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  • 1.
    Bill-Axelson, A.
    et al.
    Department of Urology, University Hospital, Uppsala, Sweden.
    Holmberg, L.
    Regional Oncologic Center, University Hospital, Uppsala, Sweden, King's College London, School of Medicine, Division of Cancer Studies, London, United Kingdom, Medical School, Division of Cancer Studies, Guy's Hospital, London SE1 9RT, United Kingdom.
    Filen, F.
    Filén, F., Department of Urology, University Hospital, Uppsala, Sweden.
    Ruutu, M.
    Department of Urology, Helsinki University Central Hospital, Helsinki, Finland.
    Garmo, H.
    Regional Oncologic Center, University Hospital, Uppsala, Sweden.
    Busch, C.
    Department of Pathology, University Hospital, Uppsala, Sweden.
    Nordling, S.
    Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland.
    Haggman, M.
    Häggman, M., Department of Urology, University Hospital, Uppsala, Sweden.
    Andersson, S.-O.
    Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Bratell, S.
    Department of Urology, Borås Hospital, Borås, Sweden.
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Palmgren, J.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Adami, H.-O.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States.
    Johansson, J.-E.
    Department of Urology, Örebro University Hospital, Örebro, Sweden, Center for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Radical prostatectomy versus watchful waiting in localized prostate cancer: The Scandinavian prostate cancer group-4 randomized trial2008Ingår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 100, nr 16, s. 1144-1154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The benefit of radical prostatectomy in patients with early prostate cancer has been assessed in only one randomized trial. In 2005, we reported that radical prostatectomy improved prostate cancer survival compared with watchful waiting after a median of 8.2 years of follow-up. We now report results after 3 more years of follow-up. Methods: From October 1, 1989, through February 28, 1999, 695 men with clinically localized prostate cancer were randomly assigned to radical prostatectomy (n = 347) or watchful waiting (n = 348). Follow-up was complete through December 31, 2006, with histopathologic review and blinded evaluation of causes of death. Relative risks (RRs) were estimated using the Cox proportional hazards model. Statistical tests were two-sided. Results: During a median of 10.8 years of follow-up (range = 3 weeks to 17.2 years), 137 men in the surgery group and 156 in the watchful waiting group died (P =. 09). For 47 of the 347 men (13.5%) who were randomly assigned to surgery and 68 of the 348 men (19.5%) who were not, death was due to prostate cancer. The difference in cumulative incidence of death due to prostate cancer remained stable after about 10 years of follow-up. At 12 years, 12.5% of the surgery group and 17.9% of the watchful waiting group had died of prostate cancer (difference = 5.4%, 95% confidence interval [CI] = 0.2 to 11.1%), for a relative risk of 0.65 (95% CI = 0.45 to 0.94, P =. 03). The difference in cumulative incidence of distant metastases did not increase beyond 10 years of follow-up. At 12 years, 19.3% of men in the surgery group and 26% of men in the watchful waiting group had been diagnosed with distant metastases (difference = 6.7%, 95% CI = 0.2 to 13.2%), for a relative risk of 0.65 (95% CI = 0.47 to 0.88, P =. 006). Among men who underwent radical prostatectomy, those with extracapsular tumor growth had 14 times the risk of prostate cancer death as those without it (RR = 14.2, 95% CI = 3.3 to 61.8, P <. 001). Conclusion: Radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery. © The Author 2008. Published by Oxford University Press.

  • 2.
    Bill-Axelson, A.
    et al.
    Department of Urology, University Hospital, Uppsala, Sweden, Department of Urology, University Hospital, SE-751 85 Uppsala, Sweden.
    Holmberg, L.
    Regional Oncologic Center, University Hospital, Uppsala, Sweden.
    Ruutu, M.
    Depatment of Urology, University of Helsinki, University Hospital of Helsinki, Helsinki, Finland.
    Haggman, M.
    Häggman, M., Department of Urology, University Hospital, Uppsala, Sweden.
    Andersson, S.-O.
    Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Bratell, S.
    Department of Urology, Boras Hospital, Boras, Sweden.
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Busch, C.
    Department of Pathology, University Hospital, Uppsala, Sweden.
    Nordling, S.
    Department of Pathology, University of Helsinki, University Hospital of Helsinki, Helsinki, Finland.
    Garmo, H.
    Regional Oncologic Center, University Hospital, Uppsala, Sweden.
    Palmgren, J.
    Dept. Med. Epidemiol. Biostatist., Karolinska Institutet, Stockholm, Sweden.
    Adami, H.-O.
    Dept. Med. Epidemiol. Biostatist., Karolinska Institutet, Stockholm, Sweden, Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States.
    Norlen, B.J.
    Norlén, B.J., Department of Urology, University Hospital, Uppsala, Sweden.
    Johansson, J.-E.
    Department of Urology, Örebro University Hospital, Örebro, Sweden, Ctr. for Assess. of Med. Technology, Örebro University Hospital, Örebro, Sweden.
    Radical prostatectomy versus watchful waiting in early prostate cancer2005Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 352, nr 19, s. 1977-1984Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results. METHODS: From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer, the secondary end points were death from any cause, metastasis, and local progression. RESULTS: During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88, P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86, P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44, P<0.001 by Gray's test). CONCLUSIONS: Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial. Copyright © 2005 Massachusetts Medical Society.

