Proportion and characteristics of men with unknown risk category in the National Prostate Cancer Register of Sweden

Tomic, Katarina; Westerberg, Marcus; Robinson, David; Garmo, Hans; Stattin, Pär

doi:10.1080/0284186x.2016.1234716

Cited by 19 publications

(19 citation statements)

References 23 publications

(29 reference statements)

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“…In a previous study in PCBaSe, men with missing data had a lower prostate cancer risk category than men with complete data [20]. In support of this view, higher PSA levels were observed in men who had undergone bone imaging than in men for whom this investigation was omitted.…”

Section: Discussionmentioning

confidence: 59%

“…In short, the strength of the association is expressed through a constant multiplier k which describes the odds of metastatic prostate cancer for men with nonignorable missing data compared to men with ignorable missing data. Men with lower Gleason grades were assumed to have a higher degree of informative missingness in favor of non-metastatic prostate cancer so the multiplier k was allowed to depend on Gleason Grade Groups, with k ¼ 0.1 for GGG 1, GGG 2: k ¼ 0.3, GGG 3: k ¼ 0.6 and GGG 4-5: k ¼ 0.7 [20]. A sensitivity analysis using different values for k was also performed.…”

Section: Methodsmentioning

confidence: 99%

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Temporal changes in survival in men with de novo metastatic prostate cancer: nationwide population-based study

et al. 2019

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Background: There have been large changes in the pattern of detection, work-up and treatment of men with prostate cancer during the last two decades. Therefore, we aimed to investigate temporal changes in survival in men with metastatic prostate cancer. Methods: Population-based cohort study in Prostate Cancer data Base Sweden of 13,709 men with de novo metastatic prostate cancer diagnosed between 1998 and 2015. Overall survival in four calendar periods were compared by the use of Kaplan-Meier analyses and Cox regression models including age at diagnosis, T stage and serum levels of prostate-specific antigen (PSA). Results: Between 1998-2001 and 2010-2015, median survival increased with 6 months for all men. The largest increase in survival was 14 months in men age 60-69 at diagnosis and in multivariable analysis risk of death decreased for men diagnosed in 2010-2015 compared to 1998-2001, hazard ratio (HR) 0.77 (95% CI: 0.68-0.86). The median PSA at date of diagnosis decreased with 46% from 181 ng/mL in 1998 to 98 ng/mL in 2015. Conclusions: There was an increase in survival among men with de novo metastatic prostate cancer in Sweden between 1998 and 2015. This increase was due to a decreased cancer extent indicated by lower PSA levels with ensuing longer lead times and speculatively also due to an increased use of chemotherapy in the latest time period. Given the increasing use of systemic treatment for advanced prostate cancer, our results are likely heralding larger increases in survival in men with metastatic prostate cancer in the near future.

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Section: Discussionmentioning

confidence: 59%

Section: Methodsmentioning

confidence: 99%

Temporal changes in survival in men with de novo metastatic prostate cancer: nationwide population-based study

et al. 2019

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“…About 11% of the PCBaSe cohort had to be excluded, as we did not have all the clinico-pathological details. Details of how missing data is handled in PCBaSe have been previously reported [ 38 ]. Finally, although we have included competing mortality risks, our model does not include co-morbidity as a variable.…”

Section: Discussionmentioning

confidence: 99%

“…Our model is unique in that it has been built from primary diagnostic source data linked to PCM outcomes, it has been tested across different treatment types and now has been validated in very large cohorts of men. It is notable that in the USA the NCCN and new AUA/ASTRO/SUO localised prostate cancer guidelines are both also endorsing five-strata systems for non-metastatic disease although with different sub-categories [ 25 , 38 ]. While the AUA/ASTRO/SUO endorse splitting the old intermediate-risk category, they do not recommend a very high-risk sub-category.…”

Section: Discussionmentioning

confidence: 99%

The Cambridge Prognostic Groups for improved prediction of disease mortality at diagnosis in primary non-metastatic prostate cancer: a validation study

