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Outcome of primary versus deferred radical prostatectomy in the National Prostate Cancer Register of Sweden follow-up study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
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2010 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 184, no 4, 1322-1327 p.Article in journal (Refereed) Published
Abstract [en]

Purpose We assessed outcomes in terms of adverse pathology and prostate cancer specific mortality in men who underwent primary or deferred radical prostatectomy.

Materials and Methods In the National Prostate Cancer Register of Sweden Follow-Up Study men 70 years old or younger at diagnosis with localized low to intermediate risk prostate cancer diagnosed from 1997 to 2002 were identified. Outcome in terms of adverse pathology, namely upgrading of Gleason score, positive surgical margins and extraprostatic extension, as well as prostate cancer specific mortality, was assessed in 2,344 men who underwent primary radical prostatectomy and 222 who underwent deferred radical prostatectomy after an initial period of surveillance.

Results Upgrading of Gleason score in surgical specimens vs core biopsies was less frequent after primary (25%) vs deferred radical prostatectomy (38%), p <0.001. There was no significant difference in the percentage of men who underwent primary vs deferred radical prostatectomy for positive surgical margins (33% vs 24%) or extraprostatic extension (27% vs 25%), and there was no difference in any 1 or more of the 3 adverse pathology features (55% vs 56%). After a median followup of 8 years 0.7% of men in the primary radical prostatectomy group and 0.9% in the deferred radical prostatectomy group had died of prostate cancer.

Conclusions There was no significant difference in the presence of any 1 or more adverse pathology features or in prostate cancer specific mortality after primary compared to deferred radical prostatectomy. However, longer followup is needed to conclusively evaluate the role of deferred radical prostatectomy.

Place, publisher, year, edition, pages
Elsevier , 2010. Vol. 184, no 4, 1322-1327 p.
Keyword [en]
prostatectomy, prostatic neoplasm
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-42197DOI: 10.1016/j.juro.2010.06.008ISI: 000282615400027PubMedID: 20723940OAI: oai:DiVA.org:umu-42197DiVA: diva2:408870
Available from: 2011-04-06 Created: 2011-04-06 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Early diagnosis and treatment of prostate cancer: observational studies in the National Prostate Cancer Register of Sweden and the Västerbotten Intervention Project
Open this publication in new window or tab >>Early diagnosis and treatment of prostate cancer: observational studies in the National Prostate Cancer Register of Sweden and the Västerbotten Intervention Project
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Tidig diagnostik och behandling av prostatacancer  : observationsstudier i Nationella Prostatacancerregistret och Västerbottens interventionsprojekt
Abstract [en]

Prostate-specific antigen (PSA) testing has caused a steep increase in the incidence of prostate cancer, especially the incidence of localised low risk disease. In order to decrease the overdiagnosis accompanied by PSA testing, analysis of inherited genetic variants have been suggested as potential tools for clinical assessment of disease risk. With the aim of minimizing overtreatment and postpone side-effects of curative treatment for low risk prostate cancer, active surveillance, a treatment strategy with initial surveillance and deferred radical prostatectomy at the time of progression has evolved. 

The aim of this thesis was to study the validity of PSA (paper I) and inherited genetic variants (paper II) for early diagnosis of prostate cancer, to assess the extent of PSA testing in Sweden (paper III), and to study the safety of deferred radical prostatectomy in localised low to intermediate risk prostate cancer (paper IV).

The study designs were i) case-control studies nested within the Västerbotten intervention project (paper I and II), ii) observational study in the Cancer Register of Sweden (paper III), and iii) observational study in the NPCR Follow-up study (paper IV).

PSA had a high validity in predicting a prostate cancer diagnosis with an area under the receiver operating characteristics (ROC) curve of 0.86 (95% CI, 0.84 to 0.88). A combined test, including PSA, the ratio of free to total PSA, and 33 single nucleotide polymorphisms (SNPs) in a genetic risk score, increased the area under curve to 0.87 (95% CI, 0.85 to 0.89). The estimated uptake of PSA testing among men aged 55 to 69 years increased from zero to 56% between 1997 and 2007 and there were large variations in the uptake of PSA testing between counties in Sweden. After a median follow-up time of eight years there was no significant difference in presence of any one or more adverse pathology features or prostate cancer specific mortality after primary compared to deferred radical prostatectomy in localised low to intermediate risk prostate cancer.

Results from these studies indicate that PSA and the hitherto identified SNPs are not suitable biomarkers in single-test prostate cancer screening. It is possible to estimate the uptake of PSA testing on a population level. Initial surveillance and deferred radical prostatectomy represent a feasible treatment strategy in localised low to intermediate risk prostate cancer.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 58 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1397
Keyword
Prostate cancer, prostate-specific antigen, single nucleotide polymorphism
National Category
Urology and Nephrology
Research subject
Urology
Identifiers
urn:nbn:se:umu:diva-42843 (URN)978-91-7459-134-7 (ISBN)
Public defence
2011-05-13, Sal E04, Byggnad 6E, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
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Supervisors
Available from: 2011-04-21 Created: 2011-04-14 Last updated: 2011-04-21Bibliographically approved

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Holmström, BennyStattin, Pär

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