  • 3.
    Bill-Axelson, Anna
    et al.
    University of Uppsala Hospital, Sweden .
    Holmberg, Lars
    University of Uppsala Hospital, Sweden Kings Coll London, England .
    Garmo, Hans
    University of Uppsala Hospital, Sweden Kings Coll London, England .
    Rider, Jennifer R.
    Brigham and Womens Hospital, MA USA Harvard University, MA USA Harvard University, MA 02115 USA .
    Taari, Kimmo
    University of Helsinki, Finland .
    Busch, Christer
    University of Uppsala Hospital, Sweden .
    Nordling, Stig
    University of Helsinki, Finland .
    Haggman, Michael
    University of Uppsala Hospital, Sweden .
    Andersson, Swen-Olof
    University of Örebro, Sweden Örebro University Hospital, Sweden .
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
    Andren, Ove
    University of Örebro, Sweden Örebro University Hospital, Sweden .
    Palmgren, Juni
    Karolinska Institute, Sweden .
    Steineck, Gunnar
    Karolinska Institute, Sweden Sahlgrens Acad, Sweden .
    Adami, Hans-Olov
    Karolinska Institute, Sweden Harvard University, MA 02115 USA .
    Johansson, Jan-Erik
    University of Örebro, Sweden Örebro University Hospital, Sweden .
    Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer2014Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 370, nr 10, s. 932-942Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundRadical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. MethodsBetween 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. ResultsDuring 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04). ConclusionsExtended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.) The randomized Swedish trial of prostatectomy versus watchful waiting in disease detected mainly clinically (not by PSA screening) continues to show a benefit for early prostatectomy. The number of men younger than 65 needed to treat to prevent one death is now four. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), a randomized trial of radical prostatectomy versus watchful waiting in men with localized prostate cancer diagnosed before the era of prostate-specific antigen (PSA) testing, showed a survival benefit of radical prostatectomy as compared with observation at 15 years of follow-up.(1) By contrast, the Prostate Cancer Intervention versus Observation Trial (PIVOT), initiated in the early era of PSA testing, showed that radical prostatectomy did not significantly reduce prostate cancer-specific or overall mortality after 12 years.(2) PSA screening profoundly changes the clinical domain of study. Among other considerations, the substantial additional lead time ...

  • 4.
    Bill-Axelson, Anna
    et al.
    University Uppsala Hospital.
    Holmberg, Lars
    University Uppsala Hospital.
    Ruutu, Mirja
    University of Helsinki.
    Garmo, Hans
    University Uppsala Hospital.
    Stark, Jennifer R
    Brigham and Womens Hospital.
    Busch, Christer
    University Uppsala Hospital.
    Nordling, Stig
    University Helsinki.
    Haggman, Michael
    Uppsala University Hospital.
    Andersson, Swen-Olof
    Department Urol, Orebro.
    Bratell, Stefan
    Boras Hospital.
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
    Palmgren, Juni
    Karolinska Institute.
    Steineck, Gunnar
    Karolinska Institute.
    Adami, Hans-Olov
    Karolinska Institute.
    Johansson, Jan-Erik
    Department Urol, Orebro.
    Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer2011Ingår i: NEW ENGLAND JOURNAL OF MEDICINE, ISSN 0028-4793, Vol. 364, nr 18, s. 1708-1717Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND In 2008, we reported that radical prostatectomy, as compared with watchful waiting, reduces the rate of death from prostate cancer. After an additional 3 years of follow-up, we now report estimated 15-year results. METHODS From October 1989 through February 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy. Follow-up was complete through December 2009, with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death. Relative risks, with 95% confidence intervals, were estimated with the use of a Cox proportional-hazards model. RESULTS During a median of 12.8 years, 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died (P=0.007). In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting, death was due to prostate cancer. This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6% and 20.7%, respectively (a difference of 6.1 percentage points; 95% confidence interval [CI], 0.2 to 12.0), and a relative risk with surgery of 0.62 (95% CI, 0.44 to 0.87; P=0.01). The survival benefit was similar before and after 9 years of follow-up, was observed also among men with low-risk prostate cancer, and was confined to men younger than 65 years of age. The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age. Among men who underwent radical prostatectomy, those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth (relative risk, 6.9; 95% CI, 2.6 to 18.4). CONCLUSIONS Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment.

