100A9 in malignant and surrounding non-malignant prostate tissues is a prognostic marker for outcome in prostate cancer patients.

    EXPERIMENTAL DESIGN: Tissue was obtained from 358 men diagnosed with prostate cancer at transurethral resection of the prostate due to obstructive voiding problems, of which 260 were then followed with watchful waiting. Tissue microarrays of both malignant and non-malignant tissues were stained with an antibody against S100A9. The number of stained inflammatory cells was scored and related to clinical outcome and histopathological parameters of known prognostic value.

    RESULTS: A high number of inflammatory cells expressing S100A9 in both malignant and surrounding non-malignant tissues were associated with significantly shorter cancer-specific survival. This association remained significant when Gleason score and local tumour stage were analysed together with S100A9 in a Cox regression model. Low number of S100A9 positive cells in non-malignant stroma was correlated to significantly longer cancer-specific survival also in patients with Gleason score 8-10 tumours. S100A9 positive cells in tumour stroma were correlated with Gleason score, hyaluronan, platelet-derived growth factor receptor beta (PDGFR-β), and androgen receptor (inverse correlation) in tumour stroma. S100A9 positive cells in non-malignant stroma correlated with androgen receptor in this tissue compartment (inverse correlation).

    CONCLUSIONS: A high number of S100A9 positive inflammatory cells in tumour stroma and in non-malignant stroma were associated with shorter cancer-specific survival in prostate cancer patients.

  • 334. Tilling, Kate
    et al.
    Garmo, Hans
    Metcalfe, Chris
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Hamdy, Freddie C.
    Neal, David E.
    Adolfsson, Jan
    Martin, Richard M.
    Davis, Michael
    Fall, Katja
    Lane, J Athene
    Adami, Hans-Olaf
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Johansson, Jan-Eric
    Donovan, Jenny L.
    Development of a New Method for Monitoring Prostate-Specific Antigen Changes in Men with Localised Prostate Cancer: A Comparison of Observational Cohorts2010Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 57, nr 3, s. 446-452Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Prostate-specific antigen (PSA) measurements are increasingly used to monitor men with localised prostate cancer (PCa), but there is little consensus about the method to use. OBJECTIVE: To apply age-specific predictions of PSA level (developed in men without cancer) to one cohort of men with clinically identified PCa and one cohort of men with PSA-detected PCa. We hypothesise that among men with clinically identified cancer, the annual increase in PSA level would be steeper than in men with PSA-detected cancer. DESIGN, SETTING, AND PARTICIPANTS: The Scandinavian Prostate Cancer Group 4 (SPCG-4) cohort consisted of 321 men assigned to the watchful waiting arm of the SPCG-4 trial. The UK cohort consisted of 320 men with PSA-detected PCa in the Prostate testing for cancer and Treatment (ProtecT) study who opted for monitoring. Multilevel models describing changes in PSA level were fitted to the two cohorts, and average PSA level at age 50, change in PSA level with age, and predicted PSA values were derived. MEASUREMENTS: PSA level. RESULTS AND LIMITATIONS: In the SPCG-4 cohort, mean PSA at age 50 was similar to the cancer-free cohort but with a steeper yearly increase in PSA level (16.4% vs 4.0%). In the UK cohort, mean PSA level was higher than that in the cancer-free cohort (due to a PSA biopsy threshold of 3.0ng/ml) but with a similar yearly increase in PSA level (4.1%). Predictions were less accurate for the SPCG-4 cohort (median difference between observed and predicted PSA level: -2.0ng/ml; interquartile range [IQR]: -7.6-0.7ng/ml) than for the UK cohort (median difference between observed and predicted PSA level: -0.8ng/ml; IQR: -2.1-0.1ng/ml). CONCLUSIONS: In PSA-detected men, yearly change in PSA was similar to that in cancer-free men, whereas in men with symptomatic PCa, the yearly change in PSA level was considerably higher. Our method needs further evaluation but has promise for refining active monitoring protocols.

