| 1. |
- Aus, Gunnar, 1958, et al.
(författare)
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Individualized screening interval for prostate cancer based on prostate-specific antigen level.
- 2005
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Ingår i: Arch Intern Med. ; 165:16, s. 1857-1861
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of the present study was to evaluate the future cumulative risk of prostate cancer in relation to levels of prostate-specific antigen (PSA) in blood and to determine whether this information could be used to individualize the PSA testing interval. Methods The study included 5855 of 9972 men (aged 50-66 years) who accepted an invitation to participate in a prospective, randomized study of early detection for prostate cancer. We used a protocol based on biennial PSA measurements starting from 1995 and 1996. Men with serum PSA levels of 3.0 ng/mL or more were offered prostate biopsies. Results Among the 5855 men, 539 cases of prostate cancer (9.2%) were detected after a median follow-up of 7.6 years (up to July 1, 2003). Cancer detection rates during the follow-up period in relation to PSA levels were as follows: 0 to 0.49 ng/mL, 0% (0/958); 0.50 to 0.99 ng/mL, 0.9% (17/1992); 1.00 to 1.49 ng/mL, 4.7% (54/1138); 1.50 to 1.99 ng/mL, 12.3% (70/571); 2.00 to 2.49 ng/mL, 21.4% (67/313); 2.50 to 2.99 ng/mL, 25.2% (56/222); 3.00 to 3.99 ng/mL, 33.3% (89/267); 4.00 to 6.99 ng/mL, 38.9% (103/265); 7.00 to 9.99 ng/mL, 50.0% (30/60); and for men with an initial PSA of 10.00 ng/mL or higher, 76.8% (53/69). Not a single case of prostate cancer was detected within 3 years in 2950 men (50.4% of the screened population) with an initial PSA level less than 1 ng/mL. Conclusions Retesting intervals should be individualized on the basis of the PSA level, and the large group of men with PSA levels of less than 1 ng/mL can safely be scheduled for a 3-year testing interval.
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| 2. |
- Stranne, Johan, 1970
(författare)
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Inguinal Hernia after Urologic Surgery in Males with Special Reference to Radical Retropubic Prostatectomy. A Clinical, Epidemiological and Methodological Study
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: In 1996 the first report indicating that inguinal hernia (IH) was a complication to radical retropubic prostatectomy (RRP) was published. The main aims of this thesis were to further establish this relation, to establish the background incidence of IH in men not subjected to surgery, to identify risk factors for postoperative IH occurrence and to investigate whether postoperative IH is a complication also after other types of surgery performed through a lower midline incision. A further aim was to form a hypothesis regarding the etiology of this complication and explore which methodological considerations have to be addressed when postoperative IH incidence is investigated. Materials and methods: A retrospective patient file survey (PFS) was used on 1039 patients subjected to RRP (n=375 [I] + 664 [III]) and pelvic lymph node dissection for staging of prostate cancer before radiotherapy (PLND) (n=184 [I]). The factors studied in the PFS were post-RRP IH incidence, age at RRP, preoperative IH morbidity, postoperative anastomotic stricture, influence of concurrent PLND at RRP and duration of surgery. From the ongoing Scandinavian Prostate Cancer Group (SPCG) 6 study a database search was used where the annual IH incidence for patients not subjected to surgery (n=953) and patients subjected to RRP (n=152) was investigated (II). Two patient administered questionnaires (PAQ) were also used. One prospective PAQ was sent to patients subjected to RRP (n=207) in whom the postoperative IH incidence was studied and preoperative IH morbidity (III). One retrospective PAQ was sent to patients subjected to PLND (n=88), open prostatectomy for benign prostatic hyperplasia (n=95) and cystectomy (n=76) where the postoperative IH incidence was explored (IV). Results and conclusions: The results show that the incidence of IH within 2 years after RRP is increased at least fifteen-fold as compared to a non-surgical group of patients. The background incidence of clinically overt IHs in men with prostate cancer and a mean age of 69 years is less than 0.5% per year. Increased age and preoperative IH morbidity are risk factors, but postoperative anastomotic stricture, concurrent PLND at the time of RRP and duration of surgery do not seem to increase the risk of post-RRP IH development. The risk of postoperative IH development after other urological procedures in males performed through a lower midline incision seems to be of a similar magnitude as following RRP. The incision per se seems to be the cause of the lesion, probably resulting in a direct disruption of the ?shutter mechanism? of the inguinal anulus internus. Constitutional factors predisposing for IH may add to the risk. In the methodological analysis PAQ was found to be superior to PFS to detect previous IH morbidity as well as postoperative IHs.
