Eivor Hernes

Association between serum 25(OH)D and death from prostate cancer

Based on observations that for certain cancers, mortality varies according to sun exposure, vitamin D has been proposed to influence on disease progression. This study aims to investigate whether serum levels of 25(OH)D are associated with prognosis in patients with prostate cancer. In total, 160 patients with a serum sample in the JANUS serum bank were included. For 123 patients a pre-treatment serum sample was taken, whereas 37 of the patients had received hormone therapy prior to the blood collection. The serum level of 25(OH)D was classified as low (< 50 nmol l−1), medium (50–80 nmol l−1) or high (>80 nmol l−1). A Cox proportional hazard regression model was used to assess the association between serum 25(OH)D and cancer mortality. During follow-up, 61 deaths occurred, of whom 52 died of prostate cancer. The median time of follow-up was 44.0 months (range, 1.2–154.6). Serum 25(OH)D at medium or high levels were significantly related to better prognosis (RR 0.33; 95% CI 0.14–0.77, RR 0.16; 95% CI 0.05–0.43) compared with the low level. Analysis restricted to patients receiving hormone therapy gave a stronger association. The serum level of 25(OH)D may be involved in disease progression and is a potential marker of prognosis in patients with prostate cancer.

Changing incidence and delay of testicular cancer in southern Norway (1981-1992)

METHODS The medical records of 352 patients with newly diagnosed testicular cancer were reviewed. Patients were orchiectomized during three 2-year periods (1981/82, 1986/87, 1991/92) and were referred for further treatment to the Norwegian Radium Hospital. They represented 96% of all cases with unilateral testicular cancer occurring within a defined area in the southern part of Norway. RESULTS An increase in testicular cancer patients was registered, mainly between the second and third time periods (61% increase). Gynaecomastia was recorded in 7% of all patients (seminoma: 6%; non-seminoma: 8%). Serum tumour markers (alpha-fetoprotein and/or human choriogonadotropin) were elevated before orchiectomy in 51% of the evaluated patients. During the studied 12-year period, considering seminoma and non-seminoma patients combined, the overall median delay decreased from 18 to 14 weeks (p = 0.006), the overall median diagnostic delay decreased from 14 to 10 weeks (p = 0.04) and the median treatment delay decreased from 37 to 28 days (p = 0.002). Due to increased frequency of stage I patients, introduction of an outpatient-based surveillance policy and improved administrative routines of the Health Care System, the median time of hospitalization was reduced from 37 (1981/82) to 9 days (1991/92). In seminoma, but not in non-seminoma patients, an overall delay of less than 16 weeks from the onset of symptoms was correlated with the incidence of stage I disease. The cancer-related 5-year survival rate for all 352 patients was 99%, without significant difference between the three periods under investigation. A patients delay of more than 3 months was correlated with a significantly decreased 5-year survival rate if all patients are considered (p = 0.02). CONCLUSION (1) The significant increase of the incidence of testicular cancer in the southern part of Norway remains unexplained and warrants intensified search for aetiological factors of this malignancy. (2) The Health Care Service is challenged to make available sufficient resources for the rapid diagnosis, treatment and follow-up of the increasing number of new patients with testicular cancer, following modern principles of toxicity-reduced and resource-saving treatment. (3) Attempts should be made to shorten the patients and doctors delay by awareness campaigns and postgraduate education of general practitioners. The importance of the determination of serum tumour markers in patients with testicular masses should, in particular, be emphasized together with the significance of gynaecomastia in the young adult male.

A national study of adverse effects and global quality of life among candidates for curative treatment for prostate cancer

Studies comparing adverse effects after different treatment methods are few and lack information on additional treatment and cancer relapse. Some US studies have provided population‐based estimates on adverse effects, however, figures from Europe are most often based on mono‐institutional experience or multicentre studies from high‐volume university‐affiliated hospitals with selected patient populations. Few studies have investigated the relationship between presence of urinary, bowel or sexual dysfunction and global quality of life (QoL). This population‐based study investigated real‐life practice with regard to prostate cancer in men who were potential candidates for curative treatment, based on high‐quality national registry data. Treatment groups of recurrence‐free men who completed their treatment or who received no cancer treatment were measured as to adverse effects, global QoL and the association between them. The study shows that each treatment method is associated with distinct patterns of urinary, bowel and sexual dysfunction and that irritative–obstructive urinary symptoms are associated with increased risk of low global QoL. This large survey also investigates the use of medication for erectile dysfunction and the relationship between such use and global QoL.

Initial management of prostate cancer: first year experience with the Norwegian National Prostate Cancer Registry

Study Type – Therapy (individual cohort)
 Level of Evidence 2b

Fatigue in prostate cancer survivors treated with definitive radiotherapy and LHRH analogs

Few studies have dealt with chronic fatigue (CF) in definitive radiotherapy (RAD) patients during and after (neo‐)adjuvant androgen deprivation therapy (ADT) for prostate cancer.