  • 335. Tomic, Katarina
    et al.
    Berglund, Anders
    Robinson, David
    Hjälm-Eriksson, Marie
    Carlsson, Stefan
    Lambe, Mats
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Capture rate and representativity of The National Prostate Cancer Register of Sweden2015Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 54, nr 2, s. 158-63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Capture rate and representativity of quality registers need to be assessed in order to ensure that register data are generalizable.

    MATERIAL AND METHODS: In 1998-2009, 103 047 men had been diagnosed with prostate cancer and registered in the Swedish Cancer Register to which registration is mandated by law and of these men, 100 849 men (98%) had also been registered in The National Prostate Cancer Register (NPCR) of Sweden. We compared demographics, cancer treatment, comorbidity, and mortality in men in NPCR, with those who had only been registered in the Cancer Register, by use of data from the Cause of Death Register, the In-Patient Register and the Prescribed Drug Register. In addition, we identified 1929 men who had prostate cancer as underlying cause of death in the Cause of Death Register who had neither been registered in the Cancer Register nor in NPCR.

    RESULTS: Compared to men in NPCR, men only registered in the Cancer Register were slightly older, median age 72 versus 71 years, and a lower proportion underwent radical prostatectomy, 15% versus 27%. Ten year prostate cancer mortality was 23% (95% CI 20-25) for men in the Cancer Register only and 24% (95% CI 24-25) in NPCR, while mortality from competing causes was 28% (95% CI 26-31) and 30% (95% CI 30-30), respectively. Men identified with prostate cancer by a death certificate were old and had high comorbidity.

    CONCLUSION: The capture rate of NPCR is very high and there are only modest differences in demographics, cancer treatment, comorbidity, and mortality between the small proportion of men only registered in the Cancer Register and men registered in NPCR, indicating that information in NPCR can be generalized to all men with prostate cancer in Sweden.

  • 336. Tomic, Katarina
    et al.
    Sandin, Fredrik
    Wigertz, Annette
    Robinson, David
    Lambe, Mats
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Evaluation of data quality in the National Prostate Cancer Register of Sweden2015Ingår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, nr 1, s. 101-111, artikel-id S0959-8049(14)01061-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Data in cancer quality registers are increasingly used for quality assurance, benchmarking, and research.

    MATERIALS AND METHODS: Data in the National Prostate Cancer Register (NPCR) of Sweden were evaluated for completeness, timeliness, comparability and validity. Completeness and timeliness were assessed by cross-linkage to the Swedish Cancer Register, comparability was examined by comparing registration routines in NPCR with national and international guidelines, and validity was assessed by re-abstraction of data from medical charts for 731 men diagnosed with prostate cancer (Pca) in 2009. Furthermore, data on treatment were validated by record linkage to the Swedish Patient Register and The Prescribed Drug Register.

    RESULTS: NPCR captured 98% of Pca cases in the Cancer Register and the mean value for completeness of the 48 evaluated variables was 90% (range 64-100%). Timeliness increased substantially from 2008 to 2012 with 95% of cases reported within 12 months after diagnosis in 2012. NPCR complied with national and international coding routines. Overall, the agreement between original data and re-abstracted data from 731 charts was high. For example, the correlation between original and re-abstracted data was 1.00 for date of surgery, and 0.97 for serum levels of prostate specific antigen and exact agreement was 97% for Gleason score at biopsy, 83% for clinical local T stage and more than 95% of the androgen deprivation therapies registered in NPCR had a corresponding filled prescription.

    CONCLUSION: Record linkages with other data sources and re-abstraction of data showed that data quality in NPCR is high.

