Scandinavian Journal of Urology最新文献

{"title":"S-phase - an independent prognostic marker in upper tract urothelial carcinoma.","authors":"Camilla Malm,&nbsp;Georg Jaremko,&nbsp;Marianne Brehmer","doi":"10.1080/21681805.2022.2107065","DOIUrl":"https://doi.org/10.1080/21681805.2022.2107065","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate S-phase fraction as a predictor of invasiveness and cancer-specific survival in upper tract urothelial carcinoma (UTUC).</p><p><strong>Patients and methods: </strong>One hundred and fifteen patients having undergone radical nephroureterectomy were analysed with histology in radical nephroureterectomy specimens as reference test and S-phase fraction as index test. Ploidy and S-phase were determined using flow cytometry. Differences in S-phase fraction were calculated between stages, grades (WHO 1999 and 2004 classifications), ploidy and patients that died of UTUC and those who did not. Five- and 10-year-cancer-specific survivals were calculated. Areas under the ROC curve (AUCs) of S-phase fraction in relation to tumour stage and to death from UTUC were measured. Multiple Cox regression was performed.</p><p><strong>Results: </strong>Independent prognostic markers of death from UTUC were S-phase fraction and stage. Correlation between S-phase fraction and risk of dying from UTUC was strong, with a 17% greater risk of death from UTUC with every 1% increase in S-phase fraction, hazard ratio = 1.17, 95% CI = 1.10-1.25, <i>p</i> < 0.001, Spearman's rho <i>ρ</i> = 0.65. AUCs for S-phase fraction as predictors of stage and death from UTUC were 0.8 (95% CI = 0.705-0.894) and 0.77 (95% CI = 0.67-0.87), respectively. Cancer-specific survival was statistically significantly different between stages, ploidy and WHO 1999 grades, but not between WHO 2004 grades. This was also reflected in S-phase fraction, which differed in LG-G1 compared with LG-G2 and in HG-G2 compared with HG-G3.</p><p><strong>Conclusion: </strong>S-phase fraction was a good test for predicting both invasiveness and cancer-specific survival. Using both WHO 1999 and 2004 classifications, rather than one system alone, had a higher predictive value of cancer-specific survival.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10447004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical consequences of routine ⁶⁸Ga-PSMA-11 PET/CT in patients with newly diagnosed prostate cancer, ISUP grade 5 and no metastases based on standard imaging - preliminary results.","authors":"Helle D Zacho,&nbsp;Surenth Nalliah,&nbsp;Astrid Petersen,&nbsp;Lars J Petersen","doi":"10.1080/21681805.2022.2119272","DOIUrl":"https://doi.org/10.1080/21681805.2022.2119272","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the clinical consequences of prostate specific membrane antigen (PSMA) PET/CT for primary staging in patients with ISUP grade 5 (Gleason score ≥9) prostate cancer (PCa), and no definitive distant metastases based on standard imaging.</p><p><strong>Methods: </strong>At our tertial referral center, PSMA PET/CT became standard of care from August 2018 for primary staging of prostate cancer given the following criteria: (1) no prior treatment for prostate cancer, (2) ISUP grade 5, (3) no definitive metastases on standard imaging (contrast enhanced CT and bone scintigraphy), and (4) deemed suitable for treatment with curative intent based on comorbidity and life expectancy. We present the preliminary results of first six months recruitment with 12 months of follow-up.</p><p><strong>Results: </strong>Forty-eight patients (mean age 69 years, median PSA 13.0 ng/mL, 20 patients with locally advanced PCa) were included. CT was positive in pelvic lymph nodes in two patients, bone scintigraphy was equivocal in three patients. PSMA PET/CT showed pathological uptake outside the prostatic bed in 22 patients (46%) of which 13 patients (27%) showed lesions confined to regional lymph nodes, and nine patients (19%) showed nonregional lymph node metastases and/or bone metastases. PSMA PET/CT changed the treatment strategy from curatively intended treatment to palliative treatment in 18 patients (38%).</p><p><strong>Conclusion: </strong>PMSA PET/CT revealed pathological uptake in a large proportion of high-risk patients at primary staging among patients with no definite metastases on standard imaging leading to change of patient management in 38% of the patients.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10447482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the relation between size of stone and its attenuation measured by Hounsfield units and the total laser energy required to fragment it.","authors":"Mohamed Saad Elsayed,&nbsp;Mohamed Esmat Abo Ghareeb,&nbsp;Hany Hamed,&nbsp;Mohamed Elmoazen,&nbsp;Ahmed Amr Shorbagy","doi":"10.1080/21681805.2022.2104366","DOIUrl":"https://doi.org/10.1080/21681805.2022.2104366","url":null,"abstract":"<p><strong>Background: </strong>Anticipating the total laser energy (TLE) of Holmium YAG laser required for ureteroscopic (URS) lithotripsy is essential to guide urologists in selecting the optimal fiber size. This study aimed at evaluating the relationship between stone size and stone attenuation measured by HU as predictors for the TLE during the procedure.