  • 5.
    Folkestad, Bengt
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Timed micturition and maximum urinary flow rate in randomly selected symptom-free males2004Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 38, nr 2, s. 136-142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To establish normal ranges for timed micturition, i.e. the time to void the first 100 ml, study its dependency on voided volume and age and compare it to maximum flow rate. Material and Methods: Randomly selected men from the National Register without voiding symptoms were investigated. These 58 men (aged 30-75 years) registered 1286 voidings (median 21 per person) at home with the aid of a portable uroflowmeter. Timed micturition and maximum flow rate were obtained from the same voidings. Results: An increase in timed micturition with an increase in age was confirmed. When estimating normal ranges it was sufficient to use the age groups ≤55 years and ≥56 years. Maximum flow rate is shown in nomograms with voided volume. Timed micturition had less dependency on voided volume than maximum flow rate. The normal ranges of timed micturition are ≤9 s for men aged ≤55 years and ≤15 s for those aged ≥56 years. The true median of timed micturition for men aged ≥56 years may be 6 s lower or 2.5 s higher than the value of a single measurement. Corresponding figures for maximum flow rate are 5 and 6 ml/s. Conclusions: Timed micturition has a low dependency on volume and values of ≤9 s and ≤15 s are normal for men aged ≤55 years and ≥56 years, respectively.

  • 6.
    Folkestad, Bengt
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Validation of timed micturition: A comparison of flow rates measured at home manually and electronically2004Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 38, nr 5, s. 385-390Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To compare and evaluate manually performed timed micturition in a domestic setting with registrations made using a home flowmeter. Material and Methods: Forty-six randomly selected men without voiding symptoms performed timed micturition at home both by hand and with a Da CapoTM home flowmeter. Statistical comparison using the Wilcoxon signed-rank test and regression analysis of the differences was performed to evaluate whether the two methods were comparable. Results: In two cases, there was a large discrepancy between the two methods. For the remaining 44 men, there were no statistically significant differences between the two methods. The median (range) timed micturition was 7 s (3-35 s) for manual measurements and 6.5 s (3.5-28 s) for electronic measurements. For each individual, the difference between the manually and electronically obtained medians was calculated. The average individual difference was 0.06 s (SD 1.6 s). Conclusion: Approximately 95% of men are able to measure timed micturition at home manually without statistically or clinically significant differences from electronically obtained measurements. One has to be aware that in a small proportion of cases timed micturition measured at home may be falsely long.

  • 7. Holmberg, Lars
    et al.
    Bill-Axelson, Anna
    Helgesen, Fred
    Salo, Jaakko
    Folmerz, Per
    Häggman, Michael
    Andersson, Swen-Olof
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Busch, Christer
    Nordling, Steg
    Palmgren, Juni
    Adami, Hans-Olov
    Johansson, Jan-Erik
    Norlén, Bo Johan
    A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer2002Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 347, nr 11, s. 781-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Radical prostatectomy is widely used in the treatment of early prostate cancer. The possible survival benefit of this treatment, however, is unclear. We conducted a randomized trial to address this question. Methods: From October 1989 through February 1999, 695 men with newly diagnosed prostate cancer in International Union against Cancer clinical stage T1b, T1c, or T2 were randomly assigned to watchful waiting or radical prostatectomy. We achieved complete follow-up through the year 2000 with blinded evaluation of causes of death. The primary end point was death due to prostate cancer, and the secondary end points were overall mortality, metastasis-free survival, and local progression. Results: During a median of 6.2 years of follow-up, 62 men in the watchful-waiting group and 53 in the radical-prostatectomy group died (P=0.31). Death due to prostate cancer occurred in 31 of 348 of those assigned to watchful waiting (8.9 percent) and in 16 of 347 of those assigned to radical prostatectomy (4.6 percent) (relative hazard, 0.50, 95 percent confidence interval, 0.27 to 0.91, P=0.02). Death due to other causes occurred in 31 of 348 men in the watchful-waiting group (8.9 percent) and in 37 of 347 men in the radical-prostatectomy group (10.6 percent). The men assigned to surgery had a lower relative risk of distant metastases than the men assigned to watchful waiting (relative hazard, 0.63, 95 percent confidence interval, 0.41 to 0.96). Conclusions: In this randomized trial, radical prostatectomy significantly reduced disease-specific mortality, but there was no significant difference between surgery and watchful waiting in terms of overall survival. Copyright ⌐ 2002 Massachusetts Medical Society.