  • 337.
    Tomic, Katarina
    et al.
    Umeå Univ, Dept Surg & Perioperat Sci, Urol & Androl, Umeå, Sweden.
    Ventimiglia, Eugenio
    URI, Unit Urol, Div Expt Oncol, Milan, Italy; IRCCS, Osped San Raffaele, Milan, Italy.
    Robinson, David
    Ryhov Hosp, Dept Urol, Jönköpinh, Sweden.
    Häggström, Christel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Umeå Univ, Dept Biobank Res, Umeå, Sweden.
    Lambe, Mats
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden; Uppsala Univ Hosp, Reg Canc Ctr Uppsala Örebro, Uppsala, Sweden.
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population-based study2018Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 142, nr 12, s. 2478-2484Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients with high socioeconomic status (SES) have better cancer outcomes than patients with low SES. This has also been shown in Sweden, a country with tax‐financed health care aiming to provide care on equal terms to all residents. The association between income and educational level and diagnostics and treatment as outlined in national guidelines and prostate cancer (Pca) and all‐cause mortality was assessed in 74,643 men by use of data in the National Prostate Cancer Register of Sweden and a number of other health care registers and demographic databases. In multivariable logistic regression analysis, men with high income had higher probability of Pca detected in a health‐check‐up, top versus bottom income quartile, odds ratio (OR) 1.60 (95% CI 1.45–1.77) and lower probability of waiting more than 3 months for prostatectomy, OR 0.77 (0.69–0.86). Men with the highest incomes also had higher probability of curative treatment for intermediate and high‐risk cancer, OR 1.77 (1.61–1.95) and lower risk of positive margins, (incomplete resection) at prostatectomy, OR 0.80 (0.71–0.90). Similar, but weaker associations were observed for educational level. At 6 years of follow‐up, Pca mortality was modestly lower for men with high income, which was statistically significant for localized high‐risk and metastatic Pca in men with no comorbidities. All‐cause mortality was less than half in top versus bottom quartile of income (12% vs. 30%, p < 0.001) among men above age 65. Our findings underscore the importance of adherence to guidelines to ensure optimal and equal care for all patients diagnosed with cancer.

  • 338.
    Tomic, Katarina
    et al.
    Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, S-90187 Umea, Sweden..
    Westerberg, Marcus
    Univ Uppsala Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden..
    Robinson, David
    Umea Univ Hosp, Dept Surg & Perioperat Sci, Urol & Androl, S-90187 Umea, Sweden.;Ryhov Hosp, Dept Urol, Jonkoping, Sweden..
    Garmo, Hans
    Univ Uppsala Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Proportion and characteristics of men with unknown risk category in the National Prostate Cancer Register of Sweden2016Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, nr 12, s. 1461-1466Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Knowledge on missing data in a clinical cancer register is important to assess the validity of research results. For analysis of prostate cancer (Pca), risk category, a composite variable based on serum levels of prostate specific antigen (PSA), stage, and Gleason score, is crucial for treatment decisions and a strong determinant of outcome. The aim of this study was to assess the proportion and characteristics of men in the National Prostate Cancer Register (NPCR) of Sweden with unknown risk category. Material and methods: Men diagnosed with Pca between 1998 and 2012 registered in NPCR with known or unknown risk category were compared with respect to age, socioeconomic factors, comorbidity, cancer characteristics, cancer treatment, and mortality from Pca and other causes. Results: In total, 3315 of 129 391 (3%) men had unknown risk category. Compared to other men in NPCR, these men more often had a concomitant bladder cancer diagnosis, 19% versus 1%, diagnosis of benign prostatic hyperplasia 31% versus 5%, received unspecified Pca treatment 16% versus 3%, had higher comorbidity, Charlson Comorbidity Index 2 or higher, 34% versus 13%, and had lower Pca mortality 12% versus 30%, but similar mortality from other causes. Conclusion: Men with unknown risk category were rare in NPCR but distinctly different from other men in NPCR in many aspects including higher comorbidity and lower Pca mortality.

