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Ventimiglia, E., Gedeborg, R., Styrke, J., Robinson, D., Stattin, P. & Garmo, H. (2024). Natural history of nonmetastatic prostate cancer managed with watchful waiting. JAMA Network Open, Article ID e2414599.
Öppna denna publikation i ny flik eller fönster >>Natural history of nonmetastatic prostate cancer managed with watchful waiting
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2024 (Engelska)Ingår i: JAMA Network Open, E-ISSN 2574-3805, artikel-id e2414599Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

Importance: It is uncertain to what extent watchful waiting (WW) in men with nonmetastatic prostate cancer (PCa) and a life expectancy of less than 10 years is associated with adverse consequences.

Objective: To report transitions to androgen deprivation therapy (ADT), castration-resistant prostate cancer (CRPC), death from PCa, or death from other causes in men treated with a WW strategy.

Design, Setting, and Participants: This nationwide, population-based cohort study included men with nonmetastatic PCa diagnosed since 2007 and registered in the National Prostate Cancer Register of Sweden with WW as the primary treatment strategy and with life expectancy less than 10 years. Life expectancy was calculated based on age, the Charlson Comorbidity Index (CCI), and a drug comorbidity index. Observed state transition models complemented observed data to extend follow-up to more than 20 years. Analyses were performed between 2022 and 2023.

Exposure: Nonmetastatic PCa.

Main Outcomes and Measures: Transitions to ADT, CRPC, death from PCa, and death from other causes were measured using state transition modeling.

Results: The sample included 5234 men (median [IQR] age at diagnosis, 81 [79-84] years). After 5 years, 954 men with low-risk PCa (66.2%) and 740 with high-risk PCa (36.1%) were still alive and not receiving ADT. At 10 years, the corresponding proportions were 25.5% (n = 367) and 10.4% (n = 213), respectively. After 10 years, 59 men with low-risk PCa (4.1%) and 221 with high-risk PCa (10.8%) had transitioned to CRPC. Ten years after diagnosis, 1330 deaths in the low-risk group (92.3%) and 1724 in the high-risk group (84.1%) were from causes other than PCa.

Conclusions and Relevance: These findings suggest that the WW management strategy is appropriate for minimizing adverse consequences of PCa in men with a baseline life expectancy of less than 10 years.

Ort, förlag, år, upplaga, sidor
American Medical Association (AMA), 2024
Nationell ämneskategori
Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-225966 (URN)10.1001/jamanetworkopen.2024.14599 (DOI)38833251 (PubMedID)2-s2.0-85195009376 (Scopus ID)
Forskningsfinansiär
Cancerfonden, 190030Region Uppsala
Tillgänglig från: 2024-06-11 Skapad: 2024-06-11 Senast uppdaterad: 2024-06-11
Stattin, P., Fleming, S., Lin, X., Lefresne, F., Brookman-May, S. D., Mundle, S. D., . . . Garmo, H. (2024). Population-based study of disease trajectory after radical treatment for high-risk prostate cancer. BJU International
Öppna denna publikation i ny flik eller fönster >>Population-based study of disease trajectory after radical treatment for high-risk prostate cancer
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2024 (Engelska)Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410XArtikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

Objectives: To investigate long-term disease trajectories among men with high-risk localized or locally advanced prostate cancer (HRLPC) treated with radical radiotherapy (RT) or radical prostatectomy (RP).

Material and Methods: Men diagnosed with HRLPC in 2006–2020, who received primary RT or RP, were identified from the Prostate Cancer data Base Sweden (PCBaSe) 5.0. Follow-up ended on 30 June 2021. Treatment trajectories and risk of death from prostate cancer (PCa) or other causes were assessed by competing risk analyses using cumulative incidence for each event.

