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Absolute and relative risk of cardiovascular disease in men with prostate cancer: results from the Population-Based PCBaSe Sweden.

https://arctichealth.org/en/permalink/ahliterature96622
Source
J Clin Oncol. 2010 Jul 20;28(21):3448-56
Publication Type
Article
Date
Jul-20-2010
Author
Mieke Van Hemelrijck
Hans Garmo
Lars Holmberg
Erik Ingelsson
Ola Bratt
Anna Bill-Axelson
Mats Lambe
Pär Stattin
Jan Adolfsson
Author Affiliation
King's College London, London, United Kingdom. mieke.vanhemelrijck@kcl.ac.uk
Source
J Clin Oncol. 2010 Jul 20;28(21):3448-56
Date
Jul-20-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Androgen Antagonists - adverse effects
Cardiovascular Diseases - etiology
Gonadotropin-Releasing Hormone - adverse effects - analogs & derivatives - therapeutic use
Humans
Male
Middle Aged
Prostatic Neoplasms - complications - drug therapy
Risk
Abstract
PURPOSE: Cardiovascular disease (CVD) is a potential adverse effect of endocrine treatment (ET) for prostate cancer (PC). We investigated absolute and relative CVD risk in 76,600 patients with PC undergoing ET, curative treatment, or surveillance. METHODS: PCBaSe Sweden is based on the National Prostate Cancer Register, which covers more than 96% of PC cases. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) of ischemic heart disease (IHD), acute myocardial infarction (MI), arrhythmia, heart failure, and stroke were calculated to compare observed and expected (using total Swedish population) numbers of CVD, taking into account age, calendar time, and previous CVD. RESULTS: Between 1997 and 2007, 30,642 patients with PC received primary ET, 26,432 curative treatment, and 19,527 surveillance. SIRs for CVD were elevated in all men with the highest for those undergoing ET, independent of circulatory disease history (SIR MI for men without circulatory disease history: 1.40 [95% CI, 1.31 to 1.49], 1.15 [95% CI, 1.01 to 1.31], and 1.20 [95% CI, 1.11 to 1.30] for men undergoing ET, curative treatment, and surveillance, respectively). Absolute risk differences (ARD) showed that two (arrhythmia) to eight (IHD) extra cases of CVD would occur per 1,000 person-years. SMRs showed similar patterns, with ARD of zero (arrhythmia) to three (IHD) per 1,000 person-years. CONCLUSION: Increased relative risks of nonfatal and fatal CVD were found among all men with PC, especially those treated with ET. Because ET is currently the only effective treatment for metastatic disease and the ARDs were rather small, our findings indicate that CVD risk should be considered when prescribing ET but should not constitute a contraindication when the expected gain is tangible.
PubMed ID
20567006 View in PubMed
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Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study.

https://arctichealth.org/en/permalink/ahliterature311023
Source
Scand J Urol. 2020 Jun; 54(3):208-214
Publication Type
Journal Article
Observational Study
Date
Jun-2020
Author
Magdalena Lycken
Linda Drevin
Hans Garmo
Anders Larsson
Ove Andrén
Lars Holmberg
Anna Bill-Axelson
Author Affiliation
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Source
Scand J Urol. 2020 Jun; 54(3):208-214
Date
Jun-2020
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Aged
Aged, 80 and over
Androgen Antagonists - therapeutic use
Combined Modality Therapy
Guideline Adherence - statistics & numerical data
Humans
Male
Middle Aged
Orchiectomy
Postoperative Period
Prostatectomy
Prostatic Neoplasms - drug therapy - surgery
Sweden
Abstract
Background: Androgen deprivation therapy (ADT) is a non-curative but essential treatment of prostate cancer with severe side effects. Therefore, both over- and underuse should be avoided. We investigated adherence to guidelines for ADT following radical prostatectomy through Swedish population-based data.Material and methods: We used the database Uppsala/Örebro PSA cohort (UPSAC) to study men with localised or locally advanced prostate cancer at diagnosis (clinical stage T1-T3, N0-NX, M0-MX, and prostate-specific antigen (PSA)
PubMed ID
32338176 View in PubMed
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Changes in lifestyle among prostate cancer survivors: A nationwide population-based study.

