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Objectives: This study aimed to compare the effectiveness of software-based fusion-targeted biopsies (STBx) versus cognitive fusion-targeted biopsies (CogTBx) in detecting prostate cancer (PCa) and clinically significant PCa.

Materials and methods: Men aged 30-85 were included in a target trial emulation if they had undergone a STBx or CogTBx of Prostate Imaging Reporting and Data System (PI-RADS) 3-5 lesions in 2020-2024. Using log-link binary regression models with inverse probability of treatment weighting to adjust for confounding, we estimated the associations between biopsy technique and detection of PCa and clinically significant PCa (Gleason ≥3 + 4 and Gleason ≥4 + 3) by use of adjusted relative risks (aRR) with 95% confidence intervals (CIs) obtained via bootstrapping.

Results: A total of 2092 men who underwent STBx and 7933 men who underwent CogTBx in 2020-2024 were identified in PCBase Xtend. The overall proportion diagnosed with PCa was 64%. STBx detected PCa with a slightly higher frequency (aRR, 1.05; 95% CI, 1.02-1.09), corresponding to an absolute increase of 3.3 percentage points (95% CI 1.2-5.3). The relative risk for detection of Gleason ≥4 + 3 was somewhat larger (aRR, 1.13; 95% CI, 1.03-1.23). The largest relative difference for detection of PCa was observed in PI-RADS 3 lesions (aRR, 1.12; 95% CI, 1.01-1.24), and this pattern became even more apparent when the outcome was restricted to clinically significant PCa.

Conclusions: Software-based fusion-targeted biopsies detected slightly more PCa and clinically significant PCa compared to cognitive fusion-targeted biopsies, particularly in men with PI-RADS 3 lesions. Prioritizing PI-RADS 3 lesions for software-based targeted fusion biopsy could optimize diagnostic effectiveness.

Background and objective

There are several methods for estimating prostate-specific antigen (PSA) doubling time (DT), and many men exhibit long periods of undetectable PSA below 0.1 ng/ml after radical prostatectomy (RP). We quantified between-method differences in estimated PSA-DT at PSA relapse after RP and evaluated how these differences affect discrimination of prostate cancer (PCa) death.

Methods

Men who underwent RP in 2007–2024 and subsequently developed a PSA relapse, defined as two consecutive values above 0.2 ng/ml, were included. We estimated PSA-DT from the date of the first undetectable PSA after RP until PSA relapse using four methods: (1) all detectable PSAs only, (2) two most recent detectable PSAs, (3) three most recent PSAs (with the third forced to 0.1 ng/ml if ≤0.1 ng/ml), and (4) all PSAs using a missing data approach. Discrimination of 10-yr PCa death was assessed using concordance index (C-index).

Key findings and limitations

A total of 3826 men were included. Median PSA-DT ranged from 4.4 to 8.6 mo, with a wide range in PSA-DT across different estimation methods. All four methods discriminated PCa death to a similar level, with C-index ranging from 0.70 to 0.74, which was slightly lower than the C-index (0.77) for the absolute PSA level at relapse. This study was restricted to men with PSA relapse after RP and may not be generalizable to other patient categories.

Conclusions and clinical implications

PSA-DT after RP was sensitive to the choice of estimation method, and all methods had comparable prognostic value to the last measured PSA level.

Objective

To estimate risk of prostate-specific antigen (PSA) relapse after radical radiotherapy (RT) for prostate cancer (PCa), and risk of PCa death after relapse according to Gleason score and time to relapse.

Patients and Methods

Men in the National Prostate Cancer Register of Sweden who underwent primary radical RT in 2007–2024 were followed until 31 December 2024. Relapse was defined as a PSA level increase of ≥2 ng/mL above nadir (Phoenix criteria). Competing risk cumulative incidence analyses were used to estimate risk of PSA relapse and risk of PCa death after relapse according to Gleason score and time to relapse.

