Scandinavian Journal of Urology最新文献

{"title":"Evidence of overestimating prostate cancer mortality in Estonia: a population-based study.","authors":"Kaire Innos,&nbsp;Keiu Paapsi,&nbsp;Indrek Alas,&nbsp;Peep Baum,&nbsp;Martin Kivi,&nbsp;Mihhail Kovtun,&nbsp;Rauno Okas,&nbsp;Helis Pokker,&nbsp;Olga Rajevskaja,&nbsp;Aleksandra Rautio,&nbsp;Mikk Saretok,&nbsp;Elari Valk,&nbsp;Mihhail Žarkovski,&nbsp;Gleb Denissov,&nbsp;Katrin Lang","doi":"10.1080/21681805.2022.2119274","DOIUrl":"https://doi.org/10.1080/21681805.2022.2119274","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer (PC) mortality statistics in Estonia has shown inconsistencies with incidence and survival trends. The aim of this population-based study was to assess the accuracy of reporting PC as the underlying cause of death and estimate the effect of misattribution in assigning cause of death on PC mortality rates.</p><p><strong>Material and methods: </strong>The Estonian Causes of Death Registry (CoDR) and Cancer Registry provided data on all men in Estonia who died in 2017 and had a mention of PC on any field of the death certificate or had a lifetime diagnosis of PC. A blinded review of medical records was conducted by an expert panel to ascertain whether the underlying cause was PC or other death. We estimated the agreement between the underlying causes of death registered at the CoDR and those ascertained by medical review and calculated corrected mortality rates.</p><p><strong>Results: </strong>The study population included 655 deaths. Among 277 PC deaths registered at CoDR, 164 (59%) were verified by medical review. Among 378 other deaths registered at CoDR, 17 (5%) were ascertained as PC deaths by medical review. In total, the number of PC deaths decreased from 277 to 181 and the corrected age standardized (world) mortality rate decreased from 20 to 13 per 100 000 (1.5-fold overestimation, 95% confidence interval 1.2-1.9).</p><p><strong>Conclusions: </strong>PC mortality statistics in Estonia should be interpreted with caution and possible overestimation considered when making policy decisions. Quality assurance mechanisms should be reinforced in the whole death certification process.</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":"10447480","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":"Community-onset urosepsis: incidence and risk factors for 30-day mortality - a retrospective cohort study.","authors":"Martin Holmbom,&nbsp;Maria Andersson,&nbsp;Magnus Grabe,&nbsp;Ralph Peeker,&nbsp;Aus Saudi,&nbsp;Johan Styrke,&nbsp;Firas Aljabery","doi":"10.1080/21681805.2022.2123039","DOIUrl":"https://doi.org/10.1080/21681805.2022.2123039","url":null,"abstract":"<p><strong>Background: </strong>Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression.</p><p><strong>Objectives: </strong>To identify risk factors associated with 30-day mortality in patients with urosepsis.</p><p><strong>Methods: </strong>From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019-2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression.</p><p><strong>Results: </strong>Urosepsis was found in 18% (n = 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n = 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR = 4.63, 95% CI = 1.47-14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR = 4.19, 95% CI = 1.41-12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%.</p><p><strong>Conclusion: </strong>The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as <i>E. faecalis</i> to optimise management, is likely to improve survival in patients with urosepsis.</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":"10447501","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":"Surgical experience is predictive for bladder tumour resection quality.","authors":"Sarah H Bube,&nbsp;Rasmus Brix,&nbsp;Maya B Christensen,&nbsp;Mathias Thostrup,&nbsp;Søren Grimstrup,&nbsp;Rikke B Hansen,&nbsp;Claus Dahl,&nbsp;Lars Konge,&nbsp;Nessn Azawi","doi":"10.1080/21681805.2022.2119271","DOIUrl":"https://doi.org/10.1080/21681805.2022.2119271","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the resection quality of transurethral bladder tumour resection (TURBT) and the association to surgeon experience depending on the presence of detrusor muscle.