Gleason scores from biopsy and RP specimens. Concordance was evaluated using the κ coefficient, and predictors of concordance were assessed in univariate and multivariate logistic regression analyses. RESULTSThe Gleason scores were identical in biopsy and RP specimens in 591 of the 1116 (53%) patients. The biopsy-based Gleason score more often under-graded (38%) than overgraded (9%) the RP-based Gleason score. Pathology units that examined > 40 RP specimens annually had a higher concordance between the Gleason score in the biopsy and RP specimen than did lowervolume units. The rate of upgrading from a Gleason score of ≤ 6 in the biopsy to ≥ 7 in the RP specimen increased with increasing preoperative prostate-specific antigen serum levels, and with increasing intervals between biopsy and RP. CONCLUSIONSThe concordance in Gleason score between biopsy and RP was highest among the pathology departments that regularly evaluated RP specimens. Careful consideration of clinical factors and biopsy grading might improve the identification of patients considered as suitable for active surveillance.

What's known on the subject? and What does the study add?• Studies comparing adverse effects after different treatment methods are few and lack information on additional treatment and cancer relapse. Some US studies have provided population-based estimates on adverse effects, however, figures from Europe are most often based on mono-institutional experience or multicentre studies from high-volume university-affiliated hospitals with selected patient populations. Few studies have investigated the relationship between presence of urinary, bowel or sexual dysfunction and global quality of life (QoL).• This population-based study investigated real-life practice with regard to prostate cancer in men who were potential candidates for curative treatment, based on high-quality national registry data. Treatment groups of recurrence-free men who completed their treatment or who received no cancer treatment were measured as to adverse effects, global QoL and the association between them. The study shows that each treatment method is associated with distinct patterns of urinary, bowel and sexual dysfunction and that irritative-obstructive urinary symptoms are associated with increased risk of low global QoL. This large survey also investigates the use of medication for erectile dysfunction and the relationship between such use and global QoL. Objectives• To provide population-based estimates of typical adverse effects (AEs), e.g. urinary, bowel and sexual dysfunction, in patients with non-metastatic recurrence-free prostate cancer (PCa) by curative treatment method, including no treatment.• To describe associations between typical AEs and global quality of life (QoL) and to study patients' use of medication for erectile dysfunction (EDmed) and the relationship between such use and global QoL.

Study Type – Therapy (individual cohort)
 Level of Evidence 2b OBJECTIVE Improving a country’s management of cancer patients requires continuous evaluation, and requires the availability of population‐based prognostic and therapeutic variables. We aimed to document the national diagnostic and therapeutic tasks in Norwegian patients with prostate cancer diagnosed in 2004, with the 2003 European Association of Urology (EAU) guidelines representing the background. PATIENTS AND METHODS The Norwegian Prostate Cancer Registry (NoPCR) was established in 2004, and data collected during this first year were reviewed. The Tumour‐Node‐Metastasis group, prostate‐specific antigen (PSA) level and Gleason score were recorded as basic diagnostic variables, with the initial treatment. Patients with nonmetastatic T1‐T3 tumours were separated from those with advanced disease (T4 and/or N+ and/or M+). Patients with T1‐T3 tumours, aged ≤75 years, and in good health were candidates for curative local treatment (‘CurCands’) and were allocated to risk groups. RESULTS The compliance rate to the NoPCR was 96%; 2693 (72%) of 3744 eligible patients had T1‐T3 tumours and 833 (22%) had advanced disease (not classifiable in 218, 6%). Of 1650 CurCands (low‐risk 500; intermediate‐risk 453; high‐risk 697), 62% had radical prostatectomy or radiotherapy with or without hormone therapy, with the remaining 23% and 10% managed by, respectively, hormone therapy only or observation (other/unknown treatment, 6%).Only 64% of CurCands in the combined intermediate/high‐risk group had local treatment. In the low‐risk group local treatment was used in 57% of the patients, mainly in men with T2 tumours. In intermediate‐ and high‐risk CurCands, PSA was the strongest factor determining the performance of curative treatment. Adjuvant radiotherapy after radical prostatectomy was used in four of 142 patients with tumour‐involved margins. CONCLUSION In 2004 the initial management of prostate cancer in Norway was largely in accordance with the 2003 EAU guidelines, though there was some evidence of ‘over‐treatment’ of low‐risk patients and ‘under‐treatment’ of intermediate‐ and high‐risk patients. Some improvement of data collection by the NoPCR is warranted. National prostate cancer registries can contribute to improving the medical care of these patients.