Results: In total, 8317 men received RT and 4923 men underwent RP. The median (interquartile range) follow-up was 6.2 (3.6–9.5) years. After RT, the 10-year risk of PCa-related death was 0.13 (95% confidence interval [CI] 0.12–0.14) and the risk of death from all causes was 0.32 (95% CI 0.31–0.34). After RP, the 10-year risk of PCa-related death was 0.09 (95% CI 0.08–0.10) and the risk of death from all causes was 0.19 (95% CI 0.18–0.21). The 10-year risks of androgen deprivation therapy (ADT) as secondary treatment were 0.42 (95% CI 0.41–0.44) and 0.21 (95% CI 0.20–0.23) after RT and RP, respectively. Among men who received ADT as secondary treatment, the risk of PCa-related death at 10 years after initiation of ADT was 0.33 (95% CI 030–0.36) after RT and 0.27 (95% CI 0.24–0.30) after RP.

Conclusion: Approximately one in 10 men with HRLPC who received primary RT or RP had died from PCa 10 years after diagnosis. Approximately one in three men who received secondary ADT, an indication of PCa progression, died from PCa 10 years after the start of ADT. Early identification and aggressive treatment of men with high risk of progression after radical treatment are warranted.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2024
Nyckelord
androgen deprivation therapy, disease progression, disease trajectories, mortality, prostate cancer, prostatectomy, radiotherapy
Nationell ämneskategori
Urologi och njurmedicin
Identifikatorer
urn:nbn:se:umu:diva-224254 (URN)10.1111/bju.16362 (DOI)001202606700001 ()38621388 (PubMedID)2-s2.0-85190946140 (Scopus ID)
Tillgänglig från: 2024-05-14 Skapad: 2024-05-14 Senast uppdaterad: 2024-05-14
Jochems, S. H. J., Häggström, C., Stattin, P., Järvholm, B. & Stocks, T. (2022). Association of Blood Pressure with Prostate Cancer Risk by Disease Severity and Prostate Cancer Death. Cancer Epidemiology, Biomarkers and Prevention, 31(7), 1483-1491
Öppna denna publikation i ny flik eller fönster >>Association of Blood Pressure with Prostate Cancer Risk by Disease Severity and Prostate Cancer Death
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2022 (Engelska)Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 31, nr 7, s. 1483-1491Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: The association of blood pressure (BP) with prostate cancer risk after accounting for asymptomatic prostate-specific antigen (PSA) testing, and with prostate cancer death, is unclear.

METHODS: We investigated BP, measured at a mean age of 38 years among 430,472 men from five Swedish cohorts, in association with incident prostate cancer (n = 32,720) and prostate cancer death (n = 6718). HRs were calculated from multivariable Cox regression models.

RESULTS: Increasing systolic and diastolic BP levels combined were associated with a slightly lower prostate cancer risk, with a HR of 0.98 (95% CI, 0.97-0.99) per standard deviation (SD) of mid-BP (average of systolic and diastolic BP). The association was restricted to the PSA era (1997 onwards, HR, 0.96; 95% CI, 0.95-0.98), to diagnoses initiated by a PSA test in asymptomatic men (HR, 0.95; 95% CI, 0.93-0.97), and to low-risk prostate cancer (HR, 0.95; 95% CI, 0.92-0.97). There was no clear association with more advanced disease at diagnosis. In cases, a slightly higher risk of prostate cancer death was observed for higher BP levels (HR, 1.05; 95% CI, 1.01-1.08) per SD of mid-BP; however, the association was restricted to distant metastatic disease (Pheterogeneity between case groups = 0.01), and there was no association for BP measured less than 10 years prior to diagnosis.

CONCLUSIONS: Prediagnostic BP is unlikely an important risk factor for prostate cancer development and death. Less asymptomatic PSA testing among men with higher BP levels may explain their lower risk of prostate cancer.

IMPACT: Elevated BP is unlikely to be an important risk factor for prostate cancer.