  • 8. Kobelt, G
    et al.
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Mattiasson, A
    The cost of feedback microwave thermotherapy compared with transurethral resection of the prostate for treating benign prostatic hyperplasia2004Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 93, nr 4, s. 543-548Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To compare the efficacy of a new microwave thermotherapy for treating benign prostatic hyperplasia (BPH), the ProstaLund Feedback Treatment (PLFT®, ProstaLund Operations AB, Lund, Sweden) and transurethral resection of the prostate (TURP) in a clinical trial to their effectiveness in clinical practice over 1 year, to estimate their cost over 1 year, and to evaluate the cost of re-interventions over a longer period (2-3 years). PATIENTS AND METHODS: In a large randomized international 1-year clinical trial PLFT was as effective as TURP in improving symptoms of BPH and urinary flow. Because PLFT is an outpatient procedure it was less costly than TURP. However, the cost-effectiveness of the new procedure depends on its long-term effectiveness in clinical practice. All 146 patients in the randomized clinical trial were included in the present analysis. The outcome was based on the International Prostate Symptom Score (IPSS) and the bother score, and costs were estimated from treatment-related adverse events and hospitalisation. To validate the estimates based on the clinical trial 1-year data on effectiveness and complete resource use in clinical practice were collected in a retrospective observational study from hospital charts and patient questionnaires of 88 patients who had undergone either TURP or PLFT. To assess the number of re-interventions after TURP after the first year information was obtained from hospital and surgical procedure data in the Swedish inpatient registry. The 3-year data for a total of 52 010 patients who had an index hospitalization for TURP between 1990 and 1995 were available for the analysis. The estimate of long-term consequences of PLFT was based on complication and re-intervention data for 87 patients who had undergone PLFT between 1997 and 1999. RESULTS: The mean 1-year costs in the clinical trial were estimated at €1763 for PLFT and €3209 for TURP. When all treatment-related resource use in clinical practice for 88 patients was included the costs were estimated at €1924 and €3264 for PLFT and TURP, respectively. The IPSS and bother scores were not significantly different between the groups in both datasets. Using the registry data the cost of TURP including re-interventions (TURP and bladder neck incisions) was estimated at €3159 over 2 years and €3185 over 3 years, the respective costs for PLFT were €2121 and at €2151. CONCLUSIONS: In the 1-year clinical trial PLFT was as effective but less costly than TURP, but long-term data are still lacking. However, the preliminary analysis over 3 years indicates that the average cost of the procedure remains lower than the total cost of TURP for the same period.