https://arctichealth.org/en/permalink/ahliterature312024
Source
Psychooncology. 2020 10; 29(10):1713-1719
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
10-2020
Author
Oskar Bergengren
Anna Pia Enblad
Hans Garmo
Ola Bratt
Lars Holmberg
Eva Johansson
Anna Bill-Axelson
Author Affiliation
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Source
Psychooncology. 2020 10; 29(10):1713-1719
Date
10-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Attitude to Health
Cancer Survivors - psychology
Diet
Exercise
Healthy Lifestyle
Humans
Male
Middle Aged
Prostatic Neoplasms - psychology - therapy
Quality of Life
Surveys and Questionnaires
Sweden
Abstract
Long-term information on lifestyle changes among prostate survivors is lacking. In this nationwide, population-based study we investigated the prevalence of lifestyle changes, factors associated with lifestyle changes and associations between lifestyle changes and general quality of life.
All men registered in the National Prostate Cancer Register of Sweden diagnosed in 2008 with low-risk prostate cancer at age 70?years or younger were sent a questionnaire. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals for factors potentially associated with lifestyle change.
Out of 1288, 1720 men (75%) were responded. A total of 279 (22%) reported a positive lifestyle change regarding diet or exercise. Poor functional outcomes after treatment was associated with exercising less (OR 1.6, 95% CI 1.2-2.1) and less interest in social activities and relationships (OR 1.8, 95% CI 1.5-2.1). Men who exercised more (OR 7.9, 95% CI 4.4-14) and men who had an increased interest in relationships and social activities (OR 5.2, 95% CI 2.1-13) reported higher general quality of life.
A considerable proportion of men reported making positive lifestyle changes after the prostate cancer diagnosis. The time after diagnosis may be a teachable moment that facilitates lifestyle interventions. Poor functional outcomes after treatment may reduce the willingness to engage in positive lifestyle change, which need be considered when supporting men after treatment. Men who made a positive lifestyle change, regardless of whether it was exercise or regarding relationships and social activities more often reported a high level of general quality of life.
PubMed ID
32779258 View in PubMed
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Determinants for choosing and adhering to active surveillance for localised prostate cancer: a nationwide population-based study.

https://arctichealth.org/en/permalink/ahliterature307528
Source
BMJ Open. 2019 12 23; 9(12):e033944
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-23-2019
Author
Oskar Bergengren
Hans Garmo
Ola Bratt
Lars Holmberg
Eva Johansson
Anna Bill-Axelson
Author Affiliation
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden Oskar.bergengren@gmail.com.
Source
BMJ Open. 2019 12 23; 9(12):e033944
Date
12-23-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Decision Making
Humans
Male
Middle Aged
Patient compliance
Prostatic Neoplasms - therapy
Retrospective Studies
Sweden
Watchful Waiting
Abstract
Knowledge about factors influencing choice of and adherence to active surveillance (AS) for prostate cancer (PC) is scarce. We aim to identify which factors most affected choosing and adhering to AS and to quantify their relative importance.
In 2015, we sent a questionnaire to all Swedish men aged =70 years registered in the National Prostate Cancer Register of Sweden who were diagnosed in 2008 with low-risk PC and had undergone prostatectomy, radiotherapy or started on AS.
Logistic regression was used to calculate ORs with 95% CIs for factors potentially affecting choice and adherence to AS.
1288 out of 1720 men (75%) responded, 451 (35%) chose AS and 837 (65%) underwent curative treatment. Of those starting on AS, 238 (53%) diverted to treatment within 7?years. Most men (83%) choose AS because 'My doctor recommended AS'. Factors associated with choosing AS over treatment were older age (OR 1.81, 95%?CI 1.29 to 2.54), a Charlson Comorbidity Index >2 (OR 1.50, 95%?CI 1.06 to 2.13), being unaccompanied when notified of the cancer diagnosis (OR 1.45, 95%?CI 1.11 to 1.89). Men with a higher prostate-specific antigen (PSA) at the time of diagnosis were less likely to adhere to AS (OR 0.26, 95%?CI 0.10 to 0.63). The reason for having treatment after initial AS was 'the PSA level was rising' in 55% and biopsy findings in 36%.