Nationell ämneskategori
Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-198223 (URN)10.1158/1055-9965.EPI-22-0159 (DOI)000823311200001 ()35511742 (PubMedID)2-s2.0-85133980998 (Scopus ID)
Forskningsfinansiär
Vetenskapsrådet, 2017-00650Vetenskapsrådet, 2015-02332Vetenskapsrådet, 2018-02825Cancerfonden, 2017/1019
Tillgänglig från: 2022-07-21 Skapad: 2022-07-21 Senast uppdaterad: 2023-05-24Bibliografiskt granskad
Braide, K., Kindblom, J., Thellenberg-Karlsson, C., Stattin, P., Hugosson, J. & Månsson, M. (2022). Risk of severe late toxicity after radiotherapy following radical prostatectomy: a nationwide study. BJU International, 130(6), 799-808
Öppna denna publikation i ny flik eller fönster >>Risk of severe late toxicity after radiotherapy following radical prostatectomy: a nationwide study
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2022 (Engelska)Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 130, nr 6, s. 799-808Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To estimate the long-term risks of severe late toxicities for radiation therapy (RT) following radical prostatectomy (RP) in an unselected nationwide cohort, as severe side-effects are rare but may occur years later. Patients and Methods: The study population comprised all men undergoing RP between 1997 and 2016 in the Prostate Cancer database Sweden (PCBaSe) (n = 40 962). By (1:2) matching, two cohorts were created: 2789 men exposed to postoperative RT and 5578 unexposed men with comparable age, comorbidities, and year of surgery. Cumulative incidences and rate ratios were calculated for the following outcomes: symptoms and interventions of the urinary or intestinal tract demanding inpatient care, secondary malignancies, and non-prostate cancer mortality. Results: The largest differences were seen for late toxicities affecting the urinary tract. The 10-year cumulative incidences among those exposed to postoperative RT vs the RP-only group were: 17.8% vs 10.5% for procedures of the urinary tract (difference 7.3%, 95% confidence interval [CI] 4.4 to 10.3; relative risk [RR] 1.74, 95% CI 1.47 to 2.05); 6.0% vs 1.2% for haematuria (difference 4.8%, 95% CI 3.1 to 6.5; RR 6.50, 95% CI 4.31 to 10.10); and 2.4% vs 1.1% for bladder cancer (difference 1.4%, 95% CI 0.4 to 2.3; RR 2.71, 95% CI 1.72 to 4.33). The groups were similar regarding intestinal toxicity, other secondary malignancies, and non-prostate cancer mortality. Adjustments for preoperative tumour risk factors did not importantly affect the rate ratios. Conclusion: Severe late toxicity after postoperative RT following RP predominately affects the bladder and can appear many years after RT.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2022
Nyckelord
mortality, prostate cancer, salvage radiation, secondary malignancy, side-effects
Nationell ämneskategori
Urologi och njurmedicin Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-196102 (URN)10.1111/bju.15769 (DOI)000798407900001 ()35523728 (PubMedID)2-s2.0-85130287887 (Scopus ID)
Tillgänglig från: 2022-06-20 Skapad: 2022-06-20 Senast uppdaterad: 2022-12-30Bibliografiskt granskad
Lundström, K.-J., Garmo, H., Gedeborg, R., Stattin, P. & Styrke, J. (2021). Short-term ciprofloxacin prophylaxis for prostate biopsy and risk of aortic aneurysm: nationwide, population-based cohort study. Scandinavian journal of urology, 55(3), 221-226
Öppna denna publikation i ny flik eller fönster >>Short-term ciprofloxacin prophylaxis for prostate biopsy and risk of aortic aneurysm: nationwide, population-based cohort study
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2021 (Engelska)Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 55, nr 3, s. 221-226Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: The use of quinolones has recently been questioned due to reports on side effects including an increased risk of aortic aneurysm. The aim of the study was to examine the risk of aortic aneurysm (AA) after short-term ciprofloxacin as prophylaxis for prostate biopsy.