  • 9. Kristjansson, B.
    et al.
    Carlsson, Per
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Ahlstrand, Christer
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Folkestad, Bengt
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Routine measurements of Health Outcome in Management of Patients with Benign Prostatic Hyperplasia (BPH)1998Ingår i: Outcome measuring : "outcome-measures make sense; do they make a difference?", Stockholm: Spri , 1998Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 10.
    Marklund, Helén
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Edéll-Gustafsson, Ulla
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sleep and health-related quality of life in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the general population and patients with inguinal hernia2010Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, nr 5, s. 304-314Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Objective. To determine whether there are differences in the quantity and quality of sleep, including sleep efficiency and insomnia, and health-related quality of life (HRQoL) between patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO), men from the general population and patients with inguinal hernia. Material and methods. The designs were descriptive and comparative. The groups consisted of 239 patients aged 45-80 years who were referred to urological departments with LUTS suggestive of benign prostatic obstruction. The comparison groups consisted of 213 randomly selected men from the general population, stratified according to age and geographical region, and 200 patients with inguinal hernia. The setting was one university and two general hospitals. The method was self-administered questionnaires about demography, comorbidity, sleep and health-related quality of life. Further, patients with LUTS answered questions about urinary symptoms and disease-specific quality of life. Results. The prevalence of insomnia was 40%, 26% and 19% and the prevalence of sleep efficiency < 85% was 49%, 38.5% and 31% in the LUTS, general population and hernia groups, respectively. The median number of nocturnal micturitions was 2, 1 and 1. In the LUTS group (n = 216), 47% had IPSS 8-19 and 44% had >/= 20 points. The HRQoL was significantly impaired in patients with LUTS compared with one or both of the comparison groups (p values < 0.05). Conclusions. Patients with LUTS suggestive of BPO had significantly impaired sleep, a higher prevalence of insomnia and significantly impaired HRQoL compared with one or both of the comparison groups.

  • 11.
    Marklund-Bau, Helén
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Edéll-Gustafsson, Ulla
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad.
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    A Swedish version of a quality of life questionnaire for partners of men with symptoms suggestive of benign prostatic obstruction2008Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 42, nr 2, s. 126-131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Little is known about the quality of life experienced by the partners of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). The aims of this study were to translate a specific quality of life questionnaire for partners to patients with benign prostatic enlargement (BPE)/BPO to swedish and to test its reliability and responsiveness. A secondary aim was to evaluate the impact the patients' urinary symptoms have on their partners' specific quality of life.

    Material and methods: This study was conducted using two groups: a reliability partner group; and a responsiveness/evaluation partner group. Both groups consisted of the partners of patients on the waiting list for transurethral resection of the prostate (TURP). The reliability of the quality of life questionnaire for the partners of men with BPE/BPO was tested in 51 partners, with a test-retest interval of 5 weeks. The partners' specific quality of life and the responsiveness of the questionnaire were evaluated in 51 partners by administering the questionnaire before and 3 months after the patient's TURP.

    Results: At the test-retest, the Spearman's rank correlation coefficient for each question varied between 0.59 and 0.86 and Cronbach's was 0.80. Partners were affected by the patients' BPO symptoms. Compassion, worry about cancer and worry about an operation were the aspects of the specific quality of life that affected most partners (92%, 77% and 65%, respectively), whereas effects on spare time and household activities affected fewer partners: 35% and 24%, respectively. The specific quality of life among partners improved significantly after the patient's TURP.

    Conclusions: The Swedish version of a partner-specific quality of life questionnaire for men with LUTS suggestive of BPE/BPO had an acceptable reliability and responsiveness. Partners are affected by the patients' symptoms, and it is emotional rather than practical aspects which most affect them.

  • 12.
    Marklund-Bau, Helén
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Edéll-Gustafsson, Ulla
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Bothersome urinary symptoms and disease-specific quality of life in patients with benign prostatic obstruction: High prevalence of urinary incontinence before and after intervention2007Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 41, nr 1, s. 32-41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Firstly, to describe self-reported urinary symptoms and bothersomeness, including disease-specific quality of life (QOL), in patients with symptomatic benign prostatic obstruction (BPO) before and 6 months after intervention. Secondly, to identify factors which predict disease-specific QOL. Thirdly, to develop and test the reliability of an instrument to evaluate incontinence, the Linköping Incontinence Questionnaire (LIQ). Finally, to translate and test the reliability of Swedish versions of the International Prostate Symptom Score, including the bother question, the American Urological Association Symptom Problem Index (SPI) and the Benign Prostatic Hyperplasia Impact Index.

    Material and methods: Disease-specific QOL was studied in 572/720 consecutively treated patients using structured questionnaires. The reliability of the instruments was tested in 122 patients with lower urinary tract symptoms (LUTS) or BPO.

    Results: The frequency and weak stream items of the SPI were among those that best explained the patients' disease-specific QOL both before and after intervention. Before and after intervention the prevalence of urinary incontinence, assessed using the LIQ instrument, was 46% and 16%, respectively. Symptoms and disease-specific QOL improved most in the surgery group, intermediately in the transurethral incision of the prostate/transurethral microwave thermotherapy group and least in the drug therapy group.

