Publications
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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.
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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.
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Qvigstad, Lars Fredrik; Aas, Kirsti; Tulipan, Andreas Julius; Hole, Knut Håkon; Storås, Anne Marie Holck & Hammarström, Clara Louise
[Show all 9 contributors for this article]
(2025).
Clinical Trial Protocol for prePSMA: A Multicenter, Randomized, Noninferiority Trial of Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography as Triage for Extended Pelvic Lymph Node Dissection in Patients Scheduled for Robot-assisted Laparoscopic Radical Prostatectomy.
European Urology Focus.
11(6),
p. 915–920.
doi:
10.1016/j.euf.2025.07.010.
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Marra, Giancarlo; Leenders, Geert J.L.H. van; David, Guglielmo; Oderda, Marco; Aas, Kirsti & Heidegger, Isabel
[Show all 23 contributors for this article]
(2025).
Assessment of the Reporting and Incidence of Prostate Cancer Unconventional Histologies in Tertiary Referral Institutions: An Under-reported but Exploding Phenomenon?
European Urology Oncology (EUO).
8(4),
p. 875–878.
doi:
10.1016/j.euo.2025.05.001.
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Prostate cancer (PCa) with unconventional histologies (UHs) is not infrequent and may be associated with different prognosis compared with conventional PCa depending on the type, subtype, or pattern considered. A recent World Health Organization update recommends UHs to be reported on biopsy and final pathology. Our study aimed to assess the incidence and reporting attitudes of PCa UHs at tertiary referral institutions. Overall, 22 and 11 centers provided data on internal pathological guidelines and/or UH incidence, respectively. A comprehensive list of UHs was reported by pathologists only in <50% of the centers. Of note, ductal, intraductal, cribriform, and sarcomatoid UHs were consistently reported in ≥85% of the centers. The incidence of UHs was 373 on 15 605 biopsies (2.4%) and 737 on 14 945 (4.9%) final pathology specimens. However, UH incidence at final pathology increased from 0.7% in 2010 to 19% in 2023, while it remained stable on biopsy (1.5% in 2010 and 2.1% in 2023). The most frequent UH was cribriform (64%), followed by ductal (10%) and intraductal (9%) PCa. In conclusion, UHs are not infrequent and their recognition is increasing. However, pathological reporting is not well standardized, and prostate biopsies likely underestimate UHs.
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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.
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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.
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Nilsson, Mona Otrebski; Storås, Anne Marie Holck; Johannessen, Tom Børge; Gjelsvik, Ylva Maria; Aas, Kirsti & Fosså, Sophie Dorothea
[Show all 7 contributors for this article]
(2025).
Adverse health outcomes for prostate cancer patients treated with radiotherapy combined with androgen-deprivation therapy: A population-based, controlled study, from Norway.
Acta Oncologica.
ISSN 0284-186X.
64,
p. 1109–1116.
doi:
10.2340/1651-226x.2025.42825.
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Background and purpose : The aim of this controlled cross-sectional, and population-based study was to evaluate adverse health outcomes (AHOs) 3 years after curative radiotherapy (RT) + androgen deprivation therapy (ADT). We also assessed Global Health/Quality of Life (QoL).
Patients/material and methods: The Cancer Registry of Norway (CRN) provided data on prostate cancer (PCa) patients diagnosed in 2017–2019. All had been treated with RT+ ADT. All had completed EPIC-26 and EORTC QLQ-C30 about 3 years after RT start (n = 663). ADT duration was stratified: Short (< 9 months), intermediate (9–18 months) and long ADT (18–24 months). A group of controls were established from the general population (n = 1,817). Outcome measures were the urinary irritative/obstructive domain summary score (DSS), the bowel and sexual DSSs (EPIC-26) and QoL (EORTC QLQ-C30).
Results: Compared to controls, patients had clinically important lower bowel, and sexual mean scores. Urinary irritative/obstructive DSS levels were similar. Overall, 43% (PCa patients) and 20% (controls) reported major sexual problems. In patients aged < 75 years, longer than short ADT duration significantly decreased sexual DSS. QoL was relatively unaffected. Low response rates, selection bias and a lack of pre-treatment data represent the studys´ limitations.
Conclusion and Interpretation: Three years post-RT+ADT, PCa patients describe clinically important lower EPIC-26 bowel and sexual DSS compared to controls. Sexual domain levels decreased with increasing ADT duration, particularly in patients < 75 years. Our observations indicate worse AHOs than previously reported and should be considered during pre-treatment counselling of PCa patients.
