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Introduction: Up to 20% of aging men have low serum testosterone (late-onset hypogonadism [LOH]), and approximately 80% develop benign prostatic enlargement (BPE) with increasing age. Both age and prostate size are linked to lower urinary tract symptoms (LUTS). This study aimed to evaluate the effect of testosterone replacement therapy (TRT) on prostate volume and LUTS in men with LOH.

Materials and methods: From 2004 to 2017, 511 men underwent annual checkups including physical examination, transrectal ultrasound, bladder scanning, serum Prostate-Specific Antigen (s-PSA), and serum testosterone and questionnaires on LUTS and LOH symptoms. None had prior treatments affecting prostate size or LUTS at baseline. During the annual follow-ups, 167 men (33%) were diagnosed with symptomatic LOH and received TRT. A longitudinal statistical model was used to compare periods with and without treatment regarding prostate growth, post-void residual urine, IPSS (International Prostate Symptom Score), quality of life (QoL), and s-PSA.

Results: Participants contributed 3745 visits (median 7 per man), including 904 (24%) after testosterone initiation. TRT was associated with a mean increase in prostate growth rate of 0.22 mL/year compared with untreated periods (p = 0.023). No significant differences were observed in LUTS, QoL, or s-PSA between treated and untreated periods

Conclusion: In ageing males with late-onset hypogonadism, testosterone replacement therapy was linked to a small but statistically significant increase in prostate growth rate without measurable effects on urinary symptoms.

Objectives: To compare overall and cancer-specific survival for clinical (c)T1aN0M0 renal cell carcinoma (RCC) in patients treated with non-surgical management (NSM: surveillance and watchful waiting) or active treatment (surgery and ablative treatments).

Patients and methods: In this nationwide real-world population-based cohort study, data on clinical, demographic, and socioeconomic factors as well as tumour characteristics and cause of death were retrieved from the Renal Cell Carcinoma Database Sweden (RCCBaSe) for 3989 patients diagnosed with cT1aN0M0 RCC, 2011–2020 and treated with either NSM or active treatment. Differences in survival between NSM and active treated patients were analysed using standard and competing-risks Cox regression models.

Results: In total, 3727 (93.4%) patients underwent active treatments, while 262 patients (6.6%) were treated with NSM. Patients in the NSM group were significantly older and had a higher comorbidity burden. During a median follow-up time of 4.1 years, all-cause mortality was significantly higher among the NSM (38.9%) than the actively treated (10.9%) patients (P < 0.001), as was cancer-specific mortality (13.0% vs 3.4%, P < 0.001). Larger tumours, older age, male sex, increased comorbidity, being unmarried or widowed, having lower disposable income, and having clear cell or papillary RCC compared with chromophobe RCC were all independently associated with poorer overall and cancer-specific survival. One of the limitations is that treatment allocation was not randomised.

Conclusion: Non-surgical management of cT1aN0M0 RCC was associated with poorer survival compared with surgery/ablation and should be offered mainly for patients with limited life expectancy and indolent renal tumours.

Background: Bladder cancer is one of the ten most common cancers worldwide. Its etiology is affected by several lifestyles, environment, and exposures such as smoking. Low vitamin D has been suggested as a risk factor. We aimed to evaluate vitamin D, D-vitamin binding protein (DVBP), and the free vitamin D index longitudinally in pre-diagnostic and diagnostic samples, as well as in patients with clinically diagnosed bladder cancer, in relation to control individuals.

Methods: The pre-diagnostic study population is derived from the population-based Northern Sweden Health and Disease Study (NSHDS). A total of 377 individuals were identified with the diagnosis of bladder carcinoma, and 377 matched controls from the same cohort. Furthermore, 353 patients were included, clinically diagnosed with bladder carcinoma, with blood samples from diagnosis. Of these, 129 had pre-diagnostic samples collected a median of 13.8 years earlier.

Results: Pre-diagnostic vitamin D, DVBP levels, and free vitamin D-index did not differ between those who later developed bladder cancer and controls. In the 129 patients with longitudinal samples, diagnostic Vitamin D levels were lower, and DVPB levels were higher at diagnosis compared to pre-diagnostic levels.

