National Prostate Cancer Register Research Articles

Evaluation of data quality in the National Prostate Cancer Register of Sweden

BackgroundData in cancer quality registers are increasingly used for quality assurance, benchmarking, and research. Materials and methodsData 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. ResultsNPCR 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 12months 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. ConclusionRecord linkages with other data sources and re-abstraction of data showed that data quality in NPCR is high.

Capture rate and representativity of The National Prostate Cancer Register of Sweden

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.

Five-year Nationwide Follow-up Study of Active Surveillance for Prostate Cancer

BackgroundActive surveillance (AS) is an important yet underutilized strategy to reduce prostate cancer (PCa) overtreatment. ObjectiveTo examine the 5-yr outcomes of AS in a population-based setting. Design, setting, and participantsFrom the National Prostate Cancer Register of Sweden, we identified 11 726 men ≤70 yr diagnosed with very low-risk to intermediate-risk PCa from 2003 to 2007 who completed 5 yr of follow-up. Of these men, 1729 (15%) chose AS for the primary management strategy. Outcome measurements and statistical analysisWe calculated the probability of discontinuation of AS over time, and Cox proportional hazards models were used to determine factors associated with discontinuation. Reasons for discontinuation were assessed by data extraction from medical charts. Results and limitationsBy 5 yr, 64% of the men remained on AS. Predictors of discontinuation were younger age, fewer comorbidities, more education, higher prostate-specific antigen (PSA), and clinical stage T2 disease; marital status did not predict discontinuation. In a subset with data on the reason for discontinuation (86%), 20% of men discontinued because of patient preference, 52% because of PSA progression, 24% because of biopsy progression, and 3% for other reasons. ConclusionsIn a population-based setting, the majority of men remained on AS at 5 yr. However, one-fifth of the men who discontinued AS did so for nonbiologic reasons. Thus, there is a need for support and counseling for men to continue AS in the absence of signs of progression to improve adherence to AS and decrease overtreatment. Patient summaryActive surveillance (AS) is an important option to delay or avoid treatment for men with favorable prostate cancer features. This study shows that at 5 yr, 64% of men across an entire population remained on AS. We concluded that AS is a durable option and that counseling may be useful to promote adherence for men without progression.

29 Active surveillance in the National Prostate Cancer Register (NPCR) of Sweden: Patterns of care and outcomes after 5 years of follow-up

29 Active surveillance in the National Prostate Cancer Register (NPCR) of Sweden: Patterns of care and outcomes after 5 years of follow-up

Nationwide, population-based study of prostate cancer stage migration between and within clinical risk categories

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

Mortality following hip fracture in men with prostate cancer.

BackgroundHip fractures are associated with increased mortality and are a known adverse effect of androgen deprivation therapy (ADT) for prostate cancer (PCa). It was our aim to evaluate how mortality after hip fracture is modified by PCa and ADT.MethodsPCa dataBase Sweden (PCBaSe 2.0) is based on the National PCa Register and also contains age and county-matched PCa-free men. We selected all men (n = 14,205) who had been hospitalized with a hip fracture between 2006 and 2010; 2,300 men had a prior PCa diagnosis of whom 1,518 (66%) were on ADT prior to date of fracture. Risk of death was estimated with cumulative incidence and standardized mortality ratios (SMRs) to make comparisons with the entire PCa population and the general population.ResultsCumulative incidences indicated that there was a higher risk of death following a hip fracture for PCa men on ADT than for PCa men not on ADT or PCa-free men, particularly in the first year. The SMRs showed that PCa men on ADT with a hip fracture were 2.44 times more likely to die than the comparison cohort of all PCa men (95%CI: 2.29-2.60). This risk was especially increased during the first month (5.64 (95%CI: 4.16–7.48)). In absolute terms, hip fractures were associated with 20 additional deaths per 1,000 person-years in PCa men not on ADT, but 30 additional deaths per 1,000 person-years for PCa men on ADT, compared to all PCa men.ConclusionHip fractures are associated with higher all-cause mortality in PCa men on ADT than in PCa men not on ADT or PCa-free men, especially within the first three months.