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Qvigstad, Lars Fredrik; Eri, Lars Magne; Diep, Lien My; Fosså, Sophie Dorothea; Aas, Kirsti & Berge, Viktor
(2024).
Reduction of lower urinary tract symptoms in prostate cancer patients treated with robot assisted laparoscopic prostatectomy.
Scandinavian Journal of Urology.
ISSN 2168-1805.
59,
p. 121–125.
doi:
10.2340/sju.v59.40070.
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Problem: The aim of this study was to evaluate the change in LUTS in patients treated with RALP and to assess factors that may predict an improvement of LUTS. Materials and method: In our institutional prospective research registry, 1935 patients operated in the period between 2009 and 2021 with complete baseline- and 12-month EPIC-26 questionnaire were eligible for the study. Also SF-12 data estimating general quality of life (QoL) were analyzed. A LUTS summary score was constructed from the two questions concerning voiding stream/residual and frequency, and transformed linearly to a 0-100 scale with higher scores representing less symptoms A change of 6 points or more were considered Meaningful Clinical Differences (MCD). Two summary scores were calculated from the SF-12 – a mental component score (MCS-12) and a physical component score (PCS-12). Multivariate regression was used to estimate covariates associated with postoperative MCD, MCS-12 and PCS-12. Results: Mean change of LUTS-score showed an increase of 10 points 12-months post-RALP. 52% of patients achieved MCD. In multivariate logistic regression, preoperative LUTS was statistically significant associated with MCD. Reduction of LUTS was associated improved mean score of MCS-12 and PCS-12. Discussion and conclusion: Along with information about risk for urinary incontinence after RALP, patients with LUTS at baseline must be informed that these symptoms may be reduced after RALP. In our study, this LUTS reduction was associated with better general QoL.
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Fosså, Sophie Dorothea; Storås, Anne Marie Holck; Aas, Kirsti; Johannessen, Tom Børge; Gjelsvik, Ylva Maria & Myklebust, Tor Åge
(2024).
Pretreatment Patient-reported Overall Health: A Prognostic Factor for Early Overall Mortality After Primary Curative Treatment of Prostate Cancer.
European Urology Open Science.
ISSN 2666-1691.
63,
p. 62–70.
doi:
10.1016/j.euros.2024.03.005.
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Background and objective Registry-based studies for prostate cancer (PCa) document higher overall mortality (OM) after high-dose radiotherapy (RT) than after radical prostatectomy (RP). Our aim was to explore the association between pretreatment patient-reported health (“OverallHealth”: OH) and curative treatment type, and the impact on early OM. Methods New PCa patients registered between 2017 and 2019 in the Cancer Registry of Norway (n = 1949) completed the European Organisation for Research and Treatment of Cancer Quality-of-Life Core 30 (QLQ-C30) questionnaire before RP (n = 592) or RT (n = 610) or after allocation to active surveillance (AS; n = 747). We dichotomised the QLQ-C30 summary score to classify patients with un-impaired versus impaired OH. Standard univariable and multivariable analyses with treatment type or OM as the outcome were conducted. The mean observation time was 4.7 years (standard deviation 1.0). Statistical significance was set at p < 0.05. Key findings and limitations Impaired OH was more frequent in the RT group (38%) than in the RP (25%) or AS (28%) group (p < 0.001). Higher age, higher risk group, and impaired OH increased the probability of undergoinRT rather than RP (p < 0.001). Impaired OH was associated with a twofold higher early OM rate in the RT group (16% vs 8%; p = 0.009) and fourfold higher OM rate in the AS group (13% vs 3%; p < 0.001). These findings remained significant in Cox regression analyses controlled for age and risk group. After RP, only locally advanced high-risk tumours were significantly associated with OM. Unknown psychometrics for the OH variable is the main study limitation. Conclusions and clinical implications Pretreatment patient-reported impaired OH, measured as the QLQ-C30 summary score, was positively associated with allocation to RT or AS and is a prognostic factor for early OM. Before allocation to RT or AS, elderly patients with PCa should be screened and treated for health problems that can be remedied. Future studies should determine the psychometrics of the QLQ-C30 summary score in comparison to established frailty screening instruments. Patient summary Patient-reported scores reflecting their overall health can help in choosing curative treatment for prostate cancer and are associated with survival during the first 5 years after treatment.