A doctor's recommendation strongly affects which treatment is chosen for men with low-risk PC. Rising PSA values were the main factor for initiating treatment for men on AS. These findings need be considered by healthcare providers who wish to increase the uptake of and adherence to AS.
PubMed ID
31874896 View in PubMed
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Dietary patterns and prostate cancer risk: report from the population based ULSAM cohort study of Swedish men.

https://arctichealth.org/en/permalink/ahliterature105741
Source
Nutr Cancer. 2014;66(1):77-87
Publication Type
Article
Date
2014
Author
Erika Ax
Hans Garmo
Birgitta Grundmark
Anna Bill-Axelson
Lars Holmberg
Wulf Becker
Björn Zethelius
Tommy Cederholm
Per Sjögren
Author Affiliation
a Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism , Uppsala University , Uppsala , Sweden.
Source
Nutr Cancer. 2014;66(1):77-87
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Diet, Carbohydrate-Restricted
Diet, Mediterranean
Diet, Protein-Restricted
Dietary Carbohydrates - administration & dosage
Dietary Proteins - administration & dosage
Energy intake
European Continental Ancestry Group
Follow-Up Studies
Food Habits
Humans
Incidence
Longitudinal Studies
Male
Motor Activity
Nutrition Assessment
Patient compliance
Proportional Hazards Models
Prostatic Neoplasms - epidemiology - prevention & control
Questionnaires
Risk factors
Sweden
Abstract
Dietary pattern analyses have increased the possibilities to detect associations between diet and disease. However, studies on dietary pattern and prostate cancer are scarce. Food intake data in the Uppsala Longitudinal Study of Adult Men cohort was determined by 7-day food records. Adherence to a modified Mediterranean Diet Score (mMDS) and a low carbohydrate-high protein (LCHP) score were grouped as low, medium, or high in the whole study population (n = 1,044) and in those identified as adequate reporters of energy intake (n = 566), respectively. Prostate cancer risk was analyzed with Cox proportional hazard regression (median follow-up 13 years) and competing risk of death was considered. There were no associations between dietary patterns and prostate cancer (n = 133) in the whole study population. Among adequate reporters the mMDS was not associated with prostate cancer (n = 72). The LCHP score was inversely related to prostate cancer in adequate reporters, adjusted hazard ratios; 0.55 (0.32-0.96) for medium and 0.47 (0.21-1.04) for high compared to low adherent participants (P-for-trend 0.04). Risk relations were not attributable to competing risk of death. In this study, a LCHP diet was associated with lower prostate cancer incidence. Relations emerged in adequate reporters, underscoring the importance of high-quality dietary data.
PubMed ID
24325263 View in PubMed
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Differences in survival from prostate cancer in Denmark, Iceland and Sweden.

https://arctichealth.org/en/permalink/ahliterature115907
Source
Eur J Cancer. 2013 May;49(8):1984-92
Publication Type
Article
Date
May-2013
Author
Klaus Brasso
Inga Jóna Ingimarsdóttir
Ea Rusch
Gerda Engholm
Jan Adolfsson
Laufey Tryggvadóttir
Eiríkur Jónsson
Anna Bill-Axelson
Erik Holmberg
Hans Henrik Storm
Author Affiliation
Urological Research Unit, Department of Urology, Rigshospitalet, University of Copenhagen, Denmark. klausbrasso@hotmail.com
Source
Eur J Cancer. 2013 May;49(8):1984-92
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Denmark - epidemiology
Humans
Iceland - epidemiology
Incidence
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Prognosis
Prostate-Specific Antigen - analysis
Prostatic Neoplasms - epidemiology - mortality - pathology
Registries - statistics & numerical data
Survival Analysis
Survival Rate - trends
Sweden - epidemiology
Time Factors
Abstract
Register-based studies have shown large survival differences among prostate cancer patients in the Nordic countries. The aim of this study was to determine the background of such differences in Denmark, Iceland and Sweden.