Population Based Study of Predictors of Adverse Pathology among Candidates for Active Surveillance with Gleason 6 Prostate Cancer

Approximately a third of prostate cancer cases with a Gleason score of 6 are upgraded at radical prostatectomy. We studied trends and predictors of upgrading and up staging among men with Gleason 6 prostate cancer who were potential candidates for active surveillance in a population based cohort. From 2007 to 2011, 13,159 men were diagnosed with Gleason 6, clinical stage T1c/T2 prostate cancer in the NPCR (National Prostate Cancer Register of Sweden). Of these men 4,500 underwent radical prostatectomy, including 2,205 with data on the extent of prostate cancer in the biopsy cores. Logistic regression was used to examine variables associated with adverse pathology (defined as upgrading to Gleason 7 or greater, or up staging to pT3 or greater) in the full group and in potential candidates for active surveillance using 6 current published protocols. Among Swedish men with clinically localized Gleason 6 prostate cancer approximately 50% had adverse pathology at radical prostatectomy. Of the men who met the study inclusion criteria of 6 different active surveillance protocols, adverse pathology was present in 33% to 45%. Predictors of adverse pathology were older age, higher prostate specific antigen, prostate specific antigen density greater than 0.15 ng/ml/cm(3), palpable disease and extent of cancer greater than 4 mm on biopsy. Larger prostate volume had an inverse relationship with adverse pathology. More than a third of men meeting the most stringent active surveillance criteria had adverse pathology at radical prostatectomy in this population based cohort. Active surveillance programs should consider prostate specific antigen density and extent of cancer on biopsy for patient selection.

Prostate cancer imaging trends after a nationwide effort to discourage inappropriate prostate cancer imaging.

BackgroundReducing inappropriate use of imaging to stage incident prostate cancer is a challenging problem highlighted recently as a Physician Quality Reporting System quality measure and by the American Society of Clinical Oncology and the American Urological Association in the Choosing Wisely campaign. Since 2000, the National Prostate Cancer Register (NPCR) of Sweden has led an effort to decrease national rates of inappropriate prostate cancer imaging by disseminating utilization data along with the latest imaging guidelines to urologists in Sweden. We sought to determine the temporal and regional effects of this effort on prostate cancer imaging rates.MethodsWe performed a retrospective cohort study among men diagnosed with prostate cancer from the NPCR from 1998 to 2009 (n = 99 879). We analyzed imaging use over time stratified by clinical risk category (low, intermediate, high) and geographic region. Generalized linear models with a logit link were used to test for time trend.ResultsThirty-six percent of men underwent imaging within 6 months of prostate cancer diagnosis. Overall, imaging use decreased over time, particularly in the low-risk category, among whom the imaging rate decreased from 45% to 3% (P < .001), but also in the high-risk category, among whom the rate decreased from 63% to 47% (P < .001). Despite substantial regional variation, all regions experienced clinically and statistically (P < .001) significant decreases in prostate cancer imaging.ConclusionsA Swedish effort to provide data on prostate cancer imaging use and imaging guidelines to clinicians was associated with a reduction in inappropriate imaging over a 10-year period, as well as slightly decreased appropriate imaging in high-risk patients. These results may inform current efforts to promote guideline-concordant imaging in the United States and internationally.

Use of 5α-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study

Objective To assess the association between 5α-reductase inhibitor (5-ARI) use in men with lower urinary tract symptoms and prostate cancer risk.Design Nationwide, population based case-control study for men diagnosed with...