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Nilsson, Mona Otrebski; Aas, Kirsti; Myklebust, Tor Åge; Gjelsvik, Ylva Maria; Johannessen, Tom Børge & Fosså, Sophie D.
(2024).
Adverse Health Outcomes 3 Years after Radical Prostatectomy Compared with Men in the General Population: A Study from the Cancer Registry of Norway.
Clinical Genitourinary Cancer.
ISSN 1558-7673.
22(6),
p. 1–9.
doi:
10.1016/j.clgc.2024.102219.
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Introduction Studies about adverse health outcomes (AHOs) after radical prostatectomy (RP) in population-based contemporary prostate cancer (PCa) patients are limited, as well as knowledge about corresponding data from age-similar men from the general population (Norms). We compared selected AHOs (pad use, intercourse inability), related problems (bother) and quality of life (QoL) between PCa patients and Norms. Patients and methods The Cancer Registry of Norway (CRN) provided data on PCa patients diagnosed in 2017-2019 and treated with RP who completed the EPIC-26 and EORTC-QLQ-C30 questionnaires 24-48 months after surgery (n = 1501). The CRN also established a group of Norms (n = 1894). Dichotomized EPIC-26 outcomes: daily use of ≥1 pad (Item#3), quality of erections (Item#9) and related bother (Item#4a/#12). EORTC-QLQ-C30: quality of life (Item#30). Multivariable logistic regressions explored associations between selected covariates and outcomes. Results In total, 41% of the patients and 5% in Norms reported pad use, the comparable figures for intercourse inability being 84% (Patients) and 48% (Norms). Among pad users, 24% of the patients and 25% of the Norms described bother. 52% of patients and 35% Norms with intercourse inability. Only bilateral nerve-sparing surgery (NSS) significantly reduced the risk of pad use and intercourse inability. Compared to Norms, PCa patients were associated with pad use, intercourse inability, related bother, and good/ fair QoL. Conclusion In these population-based cohorts, 2 in 5 patients used pads 3 years after RP, compared to 1 in 20 Norms. Intercourse inability was reported by 4 of 5 patients compared to 1 of 2 Norms. PCa patients were associated with good/ fair QoL. Bilateral NSS significantly reduced the risk of AHOs, highlighting the importance of this approach. Function and bother are different dimensions of urinary and sexual AHOs and must be reported separately. The findings from this study should be considered when counselling patients before RP.
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Haug, Erik Skaaheim; Myklebust, Tor Åge; Jones, Charles Patrick W.; Reisæter, Lars Anders Rokne; Aas, Kirsti & Berg, Arne Stenrud
[Show all 12 contributors for this article]
(2023).
Impact of prebiopsy MRI on prostate cancer staging: Results from the Norwegian Prostate Cancer Registry.
BJUI Compass.
4(3),
p. 331–338.
doi:
10.1002/bco2.214.
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The aim of this study is to evaluate the 2015 introduction of prebiopsy magnetic resonance imaging of the prostate (MRI-P) as the standard of care for diagnosing prostate cancer (PCa) by the Norwegian public health care authorities. There were three specific objectives of this study: first, to evaluate the consequences of using different TNM manuals for clinical T-staging (cT-staging) in a national setting; second, to determine if the data reveals that MRI-P based cT-staging is superior to digital rectal examination (DRE)-based cT-staging compared with pathological T-stage (pT-stage) post radical prostatectomy; and third, to assess whether treatment allocations have changed over time. Materials and Methods All patients registered in the Norwegian Prostate Cancer Registry between 2004 and 2021 were retrieved and 5538 were eligible for inclusion. Concordance between clinical T-stage (cT-stage) and pT-stage was assessed by percentage agreement, Cohen's kappa and Gwet's agreement. Results MR visualisation of lesions influences reporting of tumour extension beyond DRE findings. Agreement between cT-stage and pT-stage declined from 2004 to 2009, which coincided with an increase in the percentage being pT3. From 2010, agreement increased, which aligned with changes in cT-staging and the introduction of MRI-P. From 2017, regarding the reporting of cT-DRE and cT-Total (overall cT-stage), agreement diminished for cT-DRE but remained relatively stable (>60%) for cT-Total. Regarding treatment allocation, the study suggests that staging with MRI-P has shifted treatment towards radiotherapy in locally advanced high-risk disease. Conclusion Introduction of MRI-P has affected cT-stage reporting. Agreement between cT-stage and pT-stage appears to have improved. This study suggests that use of MRI-P influences treatment decisions in certain patient subgroups.
