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- Godtman, Rebecka Arnsrud, 1981, et al.
(författare)
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Long-Term Outcomes after Deferred Radical Prostatectomy in Men Initially Treated with Active Surveillance
- 2018
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 200:4, s. 779-785
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We sought to determine long-term outcomes after deferred radical prostatectomy. Materials and Methods: The study population consisted of all 132 men with screening detected prostate cancer who underwent deferred radical prostatectomy from January 1, 1995 to December 31, 2014 after active surveillance in the Goteborg Randomized, Population-based Prostate Cancer Screening Trial. The last date of followup was May 15, 2017. Followup during active surveillance was performed with prostate specific antigen tests every 3 to 6 months and repeat biopsies every 2 to 4 years. Triggers for radical prostatectomy were disease progression based on prostate specific antigen, grade and/or stage, or patient request. Outcomes included adverse pathology findings at radical prostatectomy, defined as Gleason score greater than 3 thorn 4, extraprostatic extension, positive margins, seminal vesicle invasion and/or Nthorn, whether the index tumor at radical prostatectomy was identified at biopsy and prostate specific antigen relapse-free survival. Kaplan-Meier analysis was performed. Results: Median time from diagnosis to surgery was 1.9 years (IQR 1.2-4.2) and median postoperative followup was 10.9 years (IQR 7.5-14.5). A total of 52 men (39%) experienced at least 1 unfavorable pathology feature at radical prostatectomy. The 10-year prostate specific antigen relapse-free survival was 79.5%. The index tumor was not identified in the diagnostic biopsy in 38 of the 132 men (29%) or at the last repeat biopsy that preceded radical prostatectomy 22 of 105 (21%). Conclusions: A large proportion of men had unfavorable pathology findings at deferred radical prostatectomy and the index tumor was frequently not identified. There is a clear need for better risk classification and protocols to determine disease progression during active surveillance.
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| 3. |
- Hugosson, Jonas, 1955, et al.
(författare)
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Eighteen-year follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial : effect of sociodemographic variables on participation, prostate cancer incidence and mortality
- 2018
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 52:1, s. 27-37
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study examined whether previously reported results, indicating that prostate-specific antigen (PSA) screening can reduce prostate cancer (PC) mortality regardless of sociodemographic inequality, could be corroborated in an 18 year follow-up. Materials and methods: In 1994, 20,000 men aged 50–64 years were randomized from the Göteborg population register to PSA screening or control (1:1) (study ID: ISRCTN54449243). Men in the screening group (n = 9950) were invited for biennial PSA testing up to the median age of 69 years. Prostate biopsy was recommended for men with PSA ≥2.5 ng/ml. Last follow-up was on 31 December 2012. Results: In the screening group, 77% (7647/9950) attended at least once. After 18 years, 1396 men in the screening group and 962 controls had been diagnosed with PC [hazard ratio 1.51, 95% confidence interval (CI) 1.39–1.64]. Cumulative PC mortality was 0.98% (95% CI 0.78–1.22%) in the screening group versus 1.50% (95% CI 1.26–1.79%) in controls, an absolute reduction of 0.52% (95% CI 0.17–0.87%). The rate ratio (RR) for PC death was 0.65 (95% CI 0.49–0.87). To prevent one death from PC, the number needed to invite was 231 and the number needed to diagnose was 10. Systematic PSA screening demonstrated greater benefit in PC mortality for men who started screening at age 55–59 years (RR 0.47, 95% CI 0.29–0.78) and men with low education (RR 0.49, 95% CI 0.31–0.78). Conclusions: These data corroborate previous findings that systematic PSA screening reduces PC mortality and suggest that systematic screening may reduce sociodemographic inequality in PC mortality.
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| 4. |
- Palmstedt, Emmeli, et al.
(författare)
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Long-term Outcomes for Men in a Prostate Screening Trial with an Initial Benign Prostate Biopsy: A Population-based Cohort
- 2019
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Ingår i: European Urology Oncology. - : Elsevier BV. - 2588-9311. ; 2:6, s. 716-722
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Tidskriftsartikel (refereegranskat)abstract
- Background: The optimal follow-up regimen for men after a benign prostate biopsy remains unknown. Objective: To investigate long-term outcomes for men after an initial benign prostate biopsy. Design, setting, and participants: All men with a benign biopsy in the first screening round of the Goteborg prostate cancer (PC) screening trial were included. The follow-up period was January 1, 1995-May 15, 2017. Intervention: Prostate-specific antigen (PSA) tests were performed every second year (upper median age limit 69 yr). Men with PSA >= 3 ng/ml underwent prostate biopsy (sextant biopsy up to 2009). Outcome measurement and statistical analysis: The 20-yr cumulative PC incidence and PC mortality were calculated using the 1 minus Kaplan-Meier method. Results and limitations: Of 452 men with a benign biopsy and followed for a median of 21.1 yr, 169 were diagnosed with PC and five died from PC. The 20-yr cumulative PC incidence and PC mortality were 40.0% and 1.4%, respectively. The corresponding figures were 38.8% and 0.6% for men with initial PSA <= 10 ng/ml, and 64.4% and 21.4% for PSA >10 ng/ml. The proportion of men untreated at final follow-up was similar in the two PSA groups (22% vs 23%). The use of sextant biopsy for many years of the trial is a limitation. Conclusions: Men with an initial benign prostate biopsy run a very low risk of dying from PC when participating in a screening program. However, if followed for a long period, many men will be diagnosed and treated for PC. Low-intensity follow-up, as in the Goteborg trial, appears sufficient for men with PSA <= 10 ng/ml after a benign biopsy. Patient summary: This study shows that men who participate in a prostate cancer screening trial have a low risk of dying from prostate cancer if the first biopsy does not show cancer. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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