Materials and Methods: We used the Prostate Cancer data Base Sweden and investigated 192,024 prostate biopsy exposures vs. 554,974 non-exposures for risk of AA. Prostate biopsy was used as a proxy for quinolone use as short-term ciprofloxacin is the recommended and documented prophylaxis in Sweden for this procedure. The outcome was the hazard ratio (HR) of AA in men who underwent a biopsy vs. those that did not.

Results: The absolute risk of AA was small, 39/10,000 person years for all AÁs and for ruptured AÁs 3.5/10,000 person years. In multivariate analyses, there were small, non-significant increases in risk of all AA’s (adjusted HR = 1.13, 95% CI: 0.91 to 1.39) and ruptured AÁs (adjusted HR = 1.05, 95% CI: 0.52 to 2.15) in men who underwent biopsy. A significantly increased risk of AA was observed in men diagnosed with high-risk prostate cancer on biopsy (HR = 1.50, 95% CI: 1.15–2.21). The use of prostate biopsy as a proxy for exposure to ciprofloxacin was a limitation of the study.

Conclusions: Short-term ciprofloxacin was not associated with an increased risk of aortic aneurysm and the increased risk in men with high-risk prostate cancer was likely due detection bias caused by imaging more commonly performed in these men.

Ort, förlag, år, upplaga, sidor
Taylor & Francis Group, 2021
Nyckelord
aortic aneurysm, ciprofloxacin, prophylaxis, Prostate biopsy
Nationell ämneskategori
Urologi och njurmedicin
Identifikatorer
urn:nbn:se:umu:diva-183575 (URN)10.1080/21681805.2021.1916072 (DOI)000667306600001 ()33908321 (PubMedID)2-s2.0-85105230378 (Scopus ID)
Forskningsfinansiär
Vetenskapsrådet, 2017-00847
Tillgänglig från: 2021-06-02 Skapad: 2021-06-02 Senast uppdaterad: 2022-01-12Bibliografiskt granskad
Lundström, K.-J., Söderstrom, L., Jernow, H., Stattin, P. & Nordin, P. (2019). Epidemiology of hydrocele and spermatocele; incidence, treatment and complications. Scandinavian journal of urology, 53(2-3), 134-138
Öppna denna publikation i ny flik eller fönster >>Epidemiology of hydrocele and spermatocele; incidence, treatment and complications
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2019 (Engelska)Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 2-3, s. 134-138Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives: To estimate the incidence of men seeking specialized care and receiving treatment for hydro or spermatocele complaints. Also, to determine the risk of complications of treatment.

Materials and methods: The total number of men living in Sweden each year from 2005 to 2014 was used to calculate incidence and age distribution of adult (≥18 years) men seeking specialized healthcare with either hydro or spermatocele. This was done by using nationwide registries, mandatory by law. They contain information on primary or discharge diagnosis, procedure codes and antibiotic prescriptions. Also, complication rates comparing aspiration (with or without sclerotherapy) and conventional surgery were analysed.

Results: The incidence of men with either hydro or spermatocele diagnosis in specialized healthcare was ∼100/100,000 men. The treatment incidence was 17/100,000 men. Orchiectomy was used as primary treatment in 2.4% of cases. The risk of experiencing a complication was clinically and statistically significantly increased with conventional surgery as compared with aspiration, 17.5% (1607/9174) vs 4.6% (181/3920), corresponding to relative risk of 3.79 (95% CI = 3.27–4.40). Hematoma and infections were the most common complications.