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Nilsson, Mona Otrebski; Aas, Kirsti; Myklebust, Tor Åge; Gjelsvik, Ylva Maria; Haug, Erik Skaaheim & Fosså, Sophie Dorothea
[Show all 7 contributors for this article]
(2023).
Do all prostate cancer patients want, and experience shared decision making prior to curative treatment?
Scandinavian Journal of Urology.
ISSN 2168-1805.
58,
p. 133–140.
doi:
10.2340/sju.v58.14730.
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Objective: In comparable men with non-metastatic prostate cancer, radical prostatectomy (RP), radiotherapy (RAD) and active surveillance (AS) are treatment options with similar survival rates, but different side-effects. Healthcare professionals consider pretreatment shared decision making (SDM) to be an essential part of medical care, though the patients’ view about SDM is less known. In this article, we explore prostate cancer (PCa) patients’ SDM wish (SDMwish), and experiences (SDMexp). Material and methods: This is a registry-based survey performed by the Cancer Registry of Norway (2017–2019). One year after diagnosis, 5,063 curatively treated PCa patients responded to questions about their pre-treatment wish and experience regarding SDM. Multivariable analyses identified factors associated with SDM. Statistical significance level: p < 0.05. Results: Overall, 78% of the patients wished to be involved in SDM and 83% of these had experienced SDM. SDMwish and SDMexp was significantly associated with decreasing age, increasing education, and living with a partner. Compared with the RP group, the probability of SDMwish and SDMexp was reduced by about 40% in the RAD and the AS groups. Conclusion: Three of four curatively treated PCa wanted to participate in SDM, and this wish was met in four of five men. Younger PCa patients with higher education in a relationship, and opting for RP, wanted an active role in SDM, and experienced being involved. Effective SDM requires the responsible physicians’ attention to the individual patients’ characteristics and needs.
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Bjerner, Lars; Bratt, Ola; Aas, Kirsti; Albertsen, Peter C.; Fosså, Sophie D. & Kvåle, Rune
[Show all 16 contributors for this article]
(2023).
Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death—Results from the Norwegian Prostate Cancer Consortium.
European Urology.
ISSN 0302-2838.
p. 1–7.
doi:
10.1016/j.eururo.2023.04.028.
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Background Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality. Objective To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death. Design, setting, and participants The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40–54 and 55–69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1, 1995 and December 31, 2005. Intervention Baseline PSA. Outcome measurements and statistical analysis We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5–0.9, 1.0–1.9, 2.0–2.9, and 3.0–3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method. Results and limitations The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0–3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40–54 and 55–69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation. Conclusions We replicated prior studies that baseline PSA at age 40–69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15–20 yr. Patient summary A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man’s risk of dying from prostate cancer in the next two decades. Keywords Prostate cancerScreeningProstate-specific antigen
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Aas, Kirsti; Berge, Viktor; Myklebust, Tor Åge & Fosså, Sophie Dorothea
(2021).
Comparative survival outcomes of high-risk prostate cancer ttreated with radical prostatectomy or definitive radiotherapy regimens.
European Urology Open Science.
ISSN 2666-1691.
26,
p. 55–63.
doi:
10.1016/j.euros.2021.01.011.
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Background: Observational data has indicated improved survival after radical
prostatectomy (RP) compared with definitive radiotherapy (RT) in men with
high-risk prostate cancer (PCa).
Objective: To compare PCa-specific mortality (PCSM) and overall mortality (OM) in
men with high-risk PCa treated with RP or RT, providing information on target
doses and fractionations.
Design, setting, and participants: This is an observational study from the Cancer
Registry of Norway. Patients were diagnosed with high-risk PCa during 2006–2015,
treated with RP
12 mo or RT
15 mo after diagnosis, and stratified according to RP
or RT modality; external beam radiotherapy (EBRT; 70–<74, 74–<78, or 78 Gy),
hypofractionated RT or EBRT combined with brachytherapy (BT-RT).
Outcome measurements and statistical analysis: Competing risk and Kaplan-
Meier methods estimated PCSM and OM, respectively. Multivariable Cox regression
models evaluated hazard ratios (HRs) for PCSM and OM.