</p><p><strong>Methods: </strong>We conducted an observational prospective cohort study of patients undergoing URS lithotripsy at the Urology department of Ain Shams University Hospitals from September 2018 to September 2019 with the use of a holmium YAG laser as the lithotripsy method. Patients' demographic and clinical characteristics, stone location, stone size, stone attenuation measured by HU from the non-contrast CT, TLE, and procedure time were recorded. Data were analyzed using Jamovi software (version 2.0 for macOS).</p><p><strong>Results: </strong>Forty patients were included in the study (22 males and 18 females) with a mean age of 57.8 years. The mean stone size was 9.8 mm³, the mean HU was 858.8 units, and the mean TLE was 3.5 KJ. Both stone size and stone attenuation measured by HU were positively correlated with TLE (<i>r</i> = 0.81 and 0.84, respectively; <i>p</i> < 0.001 for both). Further, regression analysis showed that both variables could significantly predict the TLE (<i>ß</i> = 0.001 and 0.71, respectively).</p><p><strong>Conclusions: </strong>Both stone attenuation, as measured by HU, and stone size positively correlate with TLE required for URS lithotripsy. Therefore, both HU and stone size can predict the TLE, which will be helpful to guide the urologist in selecting the optimal fiber size for the procedure.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40672810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted nephroureterectomy for upper tract urothelial carcinoma-feasibility and complications: a single center experience.","authors":"F Liedberg,&nbsp;J Abrahamsson,&nbsp;J Bobjer,&nbsp;S Gudjonsson,&nbsp;A Löfgren,&nbsp;M Nyberg,&nbsp;A Sörenby","doi":"10.1080/21681805.2022.2091018","DOIUrl":"https://doi.org/10.1080/21681805.2022.2091018","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted nephroureterectomy (RANU) is the primary treatment for upper tract urothelial carcinoma (UTUC) at our hospital for patients with clinical stage less than T2, and for patients with invasive tumours, but unfit for major surgery.</p><p><strong>Objective: </strong>To assess peri-operative conditions and outcomes of RANU at our unit, and to evaluate the safety of the procedure.</p><p><strong>Methods: </strong>The medical records of all 166 patients undergoing RANU for suspected UTUC and followed for more than three months in a large university hospital in Sweden were reviewed retrospectively. After the exclusion of twenty patients because of previous cystectomy, simultaneous surgical procedure, or other tumour types than UTUC in the pathological report, 146 patients remained for the analyses. The primary endpoint was complication rate according to Clavien-Dindo at 90 days. Secondary endpoints were perioperative bleeding, violation of oncological surgical principles, hospital stay, and re-admission within 90 days.</p><p><strong>Results: </strong>The median age was 75 [(Inter Quartile Range) IQR 70-80] years and 57% of the patients had an ASA score above 2. According to Clavien-Dindo, one patient had a grade 3 complication, and no patient had a grade 4-5 complication. The median blood loss was 50 (IQR 20-100) ml and the median hospital stay was 6 (IQR 5-7) days. Twelve patients were re-admitted to the hospital within 90 days (eight with urinary tract infection/haematuria, one with hematoma, and three with other diseases).</p><p><strong>Conclusion: </strong>Robot-assisted nephroureterectomy is a safe procedure for patients with upper tract urothelial carcinoma, with a low risk of major surgical complications.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40267868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to survey adherence to guidelines by use of clinical cancer registers.","authors":"Pär Stattin","doi":"10.1080/21681805.2022.2107069","DOIUrl":"https://doi.org/10.1080/21681805.2022.2107069","url":null,"abstract":"In the current issue of Scand J Urol, two articles on the Swedish National Guidelines on Prostate Cancer highlight new recommendations and those recommendations that differ from the EAU guidelines [1,2]. The creation and annual updates of the National Guidelines provided by the guidelines working group are important steps in providing high quality and equal quality of care for men with prostate cancer in all regions of Sweden. However, the compilation of data, formulation of recommendations, and publication of these guidelines are just the first steps in that direction. The recommendations in the Guidelines then have to be implemented by urologists and oncologists in the entire country. In order to survey the adherence to these guidelines rapid reporting and compilation of data on adherence and subsequent feed-back to each department need to be delivered. Such reporting is delivered by the National Prostate Cancer Register of Sweden (NPCR) with information on diagnostics, staging, and primary treatment in the primary registration in NPCR and for men with advanced prostate cancer there is a longitudinal registration in the Patient-overview Prostate Cancer [3,4]. One example of a rapid implementation of a change in the diagnostic work-up of men with prostate cancer is the new recommendation in the Guidelines of a magnetic resonance tomography (MRT) prior to biopsy of the prostate. The proportion of men in NPCR with PSA below 100ng/mL who underwent MRT prior to biopsy was 10% in 2016 and increased to 80% in 2021 [3]. By linking data in NPCR to other health care registers such as the Prescribed Drug Register, more comprehensive data can rapidly be captured. Such linkages show that there are still large differences in the delivery of prostate cancer care in Sweden. For example, there