Conclusion: Hydro and spermatoceles are common, affecting elderly men. Aspiration seems advantageous with respect to complications and can be recommended due to the benign course of the disease. The indication for conventional surgery might be questioned such as the use of orchiectomy as primary treatment.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2019
Nyckelord
Testicular hydrocele, spermatocele, incidence, postoperative complications
Nationell ämneskategori
Urologi och njurmedicin
Identifikatorer
urn:nbn:se:umu:diva-158954 (URN)10.1080/21681805.2019.1600582 (DOI)000465949700001 ()30990342 (PubMedID)2-s2.0-85064609438 (Scopus ID)
Tillgänglig från: 2019-05-27 Skapad: 2019-05-27 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Fritz, J., Bjorge, T., Nagel, G., Concin, H., Manjer, J., Häggström, C., . . . Ulmer, H. (2019). Insulin resistance measured by the triglyceride-glucose index and risk of obesity-related cancers: An epidemiological investigation in more than 500,000 individuals.. Paper presented at Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), MAY 31-JUN 04, 2019, Chicago, IL. Journal of Clinical Oncology, 37(15), 1552-1552
Öppna denna publikation i ny flik eller fönster >>Insulin resistance measured by the triglyceride-glucose index and risk of obesity-related cancers: An epidemiological investigation in more than 500,000 individuals.
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2019 (Engelska)Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 37, nr 15, s. 1552-1552Artikel i tidskrift, Meeting abstract (Övrigt vetenskapligt) Published
Abstract [en]

Background: The role of insulin resistance as a mediator in the association of body mass index (BMI) with site-specific cancer risk has, to our knowledge, never been systematically quantified. We aimed to determine to what extent insulin resistance measured as the logarithmized triglyceride glucose product (TyG index) mediates the effect of BMI on risk of obesity-related cancers. Methods: A total of 510,471 individuals from six European cohorts with a mean age of 43.1 years were included in the study. We fitted Cox models, adjusted for relevant confounders, to investigate associations of TyG index with ten common obesity-related cancer sites, and quantified the proportion of the effect of BMI mediated through TyG index. Results: During a median follow-up of 17.2 years, 16 052 individuals developed obesity-related cancers. TyG index was associated with the risk of cancers of the kidney (hazard ratio (HR) per one standard deviation increase 1.13, 95% confidence interval: 1.07-1.20), liver (1.13, 1.04-1.23), pancreas (1.12, 1.06-1.19), colon (1.07, 1.03-1.10), and rectum (1.09, 1.04-1.14). Substantial proportions of the effect of BMI were mediated by TyG index for cancers of the pancreas (42%), rectum (34%), and colon (20%); smaller proportions for kidney (15%) and liver (11%); none for endometrium, ovary and breast (postmenopausal). Conclusions: In this pooled cohort study including more than 500,000 individuals, insulin resistance measured as the logarithmized triglyceride glucose product significantly mediated the effect of overweight and obesity on risk of cancers of the kidney, liver, pancreas, colon, and rectum. In contrast, insulin resistance did not mediate the risk for cancers of the endometrium, ovary and breast. Our results confirm a promoting role of insulin resistance in the pathogenesis of gastrointestinal cancers. Although often claimed, insulin resistance does not appear to connect excess body weight with cancers of the female reproductive organs.

Ort, förlag, år, upplaga, sidor
American Society of Clinical Oncology, 2019
Nationell ämneskategori
Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-164084 (URN)10.1200/JCO.2019.37.15_suppl.1552 (DOI)000487345804348 ()
Konferens
Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), MAY 31-JUN 04, 2019, Chicago, IL
Anmärkning

Supplement: S (May 20, 2019)

Meeting Abstract: 1552

Tillgänglig från: 2019-10-14 Skapad: 2019-10-14 Senast uppdaterad: 2019-10-14Bibliografiskt granskad
Adamo, H. H., Hammarsten, P., Hägglöf, C., Scherdin, T. D., Egevad, L., Stattin, P., . . . Bergh, A. (2019). Prostate cancer induces C/EBPβ expression in surrounding epithelial cells which relates to tumor aggressiveness and patient outcome. The Prostate, 79(5), 435-445
Öppna denna publikation i ny flik eller fönster >>Prostate cancer induces C/EBPβ expression in surrounding epithelial cells which relates to tumor aggressiveness and patient outcome
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2019 (Engelska)Ingår i: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 79, nr 5, s. 435-445Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Implantation of rat prostate cancer cells into the normal rat prostate results in tumor-stimulating adaptations in the tumor-bearing organ. Similar changes are seen in prostate cancer patients and they are related to outcome. One gene previously found to be upregulated in the non-malignant part of tumor-bearing prostate lobe in rats was the transcription factor CCAAT/enhancer-binding protein- (C/EBP).