1941 5 α REDUCTASE INHIBITORS AND RISK OF PROSTATE CANCER. NATION-WIDE, POPULATION-BASED CASE-CONTROL STUDY

You have accessJournal of UrologyProstate Cancer: Detection & Screening (III)1 Apr 20131941 5 α REDUCTASE INHIBITORS AND RISK OF PROSTATE CANCER. NATION-WIDE, POPULATION-BASED CASE-CONTROL STUDY David Robinson, Hans Garmo, Anna Bill-Axelson, Lorelei Lorelei, Lars Holmberg, and Pär Stattin David RobinsonDavid Robinson Umeå, Sweden More articles by this author , Hans GarmoHans Garmo London, United Kingdom More articles by this author , Anna Bill-AxelsonAnna Bill-Axelson Uppsala, Sweden More articles by this author , Lorelei LoreleiLorelei Lorelei Boston, MA More articles by this author , Lars HolmbergLars Holmberg Uppsala, Sweden More articles by this author , and Pär StattinPär Stattin Umeå, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2360AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Results from two randomized clinical trials have raised concern about an increased risk of high grade prostate cancer in men on 5 α-reductase inhibitors (5-ARI). We assessed the association between 5-ARI use in men with lower urinary tract symptoms (LUTS) and prostate cancer risk. METHODS A case-control study for men diagnosed with prostate cancer 2007 to 2009 within Prostate Cancer data Base Sweden (PCBaSe) 2.0. was performed. Information from The National Prostate Cancer Register, The Patient Register, The Census, and The Prescribed Drug Register in Sweden with data on 5-ARI use prior to date of diagnosis. Cases and five controls per case randomly selected from matched men in the background population, in total 26 735 cases and 133 671 matched controls were included.Odds ratios (OR) of prostate cancer and 95% confidence intervals (95% CI) from conditional logistic regression analyses were retrived. RESULTS A total of 1499 men had been exposed to 5-ARI prior to prostate cancer diagnosis, 412 of these men had a prostate cancer with a Gleason score 8-10. There was a steady decrease in risk of prostate cancer overall for an increasing duration of exposure, down to OR 0.72 (95% CI 0.59-0.89) ptrend <0.0001, in men on 5-ARI for more than three years. This decrease was strongest for Gleason score 2–6 cancers down to OR 0.27 (95% CI 0.15-0.48) ptrend <0.0001 whereas OR for Gleason score 7 tumors was 0.79 (95% CI 0.57-1.10) ptrend=0.0004. In contrast, the risk of Gleason score 8-10 tumors did not decrease with increasing exposure time, OR 0.96 (95% CI=0.83-1.11) for 0-1 year of exposure, OR 1.07 (95% CI=0.88-1.31) for 1–2 years, OR 0.96 (95% CI=0.72–1.27) for 2–3 years and OR 1.23 (95% CI=0.90-1.68) for more than 3 years of exposure, ptrend = 0.46. CONCLUSIONS Men treated with 5-ARI for LUTS had a decreased risk of Gleason score 2–7, and no evidence of an increased risk of Gleason score 8-10 prostate cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e795-e796 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Robinson Umeå, Sweden More articles by this author Hans Garmo London, United Kingdom More articles by this author Anna Bill-Axelson Uppsala, Sweden More articles by this author Lorelei Lorelei Boston, MA More articles by this author Lars Holmberg Uppsala, Sweden More articles by this author Pär Stattin Umeå, Sweden More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

130 TEMPORAL CHANGES AND REGIONAL VARIATION IN PROSTATE CANCER IMAGING IN A NATION-WIDE, POPULATION-BASED COHORT FOLLOWING AN EFFORT TO DISCOURAGE INAPPROPRIATE USE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness (I)1 Apr 2013130 TEMPORAL CHANGES AND REGIONAL VARIATION IN PROSTATE CANCER IMAGING IN A NATION-WIDE, POPULATION-BASED COHORT FOLLOWING AN EFFORT TO DISCOURAGE INAPPROPRIATE USE Danil Makarov, Stacy Loeb, David Ulmert, Linda Drevin, Mats Lambe, and Par Stattin Danil MakarovDanil Makarov New York, NY More articles by this author , Stacy LoebStacy Loeb New York, NY More articles by this author , David UlmertDavid Ulmert New York, NY More articles by this author , Linda DrevinLinda Drevin Uppsala, Sweden More articles by this author , Mats LambeMats Lambe Stockholm, Sweden More articles by this author , and Par StattinPar Stattin Umeå, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1509AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Encouraging the appropriate use of imaging to stage incident prostate cancer is a challenging problem highlighted recently as a Physician Quality Reporting System quality measure and by ASCO as a part of the Choosing Wisely Campaign. Since 2000, the Swedish National Prostate Cancer Registry (NPCR) have led an effort to decrease national rates of inappropriate prostate cancer imaging by disseminating personalized utilization data along with the latest imaging guidelines to urologists in Sweden. We sought to determine the temporal and regional effects of this national effort on prostate cancer imaging rates. METHODS We performed a retrospective cohort study among men diagnosed with prostate cancer from the NPCR of Sweden from 1998 through 2009 (N=99,879). We analyzed patterns of imaging utilization over time stratified by clinical risk group (low, intermediate, high) and geographic region. Generalized linear models with a logit link were used to test for time trend. RESULTS Thirty six percent of these men underwent prostate cancer imaging within 6 months of diagnosis. Overall, imaging utilization for incident prostate cancer decreased over time, particularly in the low-risk group among whom the imaging rate fell from 45% to 3% (p<0.01), but also in the high risk group among whom the rate fell from 63% to 47% (p<0.01). While there was a large degree of regional variation in imaging, all Swedish regions experienced significant decreases in prostate cancer imaging (p<0.01). CONCLUSIONS Despite a modest concurrent decrease in appropriate imaging, a Swedish effort to provide data on personalized prostate cancer imaging utilization and imaging guidelines to clinicians dramatically reduced inappropriate imaging over a 10-year period. These results may inform current efforts to promote guideline concordant imaging in the US and internationally. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e52-e53 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Danil Makarov New York, NY More articles by this author Stacy Loeb New York, NY More articles by this author David Ulmert New York, NY More articles by this author Linda Drevin Uppsala, Sweden More articles by this author Mats Lambe Stockholm, Sweden More articles by this author Par Stattin Umeå, Sweden More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mortality following hip fractures in men with prostate cancer.