Gnanapragasam

Bratt

Muir

et al. 2018

BMC Med

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BackgroundThe purpose of this study is to validate a new five-tiered prognostic classification system to better discriminate cancer-specific mortality in men diagnosed with primary non-metastatic prostate cancer.MethodsWe applied a recently described five-strata model, the Cambridge Prognostic Groups (CPGs 1-5), in two international cohorts and tested prognostic performance against the current standard three-strata classification of low-, intermediate- or high-risk disease. Diagnostic clinico-pathological data for men obtained from the Prostate Cancer data Base Sweden (PCBaSe) and the Singapore Health Study were used. The main outcome measure was prostate cancer mortality (PCM) stratified by age group and treatment modality.ResultsThe PCBaSe cohort included 72,337 men, of whom 7162 died of prostate cancer. The CPG model successfully classified men with different risks of PCM with competing risk regression confirming significant intergroup distinction (p < 0.0001). The CPGs were significantly better at stratified prediction of PCM compared to the current three-tiered system (concordance index (C-index) 0.81 vs. 0.77, p < 0.0001). This superiority was maintained for every age group division (p < 0.0001). Also in the ethnically different Singapore cohort of 2550 men with 142 prostate cancer deaths, the CPG model outperformed the three strata categories (C-index 0.79 vs. 0.76, p < 0.0001). The model also retained superior prognostic discrimination in the treatment sub-groups: radical prostatectomy (n = 20,586), C-index 0.77 vs. 074; radiotherapy (n = 11,872), C-index 0.73 vs. 0.69; and conservative management (n = 14,950), C-index 0.74 vs. 0.73. The CPG groups that sub-divided the old intermediate-risk (CPG2 vs. CPG3) and high-risk categories (CPG4 vs. CPG5) significantly discriminated PCM outcomes after radical therapy or conservative management (p < 0.0001).ConclusionsThis validation study of nearly 75,000 men confirms that the CPG five-tiered prognostic model has superior discrimination compared to the three-tiered model in predicting prostate cancer death across different age and treatment groups. Crucially, it identifies distinct sub-groups of men within the old intermediate-risk and high-risk criteria who have very different prognostic outcomes. We therefore propose adoption of the CPG model as a simple-to-use but more accurate prognostic stratification tool to help guide management for men with newly diagnosed prostate cancer.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1019-5) contains supplementary material, which is available to authorized users.

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“…The men were divided into five risk categories based on a modified version of the National Comprehensive Cancer Network (NCCN) guidelines: low risk (cT1-T2, PSA < 10 and Gleason score 6/WHO grade 1), intermediate risk (cT1-T2 and PSA 10-<20 or Gleason score 7/WHO grade 2), high risk (cT3 or PSA 20-<50 or Gleason score 8/WHO grade 3), regionally metastatic (cT4 or N1 or PSA 50-<100) and metastatic (M1 or PSA 100). Men with unknown risk category were excluded [18]. Comorbidity at diagnosis was categorized according to the Charlson Comorbidity Index [19] based on ICD discharge codes up to 10 years before the prostate cancer diagnosis.…”

Section: Study Cohortmentioning

confidence: 99%

Age at diagnosis and prostate cancer treatment and prognosis: a population-based cohort study

et al. 2018

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Proportion and characteristics of men with unknown risk category in the National Prostate Cancer Register of Sweden

Abstract: Men with unknown risk category were rare in NPCR but distinctly different from other men in NPCR in many aspects including higher comorbidity and lower Pca mortality.

Cited by 19 publications

References 23 publications

Temporal changes in survival in men with de novo metastatic prostate cancer: nationwide population-based study

Temporal changes in survival in men with de novo metastatic prostate cancer: nationwide population-based study

The Cambridge Prognostic Groups for improved prediction of disease mortality at diagnosis in primary non-metastatic prostate cancer: a validation study

Age at diagnosis and prostate cancer treatment and prognosis: a population-based cohort study

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