Results

The 10-year risk of relapse in 26 634 men treated with RT was 25% (95% confidence interval [CI] 24–25%). The 10-year risk of PCa death after relapse was 35% (95% CI 33–37%). In men with relapse after >3 years the risk was 18% for Gleason score 6 and 19% for Gleason score 3 + 4, while in men with a relapse within 18 months the risk was 52% for Gleason score 4 + 3 and 75% for Gleason score 9–10. In men with a relapse at 1 year after RT there was a four-fold higher risk of PCa death for men with Gleason score 9–10 compared to men with Gleason score 6 (86% vs 22%). In contrast, in men with a relapse at 10 years after RT there were little differences in risk of PCa death according to Gleason (14% vs 23%).

Conclusion

In this population-based study of RT for PCa, there was a wide range in the estimates of risk of PCa death after relapse in highly granular groups according to Gleason score and time to relapse. Notably, some estimates did not align with the European Association of Urology relapse risk group classification.

Background and purpose: We aimed to describe temporal changes in diagnostic work-up, treatment, and prostate cancer (PCa) mortality in locally advanced PCa in 2016–2024 in Sweden.

Patient/material and methods: Men registered in the National Prostate Cancer Register of Sweden in 2016–2024 with locally advanced PCa; clinical T stage 3–4, no distant metastases, and prostate-specific antigen < 100 ng/ml were included. We computed the proportion of use of prostate magnetic resonance imaging (MRI) before biopsy, radical prostatectomy, radical radiotherapy, androgen deprivation therapy, and abiraterone, and described the trend in PCa mortality across three calendar periods.

Results: During the 9-year study period 7,484 men with locally advanced PCa were identified. Use of MRI before biopsy increased from 3% in 2016 to 73% in 2024. Concomitantly, radical treatment increased from 35% to 48%, entirely due to increased use of radiotherapy. Abiraterone was not used before 2022 but 31% received this treatment in 2024. The 3-year PCa mortality decreased from 8% (95% confidence interval [CI]: 7–9) in 2016–2018 to 6% (95% CI: 4–8) in 2022–2024.

Interpretation: In this nationwide, population-based study of men with locally advanced PCa, the use of MRI before biopsy, radical radiotherapy, and treatment with abiraterone increased over time. These changes coincided with a modest decrease in 3-year PCa mortality.

Purpose: In randomised clinical trials, doublet and triplet therapy improved survival compared to standard androgen deprivation therapy (ADT) in men with de novo metastatic castration-sensitive prostate cancer (mCSPC). Guidelines recommend doublet therapy since 2020 and triplet therapy since 2022. The aim of this study was to assess the uptake of upfront doublet and triplet therapy at a population level and assess trends in survival for all men with mCSPC.

Methods: We included men registered with de novo mCSPC in 2016-2024 in the National Prostate Cancer Register of Sweden. We estimated the annual proportion of men with de novo mCSPC who upfront received doublet therapy (ADT plus androgen receptor pathway inhibitor [ARPI] or docetaxel) or triplet therapy (ADT plus docetaxel and ARPI). Kaplan-Meier curves were used to estimate 3-year overall survival.

Results: In 9294 men diagnosed with de novo mCSPC, the use of upfront doublet therapy increased from 19% in 2016 to 66% in 2024, and the use of triplet therapy rose from 4% in 2021 to 17% in 2024. Uptake was highest among men below age 65 years, of whom 46% received doublet and 48% received triplet therapy in 2024. Three-year survival increased from 51%(95%CI: 49-52%) in 2016-2018 to 61%(95%CI: 58-64%) in 2022-2024. Among men below age 65, survival increased from 69% (95% CI: 65-73) in 2019-2021 to 77% (95% CI: 71-84) in 2022-2024.

Conclusions: The uptake of doublet and triplet therapy increased substantially during the study period, in particular among men below age 65. In parallel, 3-year overall survival increased in all men diagnosed with de novo mCSPC. These data provide support for the benefit of upfront doublet or triplet therapy in clinical practice.

Objective

To describe the risk of urinary tract events after radical radiotherapy (RT) according to pre-RT (IPSS) overall and within subgroups of prostate volume, type of RT, and use of neoadjuvant androgen-deprivation therapy (ADT), as men who undergo RT for prostate cancer have a risk of urinary tract events.