Methods: To explore this further, we examined C/EBP expression by quantitative RT-PCR, immunohistochemistry, and Western blot in normal rat prostate tissue surrounding slow-growing non-metastatic Dunning G, rapidly growing poorly metastatic (AT-1), and rapidly growing highly metastatic (MatLyLu) rat prostate tumors?and also by immunohistochemistry in a tissue microarray (TMA) from prostate cancer patients managed by watchful waiting.

Results: In rats, C/EBP mRNA expression was upregulated in the surrounding tumor-bearing prostate lobe. In tumors and in the surrounding non-malignant prostate tissue, C/EBP was detected by immunohistochemistry in some epithelial cells and in infiltrating macrophages. The magnitude of glandular epithelial C/EBP expression in the tumor-bearing prostates was associated with tumor size, distance to the tumor, and metastatic capacity. In prostate cancer patients, high expression of C/EBP in glandular epithelial cells in the surrounding tumor-bearing tissue was associated with accumulation of M1 macrophages (iNOS+) and favorable outcome. High expression of C/EBP in tumor epithelial cells was associated with high Gleason score, high tumor cell proliferation, metastases, and poor outcome.

Conclusions: This study suggest that the expression of C/EBP-beta, a transcription factor mediating multiple biological effects, is differentially expressed both in the benign parts of the tumor-bearing prostate and in prostate tumors, and that alterations in this may be related to patient outcome.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2019
Nyckelord
biomarkers, C, EBP, prostate cancer, tumors instruct adjacent tissues
Nationell ämneskategori
Cancer och onkologi Urologi och njurmedicin
Identifikatorer
urn:nbn:se:umu:diva-157947 (URN)10.1002/pros.23749 (DOI)000461573200001 ()30536410 (PubMedID)2-s2.0-85058246499 (Scopus ID)
Forskningsfinansiär
Vetenskapsrådet, Co257301Cancerfonden, 130293Cancerforskningsfonden i Norrland, LP 14-2051Cancerforskningsfonden i Norrland, AMP 15-756
Tillgänglig från: 2019-04-17 Skapad: 2019-04-17 Senast uppdaterad: 2023-12-15Bibliografiskt granskad
Crawley, D., Garmo, H., Rudman, S., Stattin, P., Zethelius, B., Holmberg, L., . . . Van Hemelrijck, M. (2018). Association between type 2 diabetes, curative treatment and survival in men with intermediate- and high-risk localized prostate cancer. BJU International, 121(2), 209-216
Öppna denna publikation i ny flik eller fönster >>Association between type 2 diabetes, curative treatment and survival in men with intermediate- and high-risk localized prostate cancer
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2018 (Engelska)Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 121, nr 2, s. 209-216Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To investigate whether curative prostate cancer (PCa) treatment was received less often by men with both PCa and Type 2 diabetes mellitus (T2DM) as little is known about the influence of T2DM diagnosis on the receipt of such treatment in men with localized PCa.

Subjects and Methods: The Prostate Cancer database Sweden (PCBaSe) was used to obtain data on men with T2DM and PCa (n = 2210) for comparison with data on men with PCa only (n = 23 071). All men had intermediate-(T1-2, Gleason score 7 and/or prostate-specific antigen [PSA] 10-20 ng/mL) or high-risk (T3 and/or Gleason score 8-10 and/or PSA 20-50 ng/mL) localized PCa diagnosed between 1 January 2006 and 31 December 2014. Multivariate logistic regression was used to calculate the odds ratios (ORs) for receipt of curative treatment in men with and without T2DM. Overall survival, for up to 8 years of follow-up, was calculated both for men with T2DM only and for men with T2DM and PCa.