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| 3. |
- Stranne, Johan, 1970, et al.
(författare)
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Inguinal hernia in stage M0 prostate cancer: a comparison of incidence in men treated with and without radical retropubic prostatectomy--an analysis of 1105 patients
- 2005
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Ingår i: Urology. - : Elsevier BV. - 0090-4295. ; 65:5, s. 847-851
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To analyze the incidence of inguinal hernia (IH) in a large group of patients with nonmetastatic prostate cancer who were treated nonoperatively, and to compare it with the incidence in a subset of patients who had undergone radical retropubic prostatectomy (RRP). IH has been reported in 12% to 21% of men at a mean period of 6 to 10 months after RRP. However, whether IH truly represents a complication after RRP has been somewhat debatable owing to the lack of proper control groups. Methods A total of 953 patients treated without surgery (nonoperative group) and 152 patients who underwent RRP (operative group) were selected from the Scandinavian Prostate Cancer Group Study No. 6 database consisting of 1218 patients with nonmetastatic prostate cancer. Radiotherapy, cryotherapy, and a follow-up duration of less than 3 months were exclusion criteria. Patients were followed up for any new medical condition at 12-week intervals for a mean period of 39 months (nonoperative group) and 50 months (operative group). Results Of the 953 patients in the nonoperative group, 23 (2.4%) developed IH versus 13 (8.6%) of 152 in the operative group (log-rank [Mantel-Cox] P = 0.010). Conclusions Within comparable age groups, the incidence of IH in men with prostate cancer treated without surgery was significantly lower than that after RRP. This phenomenon seems to be causally related to the surgical procedure. The increased risk of IH after RRP deserves further recognition and should be included in the preoperative information given to patients. Studies are warranted to define the causal mechanisms, as well as possible preventive measures. Article Outline Material and methods Results Comment Conclusions Acknowledgements References Display Full Size version of this image (56K) FIGURE 1. Cumulative hernia-free survival time in operative and nonoperative patient groups. TABLE I. Follow-up and patient age Group -------------------------------------------------------------------------------- Follow-up (mo) -------------------------------------------------------------------------------- Age at Beginning of Follow-up (yr) -------------------------------------------------------------------------------- Mean (Median) Range Mean (Median) Range Nonoperative (n = 953) 39 (42) 3–72 69 (70) 53–75 Operative (n = 152) 50 (47) 5–155 63 (64) 45–74 All (n = 1105) 41 (43) 3–155 68 (70)
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| 4. |
- Stranne, Johan, 1970, et al.
(författare)
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Inguinal hernia is a common complication in lower midline incision surgery.
- 2007
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Ingår i: Hernia. - : Springer Science and Business Media LLC. - 1265-4906 .- 1248-9204. ; 11:3, s. 247-252
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Tidskriftsartikel (refereegranskat)abstract
- Inguinal hernia is a known complication after radical retropubic prostatectomy (RRP). We have investigated whether other types of lower midline incision surgery in males increase the risk of inguinal hernia. Male patients operated with open prostatectomy for benign prostate hyperplasia (n = 95), pelvic lymph node dissection for staging of prostate cancer (n = 88), or cystectomy for bladder cancer (n = 76) were identified and were sent questionnaires in which they were asked about postoperative inguinal hernia morbidity. Two-hundred and seventy-one men operated with RRP had previously received a similar questionnaire. The answers were compared with those from a control group of 953 men who had not undergone surgery. Annual attributional hernia morbidity and Kaplan–Meier hernia-free survival were calculated. The cumulative incidence of post-operative inguinal hernia and annual attributional hernia morbidity after the respective surgical procedures were clearly higher during the early years post-operation than for nonoperated patients. Inguinal hernia is a common postoperative complication in males after all the lower midline incision surgery investigated.