49 Background: Rapid loss of bone-mineral density is a known side-effect of androgen deprivation therapy (ADT) for prostate cancer (PCa). Hip fractures are also independently associated with risk of mortality. To our knowledge few population-based observational studies have yet investigated the risk of dying following fractures among men with PCa. We aimed to assess skeletal-related events and mortality in more detail by specifically studying the link between hip fractures in PCa men and risk of death. Methods: PCBaSe Sweden 2.0 is based on the National Prostate Cancer Register and contains age and county matched men free of PCa. We selected all men (n=14,205) who had been hospitalized with a hip fracture, as registered in the National Patient Register, between 2006 and 2010. A total of 2300 were diagnosed with PCa before the hip fracture and 66% of them were treated with ADT. The main outcome was death as registered in the National Cause of Death Register. The risk of death was estimated using multivariate Cox Proportional Hazards regression analyses and standardized mortality ratios (SMRs) taking into account PCa risk category, history of fractures, civil status, Charlson Comorbidity Index, and treatment with bisphosphonates. Results: In the analysis for risk of death &gt;90 days after a hip fracture, there was an increased risk of death among PCa men on ADT, especially those aged &lt;84 years (e.g., HR at 3-6 months after hip fracture: 2.47 (95%CI: 1.85-3.30) compared to men free of PCa with a hip fracture). The SMRs showed that PCa men on ADT who got a hip fracture were seven times more likely to die than expected in the reference population of all men with PCa, whereas PCa men who were not on ADT and had a hip fracture were 13 times more likely to die than expected in this reference population. However, the absolute risk difference between men with and without a hip fracture was 30 per 1,000 person-years when evaluating the effect of a hip fracturing among men on ADT, whereas a hip fracture would cause an additional 20 per 1,000 person-years to die among PCa men without ADT as well as among men free of PCa. Conclusions: Our SMRs and absolute risk calculations show that hip fractures are more dangerous in PCa men treated with ADT than in PCa men without ADT or in men free of PCa.

National Prostate Cancer Registry 2010 in Spain

ObjectivesTo estimate the 2010 incidence of PCa in Spain and describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. Material and methodsNational epidemiological study in 25 public hospitals with a specific reference population according to the National Health System. Sociodemographic and clinical variables of all newly diagnosed, histopathological confirmed PCa cases were collected in 2010, in the area of influence of each center. The age-standardized PCa incidence was determined based on the age distribution of the Spanish population in Spain and in 3 regions: Andalusia, Catalonia and Region of Madrid. Results4087 new cases of PCa were diagnosed for a reference population of 4,933,940 men (21.8% of the Spanish male population). The estimated age-standardized PCa incidence was 82.27 cases per 100,000 men in Spain, 70.38 in Andalusia, 85.70 in Catalonia and 92.29 in the Region of Madrid. Mean age at diagnosis was 69 years. Median PSA was 8ng/ml. Gleason score was ≤6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 90% had localized disease. ConclusionsIn the 3 Regions analyzed, around 80–90% of the cases are diagnosed in a clinical localized stage. The incidence rates in Andalusía, Catalonia and Region of Madrid show a great difference between them due to several factors.