Patients with prostate cancer were identified through population-based cancer registers in the three countries. Clinical findings at diagnosis were retrieved from hospital records. In Sweden, clinical information was gathered from regional population-based prostate cancer registers. Country-specific incidence and excess mortality rates were compared, with adjustment for prognostic factors.
The relative survival in the cohorts was comparable to that in previous population-based studies. Significant differences in excess mortality rates were found across countries, which diminished or disappeared after adjustment for patient characteristics, i.e. metastatic status, clinical T stage and prostate-specific antigen level. A difference in the proportion of patients with metastatic disease was the main explanation of the differences in survival among countries, while the incidence rates of metastatic cancer were similar.
Register-based studies of the relative survival of prostate cancer patients are influenced by national differences in clinical presentation at diagnosis. Differences in the proportion of patients with metastatic spread explained most of the difference in relative survival among patients in Denmark, Iceland and Sweden. Future country comparisons of relative survival should include adjustment for differences in patient characteristics, such as stage, prostate-specific antigen level and screening intensity.
PubMed ID
23453749 View in PubMed
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Effects of Prostate-Specific Antigen Testing on Familial Prostate Cancer Risk Estimates.

https://arctichealth.org/en/permalink/ahliterature99193
Source
J Natl Cancer Inst. 2010 Aug 19;
Publication Type
Article
Date
Aug-19-2010
Author
Ola Bratt
Hans Garmo
Jan Adolfsson
Anna Bill-Axelson
Lars Holmberg
Mats Lambe
Pär Stattin
Author Affiliation
Affiliation of authors: Department of Urology, Helsingborg Hospital, Lund University, Helsingborg, Sweden (OB); Regional Oncological Centre, Uppsala, Sweden (HG, ML); Division of Cancer Studies, King's College London, Medical School, London, UK (HG, LH); Oncological Centre, CLINTEC (JA), Department of Clinical Cancer Epidemiology (AB-A), and Department of Medical Epidemiology and Biostatistics (ML), Karolinska Institute, Stockholm, Sweden; Department of Urology, Uppsala University Hospital, Uppsala, Sweden (AB-A); Urology and Andrology, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden (PS).
Source
J Natl Cancer Inst. 2010 Aug 19;
Date
Aug-19-2010
Language
English
Publication Type
Article
Abstract
Background Family history is a strong risk factor for prostate cancer. The aim of this study was to investigate whether increased diagnostic activity is related to the incidence of prostate cancer among brothers of men with prostate cancer. Methods Data were from the nationwide population-based Prostate Cancer Database Sweden (PCBaSe Sweden), which includes data from the National Prostate Cancer Register, the Swedish Cancer Register, the Register of the Total Population, the Multi-Generation Register, and the Census database. We investigated the relationship of tumor characteristics, time from diagnosis of the index patient (ie, prostate cancer patients in the National Prostate Cancer Register for whom at least one brother and their father could be identified), calendar period, geographic factors, and socioeconomic status to standardized incidence ratios (SIRs) for prostate cancer among 22 511 brothers of 13 975 index patients in PCBaSe Sweden. Results Brothers of index patients with prostate cancer were at increased risk for a diagnosis of prostate cancer (SIR = 3.1, 95% confidence interval [CI] = 2.9 to 3.3). Risk was higher for T1c tumors (SIR = 3.4, 95% CI = 3.2 to 3.8) than for metastatic tumors (SIR = 2.0, 95% CI = 1.5 to 2.6), and risk of T1c tumors was especially high during the first year after the diagnosis of the index patient (SIR = 4.3, 95% CI = 3.8 to 4.9), compared with the following years (SIR range = 2.8-3.3), and for brothers of index patients who had a higher socioeconomic status (SIR = 4.2, 95% CI = 3.7 to 4.7), compared with brothers of index patients with lower socioeconomic status (SIR = 2.8, 95% CI = 2.4 to 3.2). Conclusions Increased diagnostic activity among men with a family history of prostate cancer appears to contribute to their increased risk of prostate cancer and to lead to detection bias in epidemiological and genetic studies of familial prostate cancer.
