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Adverse effects of curative treatment of prostate cancer
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Screening for prostate cancer is debated, there is conflicting data on the net benefit of screening. Men who consider screening need to be informed on the pros and cons. Rehospitalization after surgery can be used as an indicator of general quality of care. For radical prostatectomy, little is known on the readmission rate after surgery. Men diagnosed with low- and intermediate-risk prostate cancer have low prostate-cancer specific mortality. However, adverse effects after curative treatment can be severe and decrease quality of life. Curative treatments for prostate cancer differ mainly in the pattern of adverse effects but detailed analysis of long-term adverse effects is lacking.

The aim of this thesis was to assess the perioperative quality of radical prostatectomy and the risk of adverse effects after curative treatment for prostate cancer.

Material and Methods In this thesis, data from the National Prostate Cancer Register (NPCR) and other nationwide Swedish registers were used. By use of the Swedish personal identity number, NPCR was cross-linked to other registers creating Prostate Cancer data Base Sweden (PCBaSe), a large dataset for research.

Results The proportion of men who had received information on the pros and cons of screening for prostate cancer with PSA testing was low (14%) indicating that the majority of men who were screened did not make an informed decision. The risk of rehospitalization within 90 days after radical prostatectomy was approximately 10% and similar after retropubic and robot-assisted radical prostatectomy. Compared to controls, there was an increased risk of adverse effects after both radiotherapy and radical prostatectomy up to twelve years after treatment and the overall risk was quite similar after retropubic and robot-assisted radical prostatectomy.

Conclusion Improved information to men on the pros and cons of PSA screening is warranted. The risk of adverse effects was elevated up to 12 years after curative treatment for prostate cancer. The pattern of adverse effects was different after radiotherapy and radical prostatectomy but quite similar after retropubic and robot-assisted radical prostatectomy.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2016. , 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1846
Keyword [en]
Prostate cancer, prostate-specific antigen, decision aids, radical prostatectomy, radiotherapy, patient readmission, adverse effects
National Category
Clinical Medicine
Research subject
Urology
Identifiers
URN: urn:nbn:se:umu:diva-128709ISBN: 978-91-7601-559-9 (print)OAI: oai:DiVA.org:umu-128709DiVA: diva2:1055675
Public defence
2017-01-19, Hörsal E04 Farmakologihuset, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-12-21 Created: 2016-12-13 Last updated: 2016-12-21Bibliographically approved
List of papers
1. 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
Open this publication in new window or tab >>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
2012 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 46, no 5, 326-331 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2012
Keyword
decision aids, guidelines, prostate cancer, prostate-specific antigen
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-61185 (URN)10.3109/00365599.2012.691110 (DOI)000308951000002 ()22647143 (PubMedID)
Available from: 2012-11-09 Created: 2012-11-07 Last updated: 2016-12-20Bibliographically approved
2. Rehospitalization after radical prostatectomy in a nationwide, population-based study
Open this publication in new window or tab >>Rehospitalization after radical prostatectomy in a nationwide, population-based study
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2014 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 192, no 1, 112-119 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate readmission frequencies during the 90 days following radical prostatectomy and to assess readmission risk associated with potentially related variables.

MATERIALS AND METHODS: Using the population-based, nationwide database Prostate Cancer data Base Sweden (PCBaSe), we identified men diagnosed with incident prostate cancer between 2000 and 2011 who underwent radical prostatectomy (RP) as their primary treatment, and we used logistic regression analysis to examine the association of the risk of 90-day postoperative readmission with surgical method, calendar period, tumor risk category, hospital case load, and patient characteristics.

RESULTS: During the 90 postoperative days, 2,317 (10%) of the 24,122 men identified were non-electively readmitted, specifically 10% after retropubic radical prostatectomy (RRP), 9% after robot-assisted RP (RALP) and 11% after laparoscopic RP (LRP). The range in the readmission frequency between hospitals was 0-35%. A higher risk of readmission was associated with early calendar period (2009-2011 vs. 2000-2002: odds ratio (OR), 0.71; 95% confidence interval (CI), 0.61-0.83), greater age (≥70 years vs. <60 years: OR, 1.17; 95% CI, 1.00-1.36), higher risk category (high vs. low-risk category: OR, 1.78; 95% CI, 1.57-2.03), high comorbidity (Charlson comorbidity index ≥3 vs. 0: OR, 1.77; 95% CI, 1.29-2.44), and low hospital surgical volume (≥150 vs. <30 RPs per year: OR, 0.70; 95% CI, 0.60-0.81).

CONCLUSIONS: Readmission rates after different RP methods were similar, ranging from 9% to 11%, with a wide variation between hospitals. Readmission rates can be used as an indicator of perioperative care quality, but potential confounders need to be adjusted to avoid bias.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
prostate, prostatic neoplasms, prostatectomy, patient readmission, perioperative care
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-85907 (URN)10.1016/j.juro.2014.01.109 (DOI)000342082600031 ()24508613 (PubMedID)
Available from: 2014-02-13 Created: 2014-02-13 Last updated: 2016-12-13Bibliographically approved
3. Long-term adverse effects after curative radiotherapy and radical prostatectomy: population-based nationwide register study
Open this publication in new window or tab >>Long-term adverse effects after curative radiotherapy and radical prostatectomy: population-based nationwide register study
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2016 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 5, 338-345 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to assess the risk of serious adverse effects after radiotherapy (RT) with curative intention and radical prostatectomy (RP).

Materials and methods: Men who were diagnosed with prostate cancer between 1997 and 2012 and underwent curative treatment were selected from the Prostate Cancer data Base Sweden. For each included man, five prostate cancer-free controls, matched for birth year and county of residency, were randomly selected. In total, 12,534 men underwent RT, 24,886 underwent RP and 186,624 were controls. Adverse effects were defined according to surgical and diagnostic codes in the National Patient Registry. The relative risk (RR) of adverse effects up to 12 years after treatment was compared to controls and the risk was subsequently compared between RT and RP in multivariable analyses.

Results: Men with intermediate- and localized high-risk cancer who underwent curative treatment had an increased risk of adverse effects during the full study period compared to controls: the RR of undergoing a procedures after RT was 2.64 [95% confidence interval (CI) 2.56–2.73] and after RP 2.05 (95% CI 2.00–2.10). The risk remained elevated 10–12 years after treatment. For all risk categories of prostate cancer, the risk of surgical procedures for urinary incontinence was higher after RP (RR 23.64, 95% CI 11.71–47.74), whereas risk of other procedures on the lower urinary tract and gastrointestinal tract or abdominal wall was higher after RT (RR 1.67, 95% CI 1.44–1.94, and RR 1.86, 95% CI 1.70–2.02, respectively).

Conclusion: The risk of serious adverse effects after curative treatment for prostate cancer remained significantly elevated up to 12 years after treatment.

Keyword
Adverse effects, prostate cancer, radical prostatectomy, radiotherapy
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-127955 (URN)10.1080/21681805.2016.1194460 (DOI)000384068000003 ()27333148 (PubMedID)
Available from: 2016-12-16 Created: 2016-11-21 Last updated: 2016-12-20Bibliographically approved
4. Long-term adverse effects after open retropubic and robot-assisted radical prostatectomy
Open this publication in new window or tab >>Long-term adverse effects after open retropubic and robot-assisted radical prostatectomy
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-128994 (URN)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2016-12-20

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