  • 339.
    Travis, Ruth C.
    et al.
    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..
    Martin, Richard M.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.;Univ Bristol, MRC, Univ Bristol Integrat Epidemiol Unit, Bristol, Avon, England.;Natl Inst Hlth Res Bristol, Biomed Res Unit Nutr, Bristol, Avon, England..
    Holly, Jeff M. P.
    Univ Bristol, Fac Med, Sch Clin Sci, Bristol, Avon, England..
    Albanes, Demetrius
    NCI, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA..
    Black, Amanda
    NCI, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA..
    Bueno-de-Mesquita, H. Bas
    Natl Inst Publ Hlth & Environm RIVM, Dept Determinants Chron Dis, Bilthoven, Netherlands.;Univ Med Ctr, Dept Gastroenterol & Hepatol, Utrecht, Netherlands.;Univ Malaya, Fac Med, Dept Social & Prevent Med, Kuala Lumpur, Malaysia.;Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England..
    Chan, June M.
    Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA.;Univ Calif San Francisco, Dept Urol, San Francisco, CA USA..
    Chen, Chu
    Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, 1124 Columbia St, Seattle, WA 98104 USA..
    Chirlaque, Maria-Dolores
    IMIB Arrixaca, Murcia Reg Hlth Council, Dept Epidemiol, Murcia, Spain.;CIBER Epidemiol & Salud Publ, Madrid, Spain..
    Cook, Michael B.
    NCI, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA..
    Deschasaux, Melanie
    Univ Paris 07, Univ Paris 05, Univ Paris 13,Inserm,U1153,INRA,U1125,Cnam, Sorbonne Paris Cite,Epidemiol & Biostat Res Ctr,N, F-93017 Bobigny, France..
    Donovan, Jenny L.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England..
    Ferrucci, Luigi
    NIA, Intramural Res Program, Baltimore, MD 21224 USA..
    Galan, Pilar
    Univ Paris 07, Univ Paris 05, Univ Paris 13,Inserm,U1153,INRA,U1125,Cnam, Sorbonne Paris Cite,Epidemiol & Biostat Res Ctr,N, F-93017 Bobigny, France..
    Giles, Graham G.
    Canc Council Victoria, Canc Epidemiol Ctr, Melbourne, Vic, Australia.;Univ Melbourne, Melbourne Sch Populat & Global Hlth, Ctr Biostat & Epidemiol, Melbourne, Vic, Australia..
    Giovannucci, Edward L.
    Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA.;Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA.;Harvard Univ, Sch Publ Hlth, Dept Med, 665 Huntington Ave, Boston, MA 02115 USA..
    Gunter, Marc J.
    Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England..
    Habel, Laurel A.
    Kaiser Permanente No Calif, Div Res, Oakland, CA USA..
    Hamdy, Freddie C.
    Univ Oxford, Nuffield Dept Surg, Oxford, England..
    Helzlsouer, Kathy J.
    St Johns Mercy Med Ctr, Prevent & Res Ctr, Baltimore, MD USA..
    Hercberg, Serge
    Univ Paris 07, Univ Paris 05, Univ Paris 13,Inserm,U1153,INRA,U1125,Cnam, Sorbonne Paris Cite,Epidemiol & Biostat Res Ctr,N, F-93017 Bobigny, France..
    Hoover, Robert N.
    NCI, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA..
    Janssen, Joseph A. M. J. L.
    Erasmus MC, Dept Internal Med, Rotterdam, Netherlands..
    Kaaks, Rudolf
    German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany..
    Kubo, Tatsuhiko
    Univ Occupat & Environm Hlth, Kitakyushu, Fukuoka 807, Japan..
    Le Marchand, Loic
    Univ Hawaii, Ctr Canc, Honolulu, HI 96822 USA..
    Metter, E. Jeffrey
    NIA, Intramural Res Program, Baltimore, MD 21224 USA.;Univ Tennessee, Ctr Hlth Sci, Dept Neurol, Memphis, TN 38163 USA..
    Mikami, Kazuya
    Kyoto Prefectural Univ Med, Kyoto, Japan..
    Morris, Joan K.
    Queen Mary Univ London, Wolfson Inst Prevent Med, Charterhouse Sq, London, England..
    Neal, David E.
    Univ Cambridge, Dept Oncol, Cambridge, England..
    Neuhouser, Marian L.
    Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, 1124 Columbia St, Seattle, WA 98104 USA..
    Ozasa, Kotaro
    Radiat Effects Res Fdn, Hiroshima, Japan..
    Palli, Domenico
    Canc Res & Prevent Inst ISPO, Mol & Nutr Epidemiol Unit, Florence, Italy..
    Platz, Elizabeth A.
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
    Pollak, Michael N.
    McGill Univ, Dept Med, Montreal, PQ, Canada.;McGill Univ, Dept Oncol, Montreal, PQ, Canada..
    Price, Alison J.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England..