were large differences in the distribution of an intensified treatment of men with de novo metastatic castration sensitive prostate cancer as recommended by the Guidelines. There was two-fold difference between the region with the highest and lowest use of an additional medical treatment delivered together with androgen deprivation therapy (ADT) to these men (Figure 1). However, guidelines are merely one out of several factors that affect treatment patterns. For example, treatment of men with locally advanced Pca changed substantially during the last two decades, starting well before 2014 when the first National Guidelines for Prostate Cancer were published. In 1998, less than 30% of men below age 80 with locally advanced Pca in Sweden received radical treatment, this proportion then gradually increased and was around 50% in 2008, i.e. the year before the publication of SPCG-7, a landmark study that showed an increased survival for men who were treated with radiotherapy and ADT compared to men who were treated with ADT only [3,5]. Currently, as recommended by the Guidelines almost 80% of men with locally advanced Pca receive radical treatment, mostly radiotherapy (Figure ","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40716169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical recurrence after radical prostatectomy - a large, comprehensive, population-based study with long follow-up.","authors":"Elin Axén,&nbsp;Johan Stranne,&nbsp;Marianne Månsson,&nbsp;Erik Holmberg,&nbsp;Rebecka Arnsrud Godtman","doi":"10.1080/21681805.2022.2108140","DOIUrl":"https://doi.org/10.1080/21681805.2022.2108140","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated long-term risk for biochemical recurrence and subsequent prognosis in a population-based cohort.</p><p><strong>Material and methods: </strong>We used register-based data to evaluate 6 675 consecutive patients having radical prostatectomy in Västra Götaland county in Sweden during 1995-2014. Patients were followed until death or end of study, 31 December 2014. Data were collected from registers on national, regional and local level and linked by means of the Swedish personal identity number. Biochemical recurrence was defined as PSA ≥0.2 ng/ml; failure as hormonal treatment, metastasis or prostate cancer death. Survival analysis was used to estimate time to biochemical recurrence and time to failure after biochemical recurrence for patients with 0 - 2 years, 2-5 years, 5-10 years and >10 years interval to biochemical recurrence, respectively.</p><p><strong>Results: </strong>A total of 1214 men had biochemical recurrence during follow-up. Biochemical recurrence-free survival was 83% (95% confidence interval [CI] 82-84%), 75% (95% CI 74-77%) and 69% (95% CI 67-71%) at 5, 10 and 15 years, respectively. Cumulative incidence of failure for all patients 15 years after biochemical recurrence was 50% (95% CI 43-55%) in competing risk analysis. The risk of failure after biochemical recurrence was highest among patients having biochemical recurrence within 2 years from surgery. Incomplete data on PSA-history is a limitation.</p><p><strong>Conclusions: </strong>The risk for biochemical recurrence persists 15 years after surgery. Follow-up should continue as long as treatment would be considered in case of recurrent disease.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40433717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urethral duplication with bilateral megaureter and bladder outlet obstruction: unusual case managed by PADUA technique.","authors":"Maria Escolino,&nbsp;Paolo Caione,&nbsp;Mariapina Cerulo,&nbsp;Benedetta Lepore,&nbsp;Annalisa Chiodi,&nbsp;Rachele Borgogni,&nbsp;Ciro Esposito","doi":"10.1080/21681805.2022.2096689","DOIUrl":"https://doi.org/10.1080/21681805.2022.2096689","url":null,"abstract":"Urethral duplication is a rare congenital anomaly of the lower urinary tract. The most used classification system was suggested by Effmann [1] in 1976, based on radiological findings. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally [2]. Treatment depends on the type of duplication and comorbidities [3]. We describe an unusual presentation of complete hypoplastic type 2A-2 urethral duplication according to Effmann with bilateral obstructive megaureter and prolonged bladder outlet obstruction, which was managed through Progressive Augmentation by Dilating the Urethra Anterior (PADUA).","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40485386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zoster sine herpete causing voiding disorders in females.","authors":"Vagan Barsegian,&nbsp;Inga Kosova","doi":"10.1080/21681805.2022.2096111","DOIUrl":"https://doi.org/10.1080/21681805.2022.2096111","url":null,"abstract":"Herpes zoster is caused by the reactivation of Varicella-Zoster virus and is classically characterized by unilateral vesicular rash and burning pain in the dermatomal distribution. Zoster sine herpete represents an atypical course of herpes zoster without skin involvement. The lifetime incidence rate of HZ in the general population is 10–20% [1]. It is known that voiding dysfunctions develop in 4% of HZ patients and are associated with the involvement of sacral dermatomes [2]. Common voiding disorders include dysuria, frequent urination, urinary retention and overflow incontinence. More than 150 cases of HZ-associated voiding dysfunction have been reported; however, no cases of ZSH-associated voiding disorders have been described yet.","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40603213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Norwegian perspective on the Swedish national guidelines on prostate cancer for non-metastatic disease.","authors":"Karol Axcrona,&nbsp;Sven Löffeler","doi":"10.1080/21681805.2022.2075923","DOIUrl":"https://doi.org/10.1080/21681805.2022.2075923","url":null,"abstract":"Almost two decades ago, Wiking Månsson reviewed the state of urological guidelines in an editorial in European Urology titled ‘Evidence-Based Urology – A Utopia?’ [1]. In his article, he posed the question: How are we doing in urology? and provided the rather unflattering answer: Not that good. He lamented that ‘...most of what is published in the urological journals has low level of evidence and as a consequence, low grade of recommendation’. A lot has changed since Månsson voiced his dismay and the change has mostly been for the better. Today, urological guidelines are based on a large number of randomized clinical trials and high-quality register studies. We can, with considerable pride, state that prostate cancer researchers from Scandinavia, with Sweden often in the lead, have made decisive contributions to these improvements. The Scandinavian Prostate Cancer Group (SPCG) has been the incubator of the major Nordic randomized trials, with SPCG-4 and SPCG-7 as the most widely known trials [2,3]. Furthermore, the National Prostate Cancer Register, a Swedish population-based, clinical register, has generated multiple high impact publications [4,5]. Clinical cancer registers are cost-efficient tools to study the often decade-long prostate cancer disease trajectory. In Scandinavia in general and in Sweden in particular, there is a strong scientific environment that has enabled the creation of evidence-based urological cancer guidelines. Clinical guidelines are formulated according to standard procedure, based on a transparent methodology, discussed in professional panels including representatives from other relevant professions and patient organizations. Modern guidelines are largely based on clinical evidence, with prospective randomized control trials having the highest, and retrospective studies from single institutions having the lowest impact. Changes in guidelines can have major implications for patient management, organization of the health care system and on health care economy. However, due to the high level of evidence required for strong recommendations, changes are often slow in the coming. In Europe, most countries adhere to the European Urological Association (EAU) guidelines [6]. While the recommendations in the EAU Guidelines are based on strict rules, the implementation has to be flexible since the health care systems and ‘health care culture’ varies to a certain degree across Europe. In some European countries, urologists and oncologists have adopted EAU guidelines as their own guidelines, while in other countries national guidelines have been issued. In contrast to the EAU guidelines, National guidelines can be written to suit the specific requirements, opportunities and limitations of a national health care system. For the first time a summary of the Swedish prostate cancer guidelines is published in English by Bratt et al. in this issue of the Scandinavian Journal of Urology [7]. Why is it important guidelines written by Swedi","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Swedish national guidelines on prostate cancer, part 1: early detection, diagnostics, staging, patient support and primary management of non-metastatic disease.","authors":"Ola Bratt,&nbsp;Stefan Carlsson,&nbsp;Per Fransson,&nbsp;Camilla Thellenberg Karlsson,&nbsp;Johan Stranne,&nbsp;Jon Kindblom","doi":"10.1080/21681805.2022.2094462","DOIUrl":"https://doi.org/10.1080/21681805.2022.2094462","url":null,"abstract":"<p><strong>Objective: </strong>There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on.</p><p><strong>Methods: </strong>This is part 1 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. It covers the early detection, diagnostics, staging, patient support and management of the non-metastatic disease. Part 2 covers recurrence after local treatment and management of the metastatic disease.</p><p><strong>Results: </strong>The 2022 Swedish guidelines include several new recommendations: rectal iodine-povidone to reduce post-biopsy infections, external beam radiation with focal boost to the tumour, use of a pre-rectal spacer to reduce rectal side effects after external beam radiotherapy in some expert centres, 6 months' concomitant and adjuvant rather than neoadjuvant and concomitant hormonal treatment together with radiotherapy for unfavourable intermediate and high-risk disease, and adjuvant abiraterone plus prednisolone together with a GnRH agonist for a subgroup of men with very high-risk disease. The Swedish guidelines differ from the European by having more restrictive recommendations regarding genetic testing and pelvic lymph node dissection, the risk group classification, recommending ultra-hypofractionated (7 fractions) external radiotherapy for intermediate and selected high-risk cancers, by not recommending any hormonal treatment together with radiotherapy for favourable intermediate-risk disease, and by recommending bicalutamide monotherapy instead of a GnRH agonist for some patient groups.</p><p><strong>Conclusions: </strong>The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}