Results and limitations: In total, 9254 patients were included (RP 47%, RT 53%). RT
patients were older, had poorer performance status and more unfavorable disease
characteristics. With a median follow-up time of seven and eight yrs, the overall 10-
yr PCSM was 7.2% (95% confidence interval [CI] 6.4–8.0) and OM was 22.9% (95% CI
21.8–24.1). Compared with RP, EBRT 70–<74 Gy was associated with increased (HR
1.88, 95% CI 1.33–2.65, p < 0.001) and BT-RT with decreased (HR 0.49, 95% CI 0.24–
0.96, p = 0.039) 10-yr PCSM. Patients treated with EBRT 70–78 Gy had higher
adjusted 10-yr OM than those treated with RP.
Conclusions: In men with high-risk PCa, treatment with EBRT <74 Gy was associated
with increased adjusted 10-yr PCSM and OM, and BT-RT with decreased 10-yr
PCSM, compared with RP.
Patient summary: In this study, we compared mortality after radical prostatectomy
(RP) and radiotherapy (RT) in men with high-risk prostate cancer (PCa); the results
suggest that men receiving lower-dose RT have higher, and patients receiving
brachytherapy may have lower, risk of death from PCa than patients treated with
prostatectomy.
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Fosså, Sophie Dorothea; Aas, Kirsti; Muller, Christoph Rainer; Jerm, Marianne Brenn; Tandstad, Torgrim & Lilleby, Wolfgang
[Show all 10 contributors for this article]
(2020).
Definitive radiotherapy for prostate cancer in Norway 2006-2015: Temporal trends, performance and survival.
Radiotherapy and Oncology.
ISSN 0167-8140.
155,
p. 33–41.
doi:
10.1016/j.radonc.2020.10.022.
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Background More studies are needed to document nation-wide use and effectiveness of curative definitive radiotherapy (Def-RT) in the treatment of prostate cancer (PCa). Patients and methods For 38,960 men diagnosed with PCa without distant metastases from 2006 to 2015 data from the Norwegian Prostate Cancer Registry and a national radiotherapy database (NoRadBase) was analyzed. Overall survival and PCa-specific mortality were described comparing EQD-2 < 74 Gy (“low-dose”) with EQD-2 ≥ 74 Gy (“escalated dose”). Results Use of Def-RT decreased (27–24%) whereas the proportion of radical prostatectomies (RPs) increased (31–38%). In high-risk patients the use of RP doubled (18–36%), while the proportion of Def-RT remained stable (about 35%). Before 2010, almost a quarter of patients received low-dose Def-RT with gradual increase of escalated Def-RT thereafter. Escalated Def-RT was associated with significantly more favorable 10-year PCa-specific mortality (4.4% [95% CI: 2.7–10.7%]) than observed after low-dose Def- RT (8.8% [95% CI: 6.2–9.8%), with the most beneficial effects in high-risk patients. Our analyses indicated the need to expand the NoRadBase by consensus-based quality measures. Conclusion In this nationwide cohort, the overall use of Def-RT decreased slightly. In high-risk patients the provision of Def-RT remained stable and was accompanied by doubling of patients with RP and reduction of a “no curative treatment” strategy. Escalated dose Def-RT significantly reduced 10-year PCa-specific mortality compared to low-dose Def-RT. Aiming for cancer care equity national radiotherapy registries for PCa should regularly monitor data based on consensus-based quality measures enabling feedback to the responsible hospitals.
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Aas, Kirsti; Fosså, Sophie Dorothea; Myklebust, Tor Åge; Møller, Bjørn; Kvåle, Rune & Vlatkovic, Ljiljana
[Show all 7 contributors for this article]
(2020).
Increased curative treatment is associated with decreased prostate cancer-specific and overall mortality in senior adults with high-risk prostate cancer; results from a national registry-based cohort study.
Cancer Medicine.
9(18),
p. 6646–6657.
doi:
10.1002/cam4.3297.