    Roobol, Monique J.
    Erasmus MC, Dept Urol, Rotterdam, Netherlands..
    Schaefer, Catherine
    Kaiser Permanente No Calif, Div Res, Oakland, CA USA..
    Schenk, Jeannette M.
    Fred Hutchinson Canc Res Ctr, Canc Prevent Program, 1124 Columbia St, Seattle, WA 98104 USA.;Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA..
    Severi, Gianluca
    Canc Council Victoria, Canc Epidemiol Ctr, Melbourne, Vic, Australia.;Univ Melbourne, Melbourne Sch Populat & Global Hlth, Ctr Biostat & Epidemiol, Melbourne, Vic, Australia.;Human Genet Fdn, Turin, Italy..
    Stampfer, Meir J.
    Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA.;Harvard Univ, Brigham & Womens Hosp, Sch Med, Channing Div Network Med, Boston, MA 02115 USA..
    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..
    Tamakoshi, Akiko
    Hokkaido Univ, Grad Sch Med, Sapporo, Hokkaido, Japan..
    Tangen, Catherine M.
    Univ Washington, Fred Hutchinson Canc Res Ctr, SWOG Stat Ctr, Seattle, WA 98195 USA.;Univ Washington, Dept Biostat, Seattle, WA 98195 USA..
    Touvier, Mathilde
    Univ Paris 07, Univ Paris 05, Univ Paris 13,Inserm,U1153,INRA,U1125,Cnam, Sorbonne Paris Cite,Epidemiol & Biostat Res Ctr,N, F-93017 Bobigny, France..
    Wald, Nicholas J.
    Queen Mary Univ London, Wolfson Inst Prevent Med, Charterhouse Sq, London, England..
    Weiss, Noel S.
    Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA..
    Ziegler, Regina G.
    NCI, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA..
    Key, Timothy J.
    Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England..
    Allen, Naomi E.
    Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England.;Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England..
    A Meta-analysis of Individual Participant Data Reveals an Association between Circulating Levels of IGF-I and Prostate Cancer Risk2016Ingår i: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 76, nr 8, s. 2288-2300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The role of insulin-like growth factors (IGF) in prostate cancer development is not fully understood. To investigate the association between circulating concentrations of IGFs (IGF-I, IGF-II, IGFBP-1, IGFBP-2, and IGFBP-3) and prostate cancer risk, we pooled individual participant data from 17 prospective and two cross-sectional studies, including up to 10,554 prostate cancer cases and 13,618 control participants. Conditional logistic regression was used to estimate the ORs for prostate cancer based on the study-specific fifth of each analyte. Overall, IGF-I, IGF-II, IGFBP-2, and IGFBP-3 concentrations were positively associated with prostate cancer risk (P-trend all <= 0.005), and IGFBP-1 was inversely associated weakly with risk (P-trend = 0.05). However, heterogeneity between the prospective and cross-sectional studies was evident (P-heterogeneity = 0.03), unless the analyses were restricted to prospective studies (with the exception of IGF-II, P-heterogeneity = 0.02). For prospective studies, the OR for men in the highest versus the lowest fifth of each analyte was 1.29 (95% confidence interval, 1.16-1.43) for IGF-I, 0.81 (0.68-0.96) for IGFBP-1, and 1.25 (1.12-1.40) for IGFBP-3. These associations did not differ significantly by time-to-diagnosis or tumor stage or grade. After mutual adjustment for each of the other analytes, only IGF-I remained associated with risk. Our collaborative study represents the largest pooled analysis of the relationship between prostate cancer risk and circulating concentrations of IGF-I, providing strong evidence that IGF-I is highly likely to be involved in prostate cancer development.

  • 340.
    Trinquart, Ludovic
    et al.
    Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA USA.
    Bill-Axelson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Rider, Jennifer R.
    Boston Univ, Sch Publ Hlth, Dept Epidemiol, 715 Albany St, Boston, MA 02118 USA.
    Restricted Mean Survival Times to Improve Communication of Evidence from Cancer Randomized Trials and Observational Studies2019Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 76, nr 2, s. 137-139Artikel i tidskrift (Övrigt vetenskapligt)
  • 341. Tsilidis, Konstantinos K
    et al.