</p><p><strong>Methods: </strong>A retrospective study on 640 TURBT procedures performed at Zealand University Hospital, Denmark, from 1 January 2015 - 31 December 2016. Data included patient characteristics, procedure type, surgeon category, supervisor presence, surgical report data, pathological data, complications data and recurrence data. Analysis was performed using simple and multiple logistic regression on the association between surgeon experience and the presence of detrusor muscle in resected tissue from TURBT.</p><p><strong>Results: </strong>Supervised junior residents had significant lower detrusor muscle presence (73%) compared with consultants (83%) (OR = 0.4, 95% CI = 0.21-0.83). Limitations were the retrospective design and the diversity of included TURBT.</p><p><strong>Conclusions: </strong>It was found that surgical experience predicts detrusor muscle presence and supervised junior residents performing TURBT on patients resulted in less detrusor muscle than consultants.</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":"10445777","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":"Surgical waiting times and all-cause mortality in patients with non-metastatic renal cell carcinoma.","authors":"Andreas Karlsson Rosenblad,&nbsp;Pernilla Sundqvist,&nbsp;Ulrika Harmenberg,&nbsp;Mikael Hellström,&nbsp;Fabian Hofmann,&nbsp;Anders Kjellman,&nbsp;Britt-Inger Kröger Dahlin,&nbsp;Per Lindblad,&nbsp;Magnus Lindskog,&nbsp;Sven Lundstam,&nbsp;Börje Ljungberg","doi":"10.1080/21681805.2022.2107067","DOIUrl":"https://doi.org/10.1080/21681805.2022.2107067","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage.</p><p><strong>Patients and methods: </strong>This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage.</p><p><strong>Results: </strong>During a mean follow-up time of 5 years (49,873 person-years), 23% (<i>n</i> = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02-1.04; <i>p</i> < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01-1.04; <i>p</i> < 0.001) and 1.05 (95% CI = 1.02-1.08; <i>p</i> = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (<i>p</i> = 0.079) and T4 (<i>p</i> = 0.807). Similar results were obtained for WRT and WTS.</p><p><strong>Conclusions: </strong>Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease.</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":"10813171","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":"Surgeon volume and patient-reported urinary incontinence after radical prostatectomy. Population-based register study in Sweden.","authors":"Rebecka Arnsrud Godtman,&nbsp;Erik Persson,&nbsp;Oskar Bergengren,&nbsp;Stefan Carlsson,&nbsp;Eva Johansson,&nbsp;David Robinsson,&nbsp;Jonas Hugosson,&nbsp;Pär Stattin","doi":"10.1080/21681805.2022.2119270","DOIUrl":"https://doi.org/10.1080/21681805.2022.2119270","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between surgeon volume and urinary incontinence after radical prostatectomy.</p><p><strong>Methods: </strong>A total of 8326 men in The National Prostate Cancer Register of Sweden (NPCR) underwent robot-assisted radical prostatectomy (RARP) between 2017 and 2019 of whom 56% (4668/8 326) had responded to a questionnaire one year after RARP. The questionnaire included the question: 'How much urine leakage do you experience?' with the response alternatives 'Not at all', 'A little', defined as continence and 'Moderately', 'Much/Very much' as incontinence. Association between incontinence and mean number of RARPs/year/surgeon was analysed with multivariable logistic regression including age, Charlson Comorbidity Index (CCI), PSA, prostate volume, number of biopsy cores with cancer, cT stage, Gleason score, lymph node dissection, nerve sparing intent and response rate to the questionnaire.</p><p><strong>Results: </strong>14% (659/4 668) of the men were incontinent one year after RARP. There was no statistically significant association between surgeon volume and incontinence. Older age (>75 years <i>vs</i>. < 65 years, OR 2.29 [95% CI 1.48-3.53]), higher CCI (CCI 2+ <i>vs.</i> CCI 0, OR 1.37 [95% CI 1.04-1.80]) and no nerve sparing intent (no <i>vs</i>. yes OR 1.53 [95% CI 1.26-1.85]) increased risk of incontinence. There were large differences in the proportion of incontinent men between surgeons with similar annual volumes, which remained after adjustment.</p><p><strong>Conclusions: </strong>The lack of association between surgeon volume and incontinence and the wide range in outcome between surgeons with similar volumes underline the importance of individual feedback to surgeons on functional results.</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":"10813192","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":"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}