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Background The association between curative treatment (CurTrt) and mortality in senior adults (≥70 years) with high‐risk prostate cancer (PCa) is poorly documented. In a population‐based cohort we report temporal trends in treatment and PCa‐specific mortality (PCSM), investigating the association between CurTrt and mortality in senior adults with high‐risk PCa, compared to findings in younger men (<70 years). Methods Observational study from the Cancer Registry of Norway. Patients with high‐risk PCa were stratified for three diagnostic periods (2005‐08, 2009‐12 and 2013‐16), age (<70, vs ≥70) and primary treatment (CurTrt: Radical prostatectomy (RP), Radiotherapy (RAD) vs no curative treatment (NoCurTrt)). Competing risk and Kaplan‐Meier methods estimated PCSM and overall mortality (OM), respectively. Multivariable logistic regression models estimated odds for CurTrt, and multivariable Fine Gray and Cox regression models evaluated the hazard ratios for PCSM and OM. Results Of 19 763 evaluable patients, 54% were aged ≥70 years. Senior adults had more unfavorable PCa characteristics than younger men. Across diagnostic periods, use of CurTrt increased from 15% to 51% in men aged ≥70 and 65% to 81% in men aged < 70 years. With median five years follow‐up, PCSM decreased in all patients (P < .05), in the third period restricted to senior adults. In all patients NoCurTrt was associated with three‐fold higher 5‐year PCSM and two‐fold higher OM compared to CurTrt. Conclusions In high‐risk PCa patients, increased use of CurTrt, greatest in senior men, was observed along with decreased PCSM and OM in both senior and younger adults. CurTrt should increasingly be considered in men ≥70 years.
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Kvåle, Rune; Myklebust, Tor Åge; Fosså, Sophie Dorothea; Aas, Kirsti; Ekanger, Christian & Helle, Svein Inge
[Show all 8 contributors for this article]
(2019).
Impact of positive surgical margins on secondary treatment, palliative radiotherapy and prostate cancer‐specific mortality. A population‐based study of 13 198 patients.
The Prostate.
ISSN 0270-4137.
79(16),
p. 1852–1860.
doi:
10.1002/pros.23911.
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Background:
The results of studies evaluating the impact of positive surgical margins on prostate cancer‐specific mortality have been inconsistent. We, therefore, evaluated the impact of surgical margin status on subsequent secondary treatment, palliative radiotherapy, and prostate cancer‐specific mortality.
Methods
A total of 14 837 men treated with radical prostatectomy (RP) during the period 2001 to 2015 were identified from the Cancer Registry of Norway. Of those, 13 198 (89%) patients had complete data on the preoperative prostate‐specific antigen level, pathological T‐category, Gleason score in the prostatectomy specimen, and margin status. Multivariable Cox proportional hazards models were used to evaluate the risk, and flexible parametric models for the cumulative incidence were fitted to predict the probabilities of secondary treatment (salvage radiotherapy or prophylactic breast radiation), palliative radiotherapy, and prostate cancer‐specific mortality.
Results
After a median follow‐up time of 5.2 years (3591 patients with ≥8 years of follow‐up), positive surgical margins (PSMs) were independently predictive of secondary treatment (hazard ratio [HR] = 2.43, 95% confidence interval [CI] = 2.21‐2.66) and palliative radiotherapy (HR = 1.45, 95% CI = 1.03‐2.05). After 10 years, the absolute increased risk for palliative radiotherapy in patients with PSMs after RP varied between 0.1% in pT2 tumors with a Gleason score of 6, to 12% for pT3b tumors with a Gleason score of 9 to 10. PSMs were not independently associated with prostate cancer‐specific mortality (HR = 1.14, 95% CI = 0.82‐1.59).
Conclusion
PSMs were associated with increased application of secondary treatment and palliative radiotherapy but were not predictive of prostate cancer‐specific mortality. As the use of palliative radiotherapy was only marginally increased in patients with PSMs and the lowest‐risk disease characteristics, avoiding PSMs may be of greatest prognostic relevance in patients with higher‐risk disease characteristics.
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Fosså, Sophie Dorothea; Beyer, Bud; Dahl, Alv A; Aas, Kirsti; Eri, Lars Magne & Kvan, Espen
[Show all 10 contributors for this article]
(2019).
Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique.
Scandinavian Journal of Urology.
ISSN 2168-1805.
p. 1–7.
doi:
10.1080/21681805.2019.1693625.