Conclusion: D-vitamin levels are lower at bladder cancer diagnosis compared to levels 13.8 years earlier. Additionally, the pre-diagnostic vitamin D levels did not differ from those of matched controls. Thus, we found no evidence that vitamin D would be an etiological risk factor for bladder cancer. The reduced D-vitamin levels at diagnosis in patients with bladder cancer instead indicate effects of the malignant disease itself.

Objectives: This study aimed to identify clinical and socioeconomic factors associated with treatment selection and survival in patients diagnosed with synchronous metastatic renal cell carcinoma (mRCC).

Patients and Methods: The Renal Cell Cancer Database Sweden (RCCBaSe2.0), linking the National Swedish Kidney Cancer Register with other national quality registers, was used to identify all patients with synchronous mRCC diagnosed 1 January 2014–1 July 2019 (n = 951); thus, it was performed during the tyrosine kinase inhibitor era. Logistic and Cox regression were used to evaluate associations with treatment selection, overall survival (OS) and cancer-specific survival (CSS).

Results: Upfront cytoreductive nephrectomy (uCN) was the primary treatment in 56% of patients and was associated with larger primaries and treatment at university hospitals. Immediate systemic treatment (IST) was chosen in 32% and associated with multidisciplinary team (MDT) discussions, cN1 disease, more metastatic sites and higher comorbidity index. Gender, income, education level or marital status were not associated with upfront treatment. Patients selected for uCN had longer OS and CSS compared with those allocated to IST. This association remained when adjusting for selection factors. Socioeconomic factors were not linked to survival. Limitations include the retrospective design and the lack of detailed data on the International mRCC Database Consortium risk factors.

Conclusion: Tumour-related factors had significant effects on the choice to perform uCN or not. Patients with more advanced disease, higher comorbidity index and those discussed at MDT were more likely to be offered immediate systemic treatment. Socioeconomic status did not affect treatment allocation or survival, indicating equal healthcare access for Swedish mRCC patients.

Purpose: To examine sex differences in health-related quality of life (HRQoL) among patients surgically treated for renal cell carcinoma (RCC) in Sweden, utilizing data from the National Swedish Kidney Cancer Register (NSKCR).

Methods: In this study of 4658 surgically treated RCC patients, data on HRQoL, clinical, demographic, and socioeconomic characteristics were retrieved from the NSKCR for patients undergoing surgical treatment between January 2016, and April 2024. HRQoL was measured using the 14- and 19-item versions of the Functional Assessment of Cancer Therapy – Kidney Symptom Index (FKSI-14/19) instrument six months after surgery. The association between sex and HRQoL was estimated using linear regression. Separate analyses were performed for the FKSI-14 and FKSI-19 total scores and underlying domains.

Results: In total, 3086 (66.3%) men and 1572 (33.7%) women were included. After adjusting for clinical, demographic, and socioeconomic characteristics, male sex was significantly associated with higher HRQoL. Specifically, men had higher scores, indicating fewer symptoms, for physical and mental symptoms according to FKSI-14 (P < 0.001), and for physical (P < 0.001) and emotional (P < 0.001) disease-related symptoms, as well as treatment side effects (P < 0.022), according to FKSI-19. Total HRQoL was significantly higher in men, according to both the FKSI-14 (P < 0.001) and the FKSI-19 (P < 0.001).

Conclusions: HRQoL differed significantly between men and women six months after surgery, with men reporting higher HRQoL, even after accounting for clinical, demographic, and socioeconomic factors. Healthcare professionals should be aware of the risk of lower HRQoL among female patients.

Prostate cancer treatment depends on whether the cancer exists only inside the gland or within the prostate capsule or on the outside surface of the gland. The presence on the outside surface indicates migration of the cancer to adjacent organs. This study presents a novel method for detecting prostate cancer (PCa) on the surface of excised prostate glands using Raman spectroscopy and stiffness measurements. The workflow involves assessing the location and extent of PCa via MRI before surgery, followed by 3D scanning of the excised prostate. Key positions on ten excised prostates, 211 positions with 56 deemed as cancer, are measured using Raman spectroscopy and stiffness probes. The results are mapped onto a digital representation of the prostate to aid surgical decision-making. Statistical analysis of the Raman data indicates that spectra could be divided into two components, one more related to cancer and one more related to normal tissue. A stiffness parameter was calculated from resonance measurements from the stiffness probe. The Raman components and stiffness parameters were converted to z-scores. Logistic generalized linear mixed modelling revealed that the stiffness parameter was statistically associated with cancer presence in prostate regions (p = 0.009). The scanning equipment is easy to handle and makes further larger studies possible. This method holds promise for providing real-time support during surgery, reducing the need for post-surgical therapies and minimizing patient distress.