Long-term Outcomes Among Noncuratively Treated Men According to Prostate Cancer Risk Category in a Nationwide, Population-based Study

BackgroundLimited data exist on long-term outcomes among men with prostate cancer (PCa) from population-based cohorts incorporating information on clinical risk category. ObjectiveTo assess 15-yr mortality for men with PCa treated with noncurative intent according to clinical stage, Gleason score (GS), serum levels of prostate specific antigen (PSA), comorbidity, and age. Design, setting, and participantsRegister-based cohort study of 76 437 cases in the National Prostate Cancer Register (NPCR) of Sweden diagnosed from 1991 through 2009 and treated with noncurative intent. Each case was placed in one of five risk categories: (1) low risk: T1–T2 tumor, PSA level <10 ng/ml, and GS ≤6; (2) intermediate risk: T1–T2 tumor and PSA level 10–<20 ng/ml or GS 7; (3) high risk: T3 tumor or PSA level 20–<50 ng/ml or GS ≥8; (4) regional metastases: N1 or T4 tumor or PSA level 50–100 ng/ml; and (5) distant metastases: M1 tumor or PSA ≥100 ng/ml. Outcome measurements and statistical analysisTen- and 15-yr cumulative risk of death after diagnosis from PCa, cardiovascular disease, and other causes. Results and limitationsAmong men with a Charlson Comorbidity Index (CCI) score of 0, no differences were found in observed versus expected all-cause mortality in the low-risk group. Observed mortality was only slightly greater in the intermediate-risk group, but men with high-risk localized PCa or more advanced disease had substantially higher mortality than expected. CCI was strongly associated with cumulative 10-yr mortality from causes other than PCa, especially for men <65 yr. Limitations include potential misclassification in risk category due to GS assignment. ConclusionsPCa mortality rates vary 10-fold according to risk category. The risk of death from causes other than PCa is most strongly related to comorbidity status in younger men.

Treatment with curative intent and survival in men with high‐risk prostate cancer. A population‐based study of 11 380 men with serum PSA level 20–100 ng/mL

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There are two randomized controlled trials showing that radiotherapy can be beneficial for men with locally advanced prostate cancer. The present study confirms the importance of curative treatment for men with high-risk prostate cancer. To investigate the influence of curative treatment on cause-specific mortality in men diagnosed with prostate cancer (PCa) with serum prostate-specific antigen (PSA) levels between 20 and 100 ng/mL. Patients with PCa (T1-4, N0/N1/NX, M0/MX), PSA 20-100 ng/mL and age ≤75 years were identified in the National Prostate Cancer Register of Sweden. Data on co-morbidity diagnoses were obtained from the National Patient Register and cause of death from the Cause of Death Register. Following adjustment for age at diagnosis, co-morbidity burden, Gleason score, T-category, PSA level and cause-specific mortality in relation to treatment were estimated using Cox regression analysis. A total of 11 380 men were diagnosed with PCa between 1996 and 2008 and fulfilled the inclusion criteria. The cumulative 10-year PCa-specific mortality was 36% for patients receiving only palliative treatment and 13% for those treated with curative intent. For the 8462 (74%) patients with PSA levels from 20 to 50 ng/mL at diagnosis, the hazard ratio for death from PCa was 0.23 (95% confidence interval 0.19-0.27) for those treated with curative intent compared with those given palliative treatment after adjusting for age, co-morbidity, T category, PSA level and Gleason score. The corresponding hazard ratio was 0.22 (95% confidence interval 0.17-0.30) for patients with PSA levels from 51 to 100 ng/mL. Treatment with curative intent for men with high-risk PCa was associated with reduced cause-specific mortality and should be considered even when serum PSA exceeds 20 ng/mL.

Primary cancers before and after prostate cancer diagnosis

The occurrence of multiple cancers may indicate common etiology; and, although some studies have investigated the risk of second primary cancers after prostate cancer (PCa), there are no studies on cancers before PCa. The PCBaSe Sweden database is based on the National Prostate Cancer Register (NPCR), which covers >96% of PCa cases. The authors estimated the prevalence and cumulative incidence of different cancers before and after PCa diagnosis in 72,613 men according to PCa treatment and disease stage in PCBaSe and their matched comparison cohort of men who were free of PCa. In total, 6829 men were diagnosed with another primary cancer before their PCa diagnosis, including 138 men at the time of PCa diagnosis and 5230 men were diagnosed after PCa diagnosis. Cancer of the bladder or colon and nonmelanoma of the skin were the 3 most frequently observed cancers before and after PCa diagnosis. At the time of PCa diagnosis, the prevalence of these 3 cancers was 1.94% for bladder cancer, 1.08% for colon cancer, and 1.08% for nonmelanoma skin cancer, compared with 1.30%, 0.96%, and 1.03%, respectively, for the matched comparison cohort. Five years after PCa diagnosis, the difference in incidence proportion between PCa men and their comparison cohort was 7 ‰ (95% CI, 5.6 ‰-8.5 ‰), 1.3 ‰ (0 ‰-2.6 ‰), and 1.6 ‰ (0.6 ‰-2.6 ‰) for these 3 cancers, respectively. From a uro-oncologic point of view, it is interesting to note that the prevalence of kidney cancer at the time of PCa diagnosis was 0.42% compared with 0.28% for the matched comparison cohort. Approximately 17% of all PCa occurred in combination with another primary cancer (before or after PCa diagnosis). Detection bias probably explains part of this observation, but further investigations are required to assess possible underlying mechanisms.