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Purpose: To explore whether prostatectomized men report improved post-operative erectile function and urinary control dependent on the application of intra-operative frozen section examination (NeuroSAFE) during nerve-sparing radical prostatectomies (NS-RPs). Methods: Pre- and post-RP responses to the sexual domain and the urinary incontinence subscale of EPIC-26 were analyzed in 95 and 312 men from a NeuroSAFEGroup (Martini-Klinik, Hamburg, Germany) and a Non-NeuroSAFE Group (Oslo University Hospital, Norway), respectively, undergoing NS-RPs for ≤ cT2 prostate cancer. All patients had intra-prostatic tumors as evaluated by Digital Rectal Examination. Statistical significance in bivariate and multi-variable analyses: p < 0.05. Results: With similar oncological outcomes and not associated with the performance of bilateral or unilateral NS-RP within each group patients from the NeuroSAFE Group had better sexuality outcomes than those from the NonNeuroSAFE Group (p < 0.01). Age and pre-RP sexual function represented significant co-variables. In pre-RP potent men, erectile function was preserved in 74% of men in the NeuroSAFE Group and in 46% in those from the NonNeuroSAFE Group (p < 0.01). Any superior continence-saving effect of NeuroSAFE was limited. The non-randomized small-sized observational study design represents the observations’ main limitation. Conclusions: Our study indicates that NeuroSAFE contributes to preservation of post-RP erectile function. If confirmed in a randomized trial the NeuroSAFE should be applied in patients undergoing NS-RP for maximal preservation of post-RP sexual function.
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Bjerner, Lars Johan; Bratt, Ola; Aas, Kirsti; Albertsen, Peter C.; Carlsson, Sigrid V. & Oldenburg, Jan
(2024).
Reply to Rongkang Li, Lei Peng, Shaohua Zhang, and Song Wu's Letter to the Editor re: Johan Bjerner, Ola Bratt, Kirsti Aas, et al. Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death—Results from the Norwegian Prostate Cancer Consortium. Eur Urol 2024;86:20–6.
European Urology.
ISSN 0302-2838.
doi:
10.1016/j.eururo.2024.08.034.
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Löffeler, Sven; Bertilsson, Helena Maria; Müller, Christoph Rainer; Aas, Kirsti; Haugnes, Hege Sagstuen & Aksnessæther, Bjørg Yksnøy
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(2024).
Protocol of a randomised, controlled trial comparing immediate curative therapy with conservative treatment in men aged ≥75 years with non-metastatic high-risk prostate cancer (SPCG 19/GRand-P).
BJU International.
ISSN 1464-4096.
133(6),
p. 680–689.
doi:
10.1111/bju.16314.
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Background: Older men (aged ≥75 years) with high risk, non-metastatic prostate cancer (PCa) are increasingly treated with curative therapy (surgery or radiotherapy). However, it is unclear if curative therapy prolongs life and improves health-related quality of life (HRQoL) in this age group compared to conservative therapy, which has evolved considerably during the last decade.
Study design: The Scandinavian Prostate Cancer Group (SPCG) 19/Norwegian Get-Randomized Research Group-Prostate (GRand-P) is a randomised, two-armed, controlled, multicentre, phase III trial carried out at study centres in Norway, Denmark, Finland, and Sweden.
Endpoints: The primary endpoints are overall survival and HRQoL (burden of disease scale, European Organisation for the Research and Treatment of Cancer [EORTC] Elderly Cancer patients). Secondary endpoints are PCa-specific survival, metastasis-free survival, role-functioning scale (EORTC quality of life questionnaire 30-item core), urinary irritative/obstructive scale (26-item Expanded Prostate Cancer Index Composite [EPIC-26]), bowel scale (EPIC-26), intervention-free survival, PCa morbidity, use of secondary and tertiary systemic therapies, mean quality-adjusted life-years (QALYs), and mean total healthcare costs.
Patients and methods: A total of 980 men (aged ≥75 years) with non-metastatic, high-risk PCa will initially be screened with Geriatric 8 (G8) health status screening tool and Mini-COG© brief cognitive test. Participants identified by G8 as 'fit' or 'frail' will be randomised (ratio 1:1) to either immediate curative therapy (radiotherapy or prostatectomy) or conservative therapy (endocrine therapy or observation). Participants who are unable or unwilling to participate in randomisation will be enrolled in a separate observation group. Randomised patients will be followed for 10 years.
Trial registration: Ethics approval has been granted in Norway (457593), Denmark (H-22051998), Finland (R23043) and Sweden (Dnr 2023-05296-01). The trial is registered on Clinicaltrials.org (NCT05448547).
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Published
Mar. 2, 2023 3:02 PM
- Last modified
Aug. 19, 2026 12:57 PM
