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- Godtman, Rebecka Arnsrud, 1981, et al.
(author)
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High accuracy of Swedish death certificates in men participating in screening for prostate cancer: A comparative study of official death certificates with a cause of death committee using a standardized algorithm.
- 2011
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In: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 1651-2065 .- 0036-5599.
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Journal article (peer-reviewed)abstract
- Abstract Objective. Recently, the first mortality data from the Göteborg Randomized Population-based Prostate Cancer Screening Trial showed a 44% reduction in prostate cancer (PC)-specific mortality as a result of screening with prostate-specific antigen (PSA). As death of PC is the main endpoint, an accurate determination of the cause of death (COD) is crucial. The aim of this study was therefore to investigate the accuracy of death certificates of men in the Göteborg Randomized Population-based Prostate Cancer Screening Trial. Material and methods. Men with a PC diagnosis and who died within the study period (1995-2008) were included. Relevant medical information, including death certificate, was collected. An independent COD committee reviewed the material following a flowchart to classify the COD. The committee's decision was compared with the COD on the death certificate. Results. Of the 285 men included in the study, 278 men were eligible for a comparative analysis. The committee and the death certificates agreed on PC as the underlying COD in 116 men and causes other than PC in 151. There were 11 discordant cases, for an overall agreement of 96%. Men with PC in the screening group had, compared with the control group, a significantly lower PC-specific mortality but did not differ in non-PC-specific mortality. Conclusion. This study concludes that Swedish death certificates are of high accuracy and can be used for endpoint evaluation in screening studies for PC.
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| 2. |
- Godtman, Rebecka Arnsrud, 1981, et al.
(author)
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Outcome Following Active Surveillance of Men with Screen-detected Prostate Cancer. Results from the Göteborg Randomised Population-based Prostate Cancer Screening Trial.
- 2013
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In: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 63:1, s. 101-107
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Journal article (peer-reviewed)abstract
- BACKGROUND: Active surveillance (AS) has emerged as a treatment strategy for reducing overtreatment of screen-detected, low-risk prostate cancer (PCa). OBJECTIVE: To assess outcomes following AS of men with screen-detected PCa. DESIGN, SETTING, AND PARTICIPANTS: Of the 968 men who were diagnosed with screen-detected PCa between 1995 and 2010 in the Göteborg randomised, population-based PCa screening trial, 439 were managed with AS and were included in this study. Median age at diagnosis was 65.4 yr of age, and median follow-up was 6.0 yr from diagnosis. INTERVENTION: The study participants were followed at intervals of 3-12 mo and were recommended to switch to deferred active treatment in case of a progression in prostate-specific antigen, grade, or stage. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The end points-overall survival (OS), treatment-free survival, failure-free (no relapse after radical treatment) survival, and cancer-specific survival-were calculated for various risk groups (very low, low, intermediate, and high) with Kaplan-Meier estimates. A Cox proportional hazards model as well as a competing risk analysis were used to assess whether risk group or age at diagnosis was associated with failure after AS. RESULTS AND LIMITATIONS: Forty-five per cent of all screen-detected PCa were managed with AS, and very low-risk and low-risk PCa constituted 60% of all screen-detected PCa. Thirty-seven per cent (162 of 439) switched from surveillance to deferred active treatment, and 39 men failed AS. The 10-yr OS, treatment-free survival, and failure-free survival were 81.1%, 45.4%, and 86.4%, respectively (Kaplan-Meier estimates). Men with low-, intermediate-, and high-risk tumours had a hazard ratio for failure of 2.1 (p=0.09), 3.6 (p=0.002), and 4.6 (p=0.15), respectively, compared to very low-risk tumours (Cox regression). Only one PCa death occurred, and one patient developed metastasis (both in the intermediate-risk group). The main limitation of this study is the relatively short follow-up. CONCLUSIONS: A large proportion of men with screen-detected PCa can be managed with AS. AS appears safe for men with low-risk PCa.
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| 3. |
- Godtman, Rebecka Arnsrud, 1981
(author)
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Prostate Cancer Screening - Aspects of Overdiagnosis
- 2014
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis is to explore aspects of overdiagnosis, i.e. the diagnosis of a tumor that in the absence of screening would never have been diagnosed, in prostate cancer (PC) screening. The four papers in this thesis all emerge from the Göteborg randomized population-based PC screening trial, in which 10,000 men were invited to biennial prostate-specific antigen (PSA)-screening between 1995 and 2014 and 10,000 non-invited constituted a control group. In paper I, the accuracy of cause of death (COD) certificates, for men with PC, is evaluated by comparison with the COD as assigned by an independent committee after blinded review of medical records. Paper II assesses outcomes for men with screen-detected PC managed with, so called “active surveillance”. In paper III, organized screening is compared with opportunistic screening with respect to effectiveness in reducing PC mortality, measured as the number needed to invite (NNI) to screening and overdiagnosis, measured as number needed to diagnose (NND) to prevent one man from dying from PC. Paper IV investigates the risk of being diagnosed with PC depending on age at screening and the number of screens. The overall agreement between COD certificates and the committee was 96%. A large proportion of men screen-detected PC has low-risk PC (60%) and could safely be managed with active surveillance, at least with intermediate follow-up. Organized screening was more effective in reducing PC mortality and was associated with less overdiagnosis than opportunistic screening (NNI 139, NND 13 versus NNI 493, NNI 23). The risk of being diagnosed with PC increased dramatically with age but there was no apparent relation to the number of screens. From this thesis it can be concluded that Swedish COD certificates have a high accuracy and can be used for COD determination for men with PC, at least in the age-range studied (50-64 years old at the start of screening). Active surveillance appears safe for men with low-risk PC and should be used as a treatment strategy in order to reduce overtreatment. In order to reduce overdiagnosis and improve the benefit harm ratio of PC screening, screening should be conducted within the frameworks of an organized program where “younger” men could be screened relatively intense but where “older” men are screened more selectively.
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