Information on pros and cons of prostate-specific antigen testing to men prior to blood draw: A study from the National Prostate Cancer Register (NPCR) of Sweden

Objective. Recent guidelines on serum testing of prostate-specific antigen (PSA) levels in asymptomatic men emphasize the importance of an informed decision. This study assessed the proportion of men who had received written or oral information on the possible consequences of testing of serum levels of PSA before blood draw. Material and methods. From the National Prostate Cancer Register (NPCR) in Sweden, 600 men per year were randomly selected out of all men with T1c prostate cancer who were diagnosed in the work-up of a PSA test as a part of health examination in 2006–2008. In a mailed questionnaire these men were asked whether and how they had been informed about the pros and cons of a PSA test prior to blood draw. Results. In total, 1621 out of 1800 men (90.1%) responded to the questionnaire; 39/1563 (2.5%) reported that they had received only written information before testing, 179/1563 (11.5%) had received both oral and written information, 763/1563 (48.8%) had received oral information only, 423/1563 (27.1%) had not received any information and 159/1563 (10.2%) were not aware of that a PSA test had been performed. Conclusions. The proportion of men who had received written information on the pros and cons of a PSA test before blood draw in the setting of a health examination was low. Improved routines for giving information to the patient before a PSA test are warranted.

Cohort Profile: The National Prostate Cancer Register of Sweden and Prostate Cancer data Base Sweden 2.0

In 1987, the first Regional Prostate Cancer Register was set up in the South-East health-care region of Sweden. Other health-care regions joined and since 1998 virtually all prostate cancer (PCa) cases are registered in the National Prostate Cancer Register (NPCR) of Sweden to provide data for quality assurance, bench marking and clinical research. NPCR includes data on tumour stage, Gleason score, serum level of prostate-specific antigen (PSA) and primary treatment. In 2008, the NPCR was linked to a number of other population-based registers by use of the personal identity number. This database named Prostate Cancer data Base Sweden (PCBaSe) has now been extended with more cases, longer follow-up and a selection of two control series of men free of PCa at the time of sampling, as well as information on brothers of men diagnosed with PCa, resulting in PCBaSe 2.0. This extension allows for studies with case-control, cohort or longitudinal case-only design on aetiological factors, pharmaceutical prescriptions and assessment of long-term outcomes. The NPCR covers >96% of all incident PCa cases registered by the Swedish Cancer Register, which has an underreporting of <3.7%. The NPCR is used to assess trends in incidence, treatment and outcome of men with PCa. Since the national registers linked to PCBaSe are complete, studies from PCBaSe 2.0 are truly population based.

1932 INFORMATION ON PROS AND CONS OF PSA-TESTING TO MEN PRIOR TO BLOOD DRAW. STUDY FROM THE NATIONAL PROSTATE CANCER REGISTER (NPCR) OF SWEDEN

