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Long-term adverse effects after curative radiotherapy and radical prostatectomy: population-based nationwide register study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.ORCID iD: 0000-0003-2061-5769
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Department of Urology, Ryhov Hospital, J€onk€oping, Sweden.
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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.

Place, publisher, year, edition, pages
2016. Vol. 50, no 5, 338-345 p.
Keyword [en]
Adverse effects, prostate cancer, radical prostatectomy, radiotherapy
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-127955DOI: 10.1080/21681805.2016.1194460ISI: 000384068000003PubMedID: 27333148OAI: oai:DiVA.org:umu-127955DiVA: diva2:1057131
Available from: 2016-12-16 Created: 2016-11-21 Last updated: 2016-12-20Bibliographically approved
In thesis
1. Adverse effects of curative treatment of prostate cancer
Open this publication in new window or tab >>Adverse effects of curative treatment of prostate cancer
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
Prostate cancer, prostate-specific antigen, decision aids, radical prostatectomy, radiotherapy, patient readmission, adverse effects
National Category
Clinical Medicine
Research subject
Urology
Identifiers
urn:nbn:se:umu:diva-128709 (URN)978-91-7601-559-9 (ISBN)
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

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