Patients and Methods

Men in the National Prostate Cancer Register of Sweden who underwent RT between 2018 and 2023 for whom IPSS was registered at diagnosis were included. The IPSS was stratified as: low, 0–7; moderate, 8–19; and severe, 20–35 points. Urinary tract events were defined as lower urinary tract symptoms, infections, and urological procedures after treatment and assessed based on International Classification of Diseases and Related Health Problems, 10th Revision codes and procedures in The Patient Register. Competing risk of cumulative incidence proportion of urinary tract events at 3 year after RT was computed according to the IPSS, prostate volume, type of RT, and use of neoadjuvant ADT.

Results

Of the 4436 men included, 43% had mild, 44% moderate, and 13% severe pre-RT IPSS. Incidence of urinary tract events after RT was 19% at 3 years for men with mild IPSS, 28% for moderate IPSS, and 39% for severe IPSS. The association between IPSS and urinary tract events was observed within subgroups based on prostate volume, type of RT, and use of neoadjuvant ADT. A 5-unit increase in IPSS carried a 20% increased risk of having a urinary tract event within 3 years.

Conclusion

A higher pre-RT IPSS is an indicator of increased risk of urinary tract events after RT – both overall and within subgroups of prostate volume, type of RT, and use of neoadjuvant ADT.

Background: A family history (FH) of prostate cancer increases the risk of prostate cancer, but its association with prostate cancer mortality remains unclear.Methods: FH was defined as having a first-degree relative who was diagnosed before age 60 or died from prostate cancer. We used Cox regression to estimate associations between FH and prostate cancer characteristics at diagnosis, radical treatment, and prostate cancer death in men born after 1932 and diagnosed with prostate cancer between 1998 and 2020 in Sweden.Results: Among 125,272 men with prostate cancer, 13,193 had an FH of early onset or lethal prostate cancer. At diagnosis, men with FH had 1.4 years lower median age, 0.87 ng/mL lower serum PSA, lower proportion of Gleason score 8 to 10 cancer (14.8% vs. 17.6%), lower odds for metastatic disease [OR, 0.79; 95% confidence interval (CI), 0.73-0.86], and higher odds for radical treatment (OR, 1.25; 95% CI, 1.18-1.32). With a median follow-up of 6.9 years and 12,773 prostate cancer deaths, mortality was lower (crude HR, 0.77; 95% CI, 0.73-0.82) in men with FH. Adjustment for prostate cancer characteristics attenuated this association (adjusted HR, 0.94; 95% CI, 0.88-1.00).Conclusions: Men with prostate cancer and an FH of early onset or lethal prostate cancer had more favorable cancer characteristics, a higher likelihood of radical treatment, and similar prostate cancer mortality compared with men without an FH.Impact: In men with prostate cancer, the risk of prostate cancer death seems unaffected by an FH of early onset or lethal prostate cancer after controlling for clinical characteristics. More research is needed on the potential role of screening.

Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is commonly used in cancer trials to select a study population with good performance, but ECOG-PS is rarely available in health-care registers. We assessed if patient age and comorbidity indices can substitute ECOG-PS when selecting men in register-based studies of advanced prostate cancer. ECOG-PS data for 3966 men on androgen deprivation therapy for prostate cancer were retrieved from Prostate Cancer data Base Sweden. Logistic regression models were used to discriminate between ECOG-PS 0-1 versus 2-4 based on age, Charlson comorbidity index (CCI), a novel Multidimensional Diagnosis-based Comorbidity Index (MDCI) based on ICD codes, and a Drug Comorbidity Index (DCI) based on filled prescriptions. The model based on age, MDCI, and DCI provided the best discrimination (AUC = 0.82; 95% CI 0.81-0.84). In a hypothetical cohort of 1000 men where 750 men had ECOG-PS 0-1, 600 men would be included when excluding those with high risk of ECOG-PS 2-4 using this model and 60 of these would have ECOG 2-4 instead of 250 men if all 1000 men had been included. Age and two new comorbidity indices can with reasonable precision substitute ECOG-PS and help identify subsets of study populations likely to have favourable ECOG-PS.