Background: Abdominal bulging affects up to one-fourth of patients after flank incision, with half experiencing impaired quality of life. Identifying patients at risk for morbid bulge could improve preventive and supportive care.

Purpose: To characterise muscular changes related to postoperative abdominal bulging and design a visual scoring system to grade bulge on postoperative CT scans

Material and Methods: Patients treated with open partial nephrectomy via a flank incision between 2005 and 2016 at the University Hospital of Ume & aring; were included. Pre- and postoperative CT scans of the first 50 consecutive patients were used to characterise imaging features of the postoperative abdominal wall. From these features, a four-tiered scoring system for abdominal bulge was designed. Two independent observers tested the system on CT scans from the 50 next patients. Inter-rater reliability was assessed using Fleiss' Kappa.

Results: Common features of abdominal bulging were extracted and a four-tier visual score ranging from normal abdominal wall to severe bulge was developed. Among the patients, similar to 70% had a normal abdominal wall, similar to 25% had bulge score 1, similar to 7% score 2, and similar to 1% score 3. Inter-rater agreement was 73.5%, with Fleiss' Kappa 0.44.

Conclusion: Features of bulge were reduced muscle thickness and ipsilateral gravitational slump affecting part or all of the lateral abdominal wall. The proposed scoring system demonstrated only moderate inter-rater reliability in this pilot setting. Further research on postoperative abdominal wall changes is needed before implementing imaging-based assessments in clinical care.

In renal cell carcinoma (RCC), a majority of the patients are today diagnosed incidentally due to the frequent use of cross-sectional imaging. This has resulted in the diagnosis of smaller tumours and less advanced tumour stages. Imaging for renal tumour diagnostics and staging aim to differentiate between benign and malignant disease and precise determination of primary tumour extent before decision on treatment strategy. Renal tumour biopsy serves to determine histology in a renal lesion using image-guided core biopsy to be used for treatment recommendation also in patients with metastatic disease. Treatment options are depending on not only tumour size, local tumour extent and complexity of the tumour but also patient’s comorbidity. Treatment options include surveillance, minimal invasive treatments as ablation and partial nephrectomy for nephron sparing treatment. For locally more advanced RCCs, radical nephrectomy should be considered. Surgery is performed with open technique, laparoscopically or robotic assisted, the latter becoming more frequently used.

Objective: To analyse the budget impact of adopting routine renal tumour biopsy (RTB) prior to decision on surgical treatment for clinical T1 renal tumours in Sweden.

Material and methods: This study used data from the National Swedish Kidney Cancer Register including 4,109 T1N0M0 renal tumours surgically treated during the years 2018–2022. We modelled a gradual increase in the proportion of preoperative RTBs over a five-year period, from 15.6 % of surgically removed clinical T1N0M0 renal tumors up to 90 % preoperative RTBs by 2029. Average costs per patient were calculated primarily using the Swedish cost-per-patient database. The analyses were stratified by tumour diameter: ≤40 mm (cT1a) and 41–70 mm (cT1b). The proportion of patients with benign RTB, complication rate and false negative RTBs was estimated from register data and previous research. A healthcare perspective was used and accounted for costs related to biopsy, surgery, follow-up of benign RTBs, complications and re-biopsy in cases of inconclusive RTBs.

Results: For cT1a, increasing preoperative RTBs to 90% of the study population reduced the net annual costs by €691,620, whilst for cT1b, costs increased by €67,630. Overall, an increase in preoperative RTBs to 90% of all patients with cT1 renal tumours was projected to reduce spending by €623,990 annually.

Conclusions: The budget impact analysis of routine preoperative RTBs in suspected renal cell carcinoma indicates net healthcare cost savings in cT1a and potentially for all cT1 tumours.