PubMed ID
20724726 View in PubMed
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Five-year nationwide follow-up study of active surveillance for prostate cancer.

https://arctichealth.org/en/permalink/ahliterature268837
Source
Eur Urol. 2015 Feb;67(2):233-8
Publication Type
Article
Date
Feb-2015
Author
Stacy Loeb
Yasin Folkvaljon
Danil V Makarov
Ola Bratt
Anna Bill-Axelson
Pär Stattin
Source
Eur Urol. 2015 Feb;67(2):233-8
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Biopsy
Disease Progression
Humans
Kallikreins - blood
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neoplasm Grading
Neoplasm Staging
Predictive value of tests
Probability
Prognosis
Proportional Hazards Models
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - diagnosis - epidemiology - pathology
Registries
Risk factors
Sweden - epidemiology
Time Factors
Watchful Waiting
Abstract
Active surveillance (AS) is an important yet underutilized strategy to reduce prostate cancer (PCa) overtreatment.
To examine the 5-yr outcomes of AS in a population-based setting.
From 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.
We 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.
By 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.
In 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.
Active 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.
Notes
Cites: J Gen Intern Med. 2000 Oct;15(10):694-70111089712
Cites: J Urol. 2007 Sep;178(3 Pt 1):826-31; discussion 831-217632144
Cites: J Clin Oncol. 2010 Mar 1;28(7):1117-2320124165
Cites: BJU Int. 2010 Oct;106(8):1161-420456339
Cites: Eur Urol. 2012 Dec;62(6):976-8322698574
Cites: Eur Urol. 2013 Jan;63(1):101-722980443
Cites: Med J Aust. 2013 Jun 3;198(10):540-523725268
Cites: BJU Int. 2012 Jul;110(2 Pt 2):E50-622145791
Cites: Ann Intern Med. 2012 Apr 17;156(8):582-9022351515
Cites: Ann Intern Med. 2012 Apr 17;156(8):591-522351514
Cites: J Clin Oncol. 2011 Jun 1;29(16):2185-9021464416
Cites: Cancer. 2000 Mar 1;88(5):1122-3010699903
Cites: Can J Urol. 2010 Dec;17(6):5429-3521172105
Cites: J Urol. 2011 Mar;185(3):833-921239002
Cites: J Urol. 2013 Nov;190(5):1742-923727309
Cites: Eur Urol. 2013 Jul;64(1):30-623357351
Cites: Int J Epidemiol. 2013 Aug;42(4):956-6722561842
Comment In: Eur Urol. 2015 Feb;67(2):239-4025018039
Comment In: J Urol. 2015 Jun;193(6):198125986791
PubMed ID
24993868 View in PubMed
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Incidence of fractures causing hospitalisation in prostate cancer patients: results from the population-based PCBaSe Sweden.

https://arctichealth.org/en/permalink/ahliterature126471
Source
Eur J Cancer. 2012 Jul;48(11):1672-81
Publication Type
Article
Date
Jul-2012
Author
Andreas Thorstenson
Ola Bratt
Olof Akre
Henrik Hellborg
Lars Holmberg
Mats Lambe
Anna Bill-Axelson
Pär Stattin
Jan Adolfsson
Author Affiliation
Regional Cancer Centre, Karolinska University Hospital, Stockholm, Sweden. andreas.thorstenson@capio.se
Source
Eur J Cancer. 2012 Jul;48(11):1672-81
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Aged
Androgen Antagonists - adverse effects
Antineoplastic Agents, Hormonal - adverse effects
Fractures, Bone - epidemiology
Hospitalization
Humans
Incidence
Male
Orchiectomy - adverse effects
Osteoporosis - chemically induced
Prostatic Neoplasms - complications - drug therapy - surgery
Risk factors
Sweden - epidemiology
Abstract
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.
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.
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.
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.
PubMed ID
22386317 View in PubMed
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Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial.