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| 5. |
- Stranne, Johan, 1970, et al.
(författare)
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One-third of the Swedish male population over 50 years of age suffers from lower urinary tract symptoms.
- 2009
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Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 43:3, s. 199-205
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the prevalence of and restrictions in various parts of daily life due to lower urinary tract symptoms (LUTS) in an unselected Swedish male population. MATERIAL AND METHODS: A random selection of 3345 men throughout Sweden, aged between 41 and 80, was contacted by telephone and evaluated according to International Prostate Symptom Score (IPSS). The responders were then sent two different questionnaires based on degree of LUTS, IPSS <8 or >7. RESULTS: 2106 men (66%) answered the questionnaire. Of these, 33.4% had an IPSS > 7 and the IPSS increased with age. Of the men with IPSS >7 only 41% had consulted health services for their symptoms and 23% had received treatment. Thirty-seven per cent claimed that their problems had a great negative effect on their quality of life and 77% that they had affected their relationship with their spouse negatively to a great extent. Forty per cent did not consult health services despite their symptoms. In men with an IPSS <8 as many as 33% believed that LUTS would limit them in at least some part of their daily life. CONCLUSIONS: LUTS is a common condition among Swedish men with a severe impact on quality of life and everyday life. Despite readily available medical assistance, two out of five men with LUTS still do not try to obtain a remedy. The data presented here identify a need for improved education regarding LUTS, to increase awareness of the condition and the treatment options that are available.
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| 6. |
- Stranne, Johan, 1970, et al.
(författare)
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Post-radical retropubic prostatectomy inguinal hernia: an analysis of risk factors with special reference to preoperative inguinal hernia morbidity and pelvic lymph node dissection.
- 2006
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Ingår i: J Urol. - : Ovid Technologies (Wolters Kluwer Health). ; 176:5, s. 2072-2076
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Inguinal hernia after radical retropubic prostatectomy has been reported to occur in 7% to 21% of patients. We analyzed the impact of simultaneous pelvic lymph node dissection, preoperative inguinal hernia morbidity, postoperative anastomotic stricture, duration of surgery and patient age. We also compared the detection rate of inguinal hernia events in a retrospective patient file survey to that in a prospective patient administered questionnaire. Materials and Methods A total of 498 patients underwent radical retropubic prostatectomy plus pelvic lymph node dissection and 166 underwent radical retropubic prostatectomy only. Mean followup was 40 months (median 37, range 3 to 85). All 664 patients were analyzed in the patient file survey. The patient administered questionnaire was mailed preoperatively, and after 3, 6, 12, 18, 24 and 36 months to 271 patients who underwent operation between 2001 and 2002. A total of 207 patients (76.4%) completed the preoperative questionnaire. Results The cumulative incidence of inguinal hernia after 24 months was 11.6% in the patient file survey and 15.7% in the patient administered questionnaire. In the patient file survey patient age was the only studied factor that significantly influenced risk. The patient file survey failed to detect half of the men with preoperative inguinal hernia morbidity and a third of post-radical retropubic prostatectomy inguinal hernias compared to the patient administered questionnaire. On patient administered questionnaire analysis preoperative inguinal hernia morbidity was a significant risk factor for postoperative inguinal hernia (log rank Mantel-Cox test p = 0.010). Conclusions Previous inguinal hernia morbidity and age increase the risk of post-radical retropubic prostatectomy inguinal hernia. Simultaneous pelvic lymph node dissection, postoperative anastomotic stricture and duration of surgery were not significant risk factors in this study. The patient file survey is inferior to the patient administered questionnaire for detecting inguinal hernia events.
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