    Conclusions: The frequency and weak stream items of the SPI were the factors that best explained disease-specific QOL. The prevalence of incontinence before and after intervention was higher than that previously

  • 13.
    Marklund-Bau, Helén
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
    Edéll-Gustafsson, Ulla
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sleep and partner-specific quality of life in partners of men with lower urinary tract symptoms compared with partners of men from the general population.2015Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, nr 4, s. 321-328Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aims of this study were to examine differences between partners of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and partners of men from the population regarding sleep and two aspects of quality of life, partner-specific quality of life and health-related quality of life (HRQoL), and to identify factors related to the partner-specific quality of life and the parameter sleep efficiency. Materials and methods. The design was descriptive and comparative. The subjects were partners of men with LUTS suggestive of BPO (n = 126) and partners of randomly selected men from the general population (n = 131). Self-administered questionnaires about demography, comorbidity, sleep, sexuality, partner-specific quality of life and HRQoL were used. Results. Partners of men with LUTS suggestive of BPO were significantly more affected in all variables measuring partner-specific quality of life compared with partners from the population. The most impaired aspects were compassion and worry about an operation or cancer. In logistic regression, the only explanatory factors were having a partner belonging to the LUTS group for impaired partner-specific quality of life and having a bed partner for high sleep efficiency. There were no significant differences between the two groups regarding the quantity and quality of sleep or the HRQoL. Conclusions. The partner-specific quality of life was impaired in partners of men with LUTS suggestive of BPO. Sleep and HRQoL did not differ between partners of men with LUTS and partners from the population.

  • 14.
    Marklund-Bau, Helén
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Spångberg, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Edéll-Gustafsson, Ulla
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sleep and specific quality of life (QOL) in partners of men with lower urinary tract symptoms (LUTS) compared with partners to men from the population2008Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To determine whether there are significant differences in sleep, partner specific and health related quality of life between partners of men with LUTS suggestive of benign prostatic obstruction (BPO) and partners of men from the population. Secondly, to identify factors related to the specific quality of life in partners of men with LUTS and the sleep efficiency.

    Subjects and methods: The study designs were descriptive and comparative. The subjects were partners of men with LUTS suggestive of BPO (n=126) referred to departments of urology at one university and two general hospitals and partners (n=131) of randomly selected men from the general population. Self-administered questionnaires about demography, comorbidity, sleep, sexuality, partner specific and health related quality of life were used.

    Results: Partners to men with LUTS suggestive of BPO were significantly more affected in all variables measuring partner specific quality of life compared to partners from the population. The most impaired aspects were compassion and worry about an operation or cancer.

    In logistic regression, the only explanatory factors were having a partner belonging to the LUTS group for impaired partner specific quality of life and having a bed partner for high sleep efficiency.

    There were no significant differences between the two groups regarding the quantity andquality of sleep or the health related quality of life.

    Conclusions: The partner specific quality of life was impaired in partners of men with LUTS suggestive of BPO. Sleep and health related quality of life did not differ between partners of men with LUTS and partners in the population.

  • 15. Schelin, S
    et al.
    Geertsen, U
    Walter, S
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Duelund-Jacobsen, J
    Kroyer, K
    Hjertberg, Hans
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Vatne, V
    Richthoff, J
    Nordling, J
    Feedback microwave thermotherapy versus TURP/prostate enucleation surgery in patients with benign prostatic hyperplasia and persistent urinary retention: A prospective, randomized, controlled, multicenter study2006Ingår i: Urology, ISSN 0090-4295, E-ISSN 1527-9995, Vol. 68, nr 4, s. 795-799Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess the clinical efficacy of ProstaLund Feedback Treatment (PLFT) using the CoreTherm device versus transurethral resection of the prostate (TURP) and prostate enucleation surgery. Methods: We performed a prospective, randomized, controlled, multicenter study of 120 patients with symptomatic benign prostatic hyperplasia and persistent urinary retention requiring an indwelling catheter or clean intermittent catheterization. The primary efficacy variables were success in catheter removal and symptom improvement. Results: Of the 120 patients, 79% and 88% were catheter free after PLFT and surgery, respectively. The bother score (quality-of-life question) decreased from 4.6 in both groups before treatment to 1.4 in the PLFT group and 0.8 in the surgery group at 6 months of follow-up. The peak urinary flow rate was 13.4 mL/s after PLFT and 18.0 mL/s after surgery. The mean catheterization time was 34 days in the PLFT group and 5 days in the surgery group. Conclusions: PLFT is an effective alternative to surgical treatment in this group of catheterized patients. The risk of severe complications is reduced using PLFT, and an excellent treatment option can thereby be offered to this high-risk patient group who earlier could be treated only with lifelong catheterization. © 2006 Elsevier Inc. All rights reserved.