https://arctichealth.org/en/permalink/ahliterature132398
Source
Lancet Oncol. 2011 Sep;12(9):891-9
Publication Type
Article
Date
Sep-2011
Author
Eva Johansson
Gunnar Steineck
Lars Holmberg
Jan-Erik Johansson
Tommy Nyberg
Mirja Ruutu
Anna Bill-Axelson
Author Affiliation
Department of Surgical Sciences, University Hospital of Uppsala, Uppsala, Sweden. eva.johansson.eva@spray.se
Source
Lancet Oncol. 2011 Sep;12(9):891-9
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anxiety - etiology - psychology
Erectile Dysfunction - etiology - psychology
Finland
Humans
Male
Middle Aged
Neoplasm Staging
Patient Selection
Prostatectomy - adverse effects - psychology
Prostatic Neoplasms - pathology - psychology - surgery
Quality of Life
Questionnaires
Risk assessment
Risk factors
Sweden
Time Factors
Treatment Outcome
Urinary Incontinence - etiology - psychology
Watchful Waiting
Abstract
For men with localised prostate cancer, surgery provides a survival benefit compared with watchful waiting. Treatments are associated with morbidity. Results for functional outcome and quality of life are rarely reported beyond 10 years and are lacking from randomised settings. We report results for quality of life for men in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) after a median follow-up of more than 12 years.
All living Swedish and Finnish men (400 of 695) randomly assigned to radical prostatectomy or watchful waiting in SPCG-4 from 1989 to 1999 were included in our analysis. An additional 281 men were included in a population-based control group matched for region and age. Physical symptoms, symptom-induced stress, and self-assessed quality of life were evaluated with a study-specific questionnaire. Longitudinal data were available for 166 Swedish men who had answered quality-of-life questionnaires at an earlier timepoint.
182 (88%) of 208 men in the radical prostatectomy group, 167 (87%) of 192 men in the watchful-waiting group, and 214 (76%) of 281 men in the population-based control group answered the questionnaire. Men in SPCG-4 had a median follow-up of 12·2 years (range 7-17) and a median age of 77·0 years (range 61-88). High self-assessed quality of life was reported by 62 (35%) of 179 men allocated radical prostatectomy, 55 (34%) of 160 men assigned to watchful waiting, and 93 (45%) of 208 men in the control group. Anxiety was higher in the SPCG-4 groups (77 [43%] of 178 and 69 [43%] of 161 men) than in the control group (68 [33%] of 208 men; relative risk 1·42, 95% CI 1·07-1·88). Prevalence of erectile dysfunction was 84% (146 of 173 men) in the radical prostatectomy group, 80% (122 of 153) in the watchful-waiting group, and 46% (95 of 208) in the control group and prevalence of urinary leakage was 41% (71 of 173), 11% (18 of 164), and 3% (six of 209), respectively. Distress caused by these symptoms was reported significantly more often by men allocated radical prostatectomy than by men assigned to watchful waiting. In a longitudinal analysis of men in SPCG-4 who provided information at two follow-up points 9 years apart, 38 (45%) of 85 men allocated radical prostatectomy and 48 (60%) of 80 men allocated watchful waiting reported an increase in number of physical symptoms; 50 (61%) of 82 and 47 (64%) of 74 men, respectively, reported a reduction in quality of life.
For men in SPCG-4, negative side-effects were common and added more stress than was reported in the control population. In the radical prostatectomy group, erectile dysfunction and urinary leakage were often consequences of surgery. In the watchful-waiting group, side-effects can be caused by tumour progression. The number and severity of side-effects changes over time at a higher rate than is caused by normal ageing and a loss of sexual ability is a persistent psychological problem for both interventions. An understanding of the patterns of side-effects and time dimension of their occurrence for each treatment is important for full patient information.
US National Institutes of Health; Swedish Cancer Society; Foundation in Memory of Johanna Hagstrand and Sigfrid Linnér.
Notes
Comment In: Ann Intern Med. 2012 Apr 17;156(8):JC4-0322508743
Comment In: Lancet Oncol. 2011 Sep;12(9):832-321821473
PubMed ID
21821474 View in PubMed
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27 records – page 1 of 3.