Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005.
OBJECTIVE
The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment.


METHODS
Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis.


RESULTS
In total, 72,028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of > 100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score <6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged > or =75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden.


CONCLUSIONS
All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer.
Adolfsson
Jan
J
Oncological Centre, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden. jan.adolfsson@karolinska.se
Garmo
Hans
H
Varenhorst
Eberhard
E
Ahlgren
Göran
G
Ahlstrand
Christer
C
Andrén
Ove
O
Bill-Axelson
Anna
A
Bratt
Ola
O
Damber
Jan-Erik
JE
Hellström
Karin
K
Hellström
Magnus
M
Holmberg
Erik
E
Holmberg
Lars
L
Hugosson
Jonas
J
Johansson
Jan-Erik
JE
Petterson
Bill
B
Törnblom
Magnus
M
Widmark
Anders
A
Stattin
Pär
P
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden
D017430:Prostate-Specific Antigen