Results: Men with T2DM were less likely to receive curative treatment for PCa than men without T2DM (OR 0.78, 95% confidence interval 0.69-0.87). The 8-year overall survival rates were 79% and 33% for men with T2DM and high-risk PCa who did and did not receive curative treatment, respectively.

Conclusions: Men with T2DM were less likely to receive curative treatment for localized intermediate-and high-risk PCa. Men with T2DM and high-risk PCa who received curative treatment had substantially higher survival times than those who did not. Some of the survival differences represent a selection bias, whereby the healthiest patients received curative treatment. Clinicians should interpret this data carefully and ensure that individual patients with T2DM and PCa are not under-nor overtreated.

Ort, förlag, år, upplaga, sidor
WILEY, 2018
Nyckelord
diabetes, curative treatment, prostatectomy, external beam radiotherapy, #ProstateCancer, #PCSM
Nationell ämneskategori
Urologi och njurmedicin
Identifikatorer
urn:nbn:se:umu:diva-144946 (URN)10.1111/bju.13880 (DOI)000424029800012 ()28418195 (PubMedID)2-s2.0-85019578089 (Scopus ID)
Tillgänglig från: 2018-02-23 Skapad: 2018-02-23 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
FitzGerald, L. M., Zhao, S., Leonardson, A., Geybels, M. S., Kolb, S., Lin, D. W., . . . Stanford, J. L. (2018). Germline variants in IL4, MGMT and AKT1 are associated with prostate cancer-specific mortality: an analysis of 12,082 prostate cancer cases. Prostate Cancer and Prostatic Diseases, 21(2), 228-237
Öppna denna publikation i ny flik eller fönster >>Germline variants in IL4, MGMT and AKT1 are associated with prostate cancer-specific mortality: an analysis of 12,082 prostate cancer cases
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2018 (Engelska)Ingår i: Prostate Cancer and Prostatic Diseases, ISSN 1365-7852, E-ISSN 1476-5608, Vol. 21, nr 2, s. 228-237Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Prostate cancer (PCa) is a leading cause of mortality and genetic factors can influence tumour aggressiveness. Several germline variants have been associated with PCa-specific mortality (PCSM), but further replication evidence is needed. Methods Twenty-two previously identified PCSM-associated genetic variants were genotyped in seven PCa cohorts (12,082 patients; 1544 PCa deaths). For each cohort, Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for risk of PCSM associated with each variant. Data were then combined using a meta-analysis approach. Results Fifteen SNPs were associated with PCSM in at least one of the seven cohorts. In the meta-analysis, after adjustment for clinicopathological factors, variants in the MGMT (rs2308327; HR 0.90; p-value = 3.5 x 10(-2)) and IL4 (rs2070874; HR 1.22; p-value = 1.1 x 10(-3)) genes were confirmed to be associated with risk of PCSM. In analyses limited to men diagnosed with local or regional stage disease, a variant in AKT1, rs2494750, was also confirmed to be associated with PCSM risk (HR 0.81; p-value = 3.6 x 10(-2)). Conclusions This meta-analysis confirms the association of three genetic variants with risk of PCSM, providing further evidence that genetic background plays a role in PCa-specific survival. While these variants alone are not sufficient as prognostic biomarkers, these results may provide insights into the biological pathways modulating tumour aggressiveness.

Ort, förlag, år, upplaga, sidor
Nature Publishing Group, 2018
Nationell ämneskategori
Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-150859 (URN)10.1038/s41391-017-0029-2 (DOI)000437334500010 ()29298992 (PubMedID)2-s2.0-85040017696 (Scopus ID)
Tillgänglig från: 2018-09-07 Skapad: 2018-09-07 Senast uppdaterad: 2018-09-07Bibliografiskt granskad
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