Ingrid Hannestad

• Hannestad, Ingrid; Myklebust, Tor Åge; Fosså, Sophie Dorothea; Müller, Stig & Aas, Kirsti (2026). Does active surveillance prior to radical prostatectomy increase the risk of adverse pathological findings or postoperative prostate cancer treatment? World Journal of Urology. ISSN 0724-4983. 44(1). doi: 10.1007/s00345-026-06617-5. Full text in Research Archive Show summary

  Purpose Active surveillance (AS) is an established management strategy for men with low- and favorable intermediate-risk prostate cancer (PCa). Nevertheless, a substantial proportion of patients ultimately undergo radical prostatectomy (RP), and the impact of prior AS on subsequent outcomes remains uncertain. We therefore compared surgical methods, adverse pathological findings and post-RP PCa-treatment among men undergoing deferred RP after AS with those of comparable men treated with immediate RP. Methods Using nationwide data from the Norwegian Prostate Cancer Registry, we identified men diagnosed between 2009 and 2022 with low- or intermediate-risk PCa who underwent deferred RP following AS or immediate RP. Descriptive statis tics summarized clinical characteristics and surgical methods. Multivariable logistic regression evaluated adverse pathologi cal findings in the surgical specimen, and Cox proportional hazards models analyzed post-RP PCa-treatment. Kaplan-Meier analyses with log-rank test assessed 10-year PCa-specific survival. Results Compared with immediate RP (n = 5767), the deferred RP (n = 1839) group had more unfavorable preoperative tumor characteristics, fewer nerve-sparing procedures and more frequent lymph node dissection. Deferred RP after AS was associated with higher risk of adverse pathological findings (OR 1.99, 95% CI 1.8–2.3) and post-RP PCa-treatment (HR 1.52, 95% CI 1.3–1.8). Ten-year PCa-specific survival did not differ between groups. Limitations include incomplete data on surveillance intensity. Conclusion Deferred RP after AS was associated with more extensive surgery, adverse pathological findings and post-RP PCa-treatment, but similar ten-year PCa-specific survival, compared to immediate RP. These findings emphasize the need for surveillance strategies that ensure timely detection of disease progression and transition to radical treatment.

• Hannestad, Ingrid; Myklebust, Tor Åge; Fosså, Sophie Dorothea; Müller, Stig & Aas, Kirsti (2025). Real-world implementation and guideline adherence at inclusion of active surveillance for men with prostate cancer: a population-based study from the Cancer Registry of Norway. Scandinavian Journal of Urology. ISSN 2168-1805. 60, p. 218–225. doi: 10.2340/sju.v60.45023. Full text in Research Archive Show summary

  Objectives: This study aimed to evaluate the implementation of and adherence to national guidelines at inclusion amongst men with newly diagnosed prostate cancer (PCa) managed with active surveillance (AS) in Norway. Materials and methods: We conducted a population-based cohort study using data from the Norwegian Prostate Cancer Registry, encompassing all men diagnosed with PCa and managed with AS from 2009 to 2022. We assessed guideline adherence based on AS inclusion criteria defined in the national guidelines and analysed the factors associated with adherence. Non-adherence was defined as inclusion in AS despite not meeting formal criteria. Results: Among 69,996 men diagnosed with PCa, 11 449 (16.4%) were managed with AS. Overall adherence to national guidelines for AS inclusion was 64%, rising from 60% in 2009 to 77% in 2022, with a notable increase after the 2020 guideline update. Higher adherence was associated with more recent diagnoses, younger age, lower Eastern Cooperative Oncology Group (ECOG) performance status, and evaluation by a private specialist. Significant regional variations in guidelines adherence were observed. Conclusions: While the use of AS for localised PCa increased in Norway over time, only two in three men were eligible for AS and regional variations persisted. This study highlights the need for strategies to standardise AS implementation across healthcare settings to ensure uniform and evidence-based management of patients with localised PCa nationwide.

• Akhtar, Saima Naz; Gudbrandsdottir, Gigja; Aarsæther, Erling Johan; Carlsen, Birgitte; Dimmen, Magne & Hannestad, Ingrid [Show all 14 contributors for this article] (2025). Presentation and survival for urachal cancer: Findings from a nationwide multicenter cohort study in Norway. Urologia. ISSN 0391-5603. 92(4), p. 595–602. doi: 10.1177/03915603251358961. Full text in Research Archive Show summary

  Background and objective: This study aims to map the prevalence and treatment of urachal cancer (UrC) in Norway, establish survival rates, identify prognostic factors, and evaluate whether any of the three commonly used staging systems for UrC provide superior prognostic value. Methods: In this retrospective cohort study, data from the National Cancer Register was collected to identify patients diagnosed with UrC between1997 and2022. Eligible cases (n = 43) underwent retrospective review of their individual hospital records. All patients were staged using the Sheldon, Mayo, and Limonnik-revised TNM systems. This was performed locally and then checked by the coordinating center. Key findings and limitations: The median age at surgery was 59.5 years (IQR 49–73), with 57% of patients being male. The median follow-up time for survivors was 98 months (IQR 81–153). Macroscopic hematuria was the most common presentation (67%, n = 28). Recurrence-free survival (RFS) rates at 1, 3, and 5 years were 71%, 57%, and 53%, respectively. Cancer specific survival (CSS) was 95%, 62%, 55%, and overall survival (OS) rates were 93%, 61%, 46% at the same time points. Smaller tumor size was an independent predictor of improved CSS (HR 1.3, CI: 1.01–1.6, p = 0.045). Of the three staging systems, only the Mayo system showed statistically significant differences between stages for OS, while none of the systems, including Mayo, showed significant differences for CSS. Study limitations include a small sample size and a prolonged study period of 25 years, which may affect the generalizability of the findings and introduce bias due to changes in clinical practice over time, such as advancements in surgical techniques, and oncological therapies. Conclusions and clinical implications: Urachal cancer is frequently diagnosed at an advanced stage. Our findings suggest that the Mayo system more effectively distinguishes between localized, locally advanced, and advanced disease compared to the Sheldon and Limonnik-revised TNM systems.

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