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 20121932 INFORMATION ON PROS AND CONS OF PSA-TESTING TO MEN PRIOR TO BLOOD DRAW. STUDY FROM THE NATIONAL PROSTATE CANCER REGISTER (NPCR) OF SWEDEN Jon Fridriksson, Katarina Gunseus, and Pär Stattin Jon FridrikssonJon Fridriksson Umeå, Sweden More articles by this author , Katarina GunseusKatarina Gunseus Umeå, Sweden More articles by this author , and Pär StattinPär Stattin New York City, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2089AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES National guidelines on detection and treatment of prostate cancer were issued by The National Board of Health and Welfare in Sweden in 2007. These Guidelines strongly recommended that all asymptomatic men who underwent testing of serum levels of prostate specific antigen (PSA) should receive written information on the pros and cons of the PSA-test prior to the blood draw. A brochure with patient information was published. We assessed the proportion of men who were diagnosed with prostate cancer who had received such information before and after these recommendations had been published. METHODS In NPCR, we annually randomly selected 600 men out of all men with T1c prostate cancer who were diagnosed in the work-up of a PSA-test as a part of health examination in the years 2006-2008. In a questionnaire these men were asked if they had been informed about the pros and cons of the PSA-test prior to the blood draw and how they had received this information. RESULTS In total 1 563 out of 1 800 (87%) men responded. Out of those 1 563 men 981 (63%) had received information prior to testing, 423/1563 (27%) had not received information, and 159/1563 (10%) were not aware of that a PSA-test had been performed. There was little difference in the proportion of men informed over time, 60%, 65% and 64% for 2006, 2007 and 2008 respectively. Most men had been informed orally; 763/981 (78%), few men had received both written and oral information; 179/981 (18%) and even fewer had received only written information; 39/981 (4%) (Figure 1). There was a modest increase over time in the ratio of men who had received written or both oral and written information from 12% in 2006 to 16% in 2008. CONCLUSIONS The proportion of men who had received written information on the pros and cons of a PSA-test prior blood draw was low. No major changes in the distribution of written information prior to PSA-testing were seen after the publication of the Guidelines, suggesting that these have had a modest impact on patient information about PSA-testing before testing. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e780 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jon Fridriksson Umeå, Sweden More articles by this author Katarina Gunseus Umeå, Sweden More articles by this author Pär Stattin New York City, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

157 LONG-TERM OUTCOMES ACCORDING TO RISK CATEGORY OF PROSTATE CANCER IN A NATION-WIDE, POPULATION-BASED STUDY

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History I1 Apr 2012157 LONG-TERM OUTCOMES ACCORDING TO RISK CATEGORY OF PROSTATE CANCER IN A NATION-WIDE, POPULATION-BASED STUDY Jennifer Rider, Fredrik Sandin, Katja Fall, and Pär Stattin Jennifer RiderJennifer Rider Boston, MA More articles by this author , Fredrik SandinFredrik Sandin Uppsala, Sweden More articles by this author , Katja FallKatja Fall Örebro, Sweden More articles by this author , and Pär StattinPär Stattin Umeå, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.208AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are very limited data on long-term outcomes among men diagnosed with prostate cancer (PCa) from cohorts that incorporate information on risk categories. We aimed to separately assess death from PCa, cardiovascular disease (CVD), and other causes for men with PCa according to risk category defined by clinical stage, Gleason score and serum levels of PSA at diagnosis. METHODS We utilized a population-based cohort study of 117,328 PCa cases in the National Prostate Cancer Register (NPCR) of Sweden diagnosed between 1991-2009 categorized into five risk categories according to the National Comprehensive Cancer Network. The cumulative probability of death for up to 15 years of follow-up was estimated using a period analysis and by treating death from PCa, death from CVD, and death from other causes as competing events. Estimates were stratified by risk group and by age. The observed overall mortality was also compared to expected mortality as estimated by use of population death rates from the Swedish male population matched to the study population by age and calendar year. RESULTS As shown in Figure 1, the cumulative risk of death from PCa and other causes, respectively, at 15 years following diagnosis ranged from 7.2% (95% CI: 5.9-8.6%) and 38.6% (36.0-41.3%) for men with low-risk disease, to 68.9% (67.7-70.1%) and 28.1% (95% CI: 26.9-29.2%) for men presenting with distant metastases. At 15 years, CVD alone was responsible for the greatest proportion of deaths among PCa patients with low- and intermediate-risk disease. Regardless of age, observed mortality was no different than expected among men with localized low-risk PCa. Risk of excess mortality increased steadily with longer follow-up among men with localized intermediate-risk, localized high-risk, regionally metastatic, and metastatic disease at diagnosis. CONCLUSIONS The majority of deaths among men with localized disease - even disease considered high risk at diagnosis - are from causes other than PCa. Our results not only highlight the need for more refined tools for PCa diagnosis and therapeutic selection, but also demonstrate the importance of strategies to reduce CVD and other preventable causes of death among men with PCa. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e65 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Rider Boston, MA More articles by this author Fredrik Sandin Uppsala, Sweden More articles by this author Katja Fall Örebro, Sweden More articles by this author Pär Stattin Umeå, Sweden More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...