Fatigue in hormone-naïve prostate cancer patients treated with radical prostatectomy or definitive radiotherapy

Chronic fatigue (CF) is a distressing symptom that follows cancer treatment; however, it has rarely been studied in hormone-naïve prostate cancer survivors after radical prostatectomy (RP) or definitive radiotherapy (RAD). We investigated CF in prostate cancer survivors after RP or RAD as monotherapy and explored associations between CF and medical and psychosocial variables. A population-based, cross-sectional postal survey in 2006 included Norwegian hormone-naïve survivors with the diagnosis of prostate cancer in 2004 who were treated with RP (n=337) or RAD (n=184). The primary outcome variable was prevalence of CF (defined as fatigue lasting 6 months or longer). Twelve to 32 months after RP and RAD, 13.4 and 26.1% of the patients after, respectively, RP and RAD reported CF inversely associated with pretreatment age (P=0.003). In multivariate analysis, high neuroticism, post-treatment co-morbidity, pain, urinary and intestinal dysfunction, but not sexual dysfunction, were positively associated with reporting CF. Further studies of CF in prostate cancer survivors should take into consideration the survivors’ pretreatment medical and psychosocial situation.

Changes in prostate-specific antigen, markers of bone metabolism and bone scans after treatment with radium-223.

Abstract Objective.The aim of this study was to assess treatment-related changes in prostate-specific antigen (PSA), total and bone alkaline phosphatase (total ALP, bone ALP), and changes on conventional bone scans in patients with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases who received six cycles of radium-223 (Ra-223). Materials and methods. Changes in PSA, total ALP and bone ALP (≥30% increase or decrease), and changes on bone scans were assessed before and after six monthly cycles of Ra-223 therapy (50 kBq/kg body weight) in 14 patients with mCRPC with bone metastases and four patients on placebo. Results.Post-treatment PSA increased by at least 30% in 11 out of 14 patients and remained stable in three. Total ALP and bone ALP decreased in six and nine patients, respectively. In 10 out of 12 evaluable patients the uptake on post-treatment bone scan was reduced in lesions with high pretreatment uptake, in 11 patients accompanied by the development of new or expanded bone lesions. FACBC position emission tomography/computed tomography scans confirmed the growth of new or expanded bone metastases in two patients. Conclusions.These observations support the notion that Ra-223 kills tumour cells in metastases surrounded by highly proliferating osteoblasts, consistent with the reported survival benefit. The radiation effect in small tumour deposits not surrounded by increased osteoblast activity seems, however, insufficient, thus allowing continuous tumour growth. Long-lasting PSA reductions are the exception rather than the rule during Ra-223 treatment, whereas alkaline phosphatases decrease more frequently. To improve the overall anticancer effect, Ra-223 might be a valuable component of combination treatment.

High prostate cancer mortality in Norway: Influence of Cancer Registry information?

Norway has among the highest prostate cancer mortality rates in the world. The aim of the present project was to assess whether this can be explained by the unique routine procedure of information transfer from the Cancer Registry of Norway (CR) to the Norwegian Cause of Death Registry (COD Registry). Norwegian prostate cancer patients deceased during 1996 were identified (n=2012). The information basis of the official mortality statistics was reviewed by two physicians, who independently identified the underlying cause of death, primarily prostate cancer or not, supplemented by consensus of two other physicians. The coding was done in two steps; first without, then with CR information. Project physicians identified 1063 deaths from prostate cancer as compared to the official number of 1161, with discrepancy as to prostate cancer death in 126 deceased. Information from the CR increased the projects age‐adjusted (world standard population) prostate cancer mortality rate by less than 1% (from 22.7 to 22.9 per 100 000). In conclusion, the high rates of prostate cancer mortality in Norway could not be explained by information transfer from the CR to the COD Registry.

Androgen-independent prostate cancer--the clinical problem of a growing pelvic tumour.

This retrospective study describes three clinically different groups of patients with symptomatic androgen-independent prostate cancer (AIPC) referred to palliative radiotherapy (RT): those with a symptomatic pelvic tumour and pelvis-confined disease (M0 P-RT: 35 patients), those with a symptomatic pelvic tumour and distant metastases (M+ P-RT: 97 patients) and those with painful bone metastases (BM-RT: 193 patients). The study emphasises the need of a combined surgical and radiotherapeutic palliation in AIPC patients with symptomatic pelvic tumours. Median overall survival from time of palliative RT was 19, 9 and 8 months for M0 P-RT, M+ P-RT and BM-RT patients, respectively (p<0.001). The significantly prolonged natural course of P-RT patients without distant metastases has to be accounted for in clinical trials of AIPC patients in whom survival represents an endpoint. Furthermore, the optimal palliation regimens for P-RT patients are still to be defined.

High prostate cancer mortality in Norway evaluated by automated classification of medical entities.

The new standard of cause of death classification is an automated selection of the underlying cause of death using the international software Automated Classification of Medical Entities (ACME). Norwegian mortality rates are, however, based on manual classification of deaths. The aim of this study was to investigate how the use of ACME would influence Norwegian prostate cancer mortality rates. A previously described cohort of Norwegian prostate cancer patients deceased during 1996 was applied. Multiple causes of death data based on information from death certificates, autopsies and queries was coded according to ACME specifications, thereby ACME selected the underlying cause of death. In addition, the underlying cause of death that originally was manually classified for the official mortality statistics was retrieved from Statistics Norway in all cases. Age-standardized prostate cancer mortality rates (world population) per 100 000 person–years were calculated. A total of 2012 cases were included. On the basis of ACME classification, the age-standardized prostate cancer mortality rate in Norway for 1996 would have been 24.4 (95% confidence interval: 22.9–26.0) as compared with the rate based on manual classification for the official mortality statistics of 24.9 (95% confidence interval: 23.4–26.5). Thus, automated classification by ACME does not significantly influence the age-adjusted Norwegian prostate cancer mortality rate for the year 1996. There is reason to assume that the use of manual classification of deaths is not a major explanation of the high prostate cancer mortality rates in Norway.