  • 16. Schäfer, Werner
    et al.
    Abrams, Paul
    Liao, Limin
    Mattiasson, Anders
    Pesce, Francesco
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Sterling, Arthur
    Zinner, Norman
    van Kerrebroeck, Philip
    Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure-flow studies2002Ingår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 21, s. 261-274Artikel i tidskrift (Refereegranskat)
  • 17.
    Spetz, Anna-Clara
    et al.
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Hammar, Mats
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Lindberg, Bengt
    Department of Surgery, Kungälv Hospital, Kungälv, Sweden.
    Spångberg, Anders
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    Varenhorst, Eberhard
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    Prospective evaluation of hot flashes during treatment with parenteral estrogen or complete androgen ablation for metastatic carcinoma of the prostate2001Ingår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 166, nr 2, s. 517-520Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    We evaluated the incidence and frequency of, and distress due to hot flashes after castration therapy with polyestradiol phosphate and complete androgen ablation.

    Materials and Methods

    A total of 915 men with metastatic prostate carcinoma enrolled in the Scandinavian Prostatic Cancer Group-5 trial study were randomized to intramuscular injections of 240 mg. Polyestradiol phosphate every 2 weeks for 8 weeks followed by monthly subcutaneous injections or complete androgen ablation, that is bilateral orchiectomy or 3.75 mg. of the gonadotropin-releasing hormone analog triptorelin monthly combined with 250 mg. of the antiandrogen flutamide 3 times daily. The incidence and frequency of, and distress due to hot flashes were recorded at regular intervals using a questionnaire.

    Results

    Of the 915 men 901 were evaluated at a median followup of 18.5 months. The incidence of hot flashes was 30.1% and 74.3% in the polyestradiol phosphate and complete androgen ablation groups, respectively (p <0.001). In the polyestradiol phosphate group the frequency of and distress due to hot flashes were significantly lower than in the androgen ablation group. There was complete relief from hot flashes in 50% of the men on polyestradiol phosphate during followup compared with none on androgen ablation. The incidence of hot flashes did not differ in men with and without tumor progression.

    Conclusions

    Endocrine treatment with polyestradiol phosphate induced fewer and less distressing hot flashes than complete androgen ablation. Flashes also disappeared to a greater extent during polyestradiol phosphate than during androgen ablation. The data in this study enable us to provide thorough individual information to patients on the risk and grade of expected distress and duration of hot flashes during polyestradiol phosphate or complete androgen ablation treatment.

  • 18.
    Spångberg, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Variability of pressure-flow studies in men with lower urinary tract symptoms - Editorial Comment2000Ingår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 19, nr 6, s. 653-656Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Abstract Not Available

  • 19.
    Spångberg, Anders
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
    Dahlgren, Helena
    Statens beredning för medicinsk utvärdering (SBU), Stockholm, Sweden.
    [Benign prostatic hyperplasia with bladder outflow obstruction. A systematic review].2013Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 13-14, s. 682-685Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Godartad prostataförstoring med avflödeshinder är en vanlig sjukdom. Försäljningen av ­l­äkemedel i Sverige motsvarar kontinuerlig behandling av 100 000 män. Antalet operationer per år är 4 500.

    SBU publicerade 2011 en systematisk litteraturgranskning av området.

    En stor del av handläggningen kan ske i primärvården. Patienterna behandlas i regel på sannolikhetsdiagnos och endast ett fåtal gör tryck–flödes­undersökning som kan ge säker diagnos.

    Vid lindriga besvär krävs ingen behandling. Vid måttliga–­svåra besvär står valet mellan en mindre effektiv och lindrig behandling, läkemedel, och en besvärligare men också mycket effektivare kirurgisk behandling.

  • 20.
    Spångberg, Anders
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Folkestad, Bengt
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    Kristjansson, B
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    New method to quantify the urodynamic improvement when treating bladder utlet obstruction - The efficacy of transurethral resectionin benign prostatic hypertrophy1995Ingår i: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 14, nr 4, s. 325-335Artikel i tidskrift (Refereegranskat)
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