Regional Cancer Centre, Uppsala Örebro University hospital SE UPPSALA

Transkript

1 Landstingens och regionernas nationella samverkansgrupp inom cancersjukvården Prostate cancer Report from the National Prostate Cancer Register, 14 September 15

2 Regional Cancer Centre, Uppsala Örebro University hospital SE UPPSALA 2 Prostate cancer - National report, 14

3 1 FOREWORD Each year approximately 1 men are diagnosed with prostate cancer in Sweden All cases of prostate cancer diagnosed in Sweden are registered in The National Prostate Cancer Register (NPCR) Sweden since 1998 in the six health care regions with a capture ratio of more than 98% compared to The Swedish Cancer Register to which registration is mandatory and regulated by law NPCR contains data on tumour characteristics and treatment delivered or decided upon up to six months after date of diagnosis Detailed information on data available in NPCR is found in (1) The data in NPCR is primarily intended to provide a sound basis for quality assurance and bench marking in order to improve care of patients with prostate cancer in Sweden Data from NPCR are also used for research and a set of linkages between NPCR and other health care registers and demographic databases has been performed in the research project Prostate cancer data Base Sweden (PCBaSe) A full description of these data sets as well as the output from this project was recently published (1) This version of the report contains all tables and figures from the full report in Swedish The Swedish version contains a comprehensive commentary text that is not provided in the English version 1 Cohort Profile: The National Prostate Cancer Register (NPCR) of Sweden and Prostate Cancer data Base Sweden (PCBaSe) M Van Hemelrijck, A Wigertz, F Sandin, H Garmo, K Hellström, P Fransson, A Widmark, M Lambe, J Adolfsson, E Varenhorst, J-E Johansson, P Stattin for NPCR and PCBaSe Sweden Int J Epidemiol PMID September 15 Pär Stattin, Fredrik Sandin, David Robinson, Ingela Franck Lissbrant and Marie Hjälm Eriksson for the steering group of NPCR Fredrik Sandin, Regional cancer centre, Uppsala Örebro, performed data management and statistical analysis for this report 3

4 TABLE OF CONTENTS TABLE OF CONTENTS 1 FOREWORD 3 2 INTRODUCTION Background 13 3 RESULTS Quality indicators Diagnostics Tumour data 3 34 Treatment Waiting times Prostate cancer-specific mortality PROM/PREM 84 4 RESEARCH Publications based on NPCR from the past five years 88 4 Prostate cancer - National report, 14

5 TABLES TABLES 1 Number of cases and capture ratio (%) of cases reported to the National Prostate Cancer Register (NPCR) of Sweden by health care region and year, Number of cases and capture ratio (%) in NPCR by county, for year of diagnosis Main reason for the initiation of the medical investigation that led to the prostate cancer diagnosis by year of diagnosis, Serum PSA-level (µg/l) by year of diagnosis, Number of cores obtained per diagnostic session by year of diagnosis, Comparison of number of cases in the risk category very low risk according to the old and new definition, Number of cases (%) by county and risk category, Number of cases (%) by year of diagnosis and risk category, Number and percentages of men with the primary treatment type registered within six months following diagnosis by health care region and year, Treatment strategy for men in the risk category very low risk by county, Treatment strategy for men in the risk category low risk by county, Treatment strategy for men in the risk category intermediate risk by county, Treatment strategy for men in the risk category localized high risk by county, Treatment strategy for men in the risk category locally advanced by county, Treatment strategy for men with regional metastases by county, Treatment strategy for men with distant metastases by county, Type of radical prostatectomy (primary treatment) by year of diagnosis, Type of radical prostatectomy (primary treatment) by year of treatment, Type of radical prostatectomy (primary treatment) by hospital, year of treatment Preoperative nerve sparing intent by year of treatment, Preoperative nerve sparing intent by risk category (low, intermediate and high risk), year of treatment Pathological T-stage (pt-stage) by year of treatment, Positive surgical margin by year of treatment, Number and percentages of men with a registered radiotherapy form out of men with primary or adjuvant radiotherapy reported on the primary treatment form by health care region and year of referal to the oncology department, Number of performed radiotherapy treatments per year of treatment, Number of registered performed radiotherapy treatments by hospital, year of treatment Type of primary/secondary radiotherapy by hospital, year of treatment Dose fraction/total dose used for primary external beam radiotherapy or given after a period of active surveillance to men with prostate cancer of low- or intermediate risk (at time of diagnosis) by hospital, year of treatment Dose fraction/total dose used for primary external beam radiotherapy or given after a period of active surveillance to men with prostate cancer of high risk (at time of diagnosis) by hospital, year of treatment a Type of hormonal treatment for men with M1 or PSA 1 µg/l by hospital, b Type of hormonal treatment for men with M1 or PSA 1 µg/l by hospital, 14, cont d 72 31a Type of hormonal treatment for men with M/MX and PSA 1 µg/l by hospital,

6 FIGURES 31b Type of hormonal treatment for men with M/MX and PSA 1 µg/l by hospital, 14, cont d Number of men with Patient Reported Outcome Measures (PROM) data at baseline and one year after curatively intended treatment PREM - Patient Reported Experience Measures -reported experience of participation in treatment decision and information about the disease among men with prostatectomy or radiotherapy as primary treatment, year of diagnosis FIGURES 1 Patient overview Prostate Cancer (PPC) shows treatment, lab values (PSA, Hb), imaging, general condition and adverse effects (ECOG WHO, SRE) 12 2 Age-standardized prostate cancer incidence and mortality per 1 men, Sweden Proportion of men reported to NPCR within a month from the time point when diagnostic information was given to the patient by health care region, Proportion of men assigned a navigator nurse by health care region, Proportion of men with time between date of referral and first visit at a specialist clinic being 6 days or less by health care region, Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by health care region, Proportion of men with expected survival exceeding 5 years (age at diagnosis 8 years) with high risk or locally advanced prostate cancer examined with bone scan or other bone investigation by health care region, Proportion of men (75 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by health care region, Participation in multidisciplinary team conference concerning curative treatment for men (8 years or younger at time of diagnosis) with prostate cancer of high risk by health care region, Proportion of men (75 years or younger at time of diagnosis) with localized high risk prostate cancer given curative primary treatment by health care region, Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by health care region, Proportion of men with pathologic pt2-tumour after radical prostatectomy having negative surgical margins by health care region, Proportion of men reported to NPCR within a month from the time point when diagnostic information was given to the patient by hospital, Proportion of men assigned a navigator nurse by hospital, Proportion of men with time between date of referral and first visit at a specialist clinic being 6 days or less by hospital, Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by hospital, Proportion of men with expected survival exceeding 5 years (age at diagnosis 8 years) with high risk or locally advanced prostate cancer examined with bone scan or other bone investigation by hospital, Proportion of men (75 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by hospital, Participation in multidisciplinary team conference concerning curative treatment for men (8 years or younger at time of diagnosis) with prostate cancer of high risk by hospital, Prostate cancer - National report, 14

7 FIGURES Proportion of men (75 years or younger at time of diagnosis) with localized high risk prostate cancer given curative primary treatment by hospital, Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by hospital Proportion of men with pathologic pt2-tumour after radical prostatectomy having negative surgical margins by hospital, Time (months) between date of diagnosis and reporting to the NPCR for cases diagnosed Time (months) between date of diagnosis and reporting to the NPCR for cases diagnosed 14 by health care region Incidence and main reason for initiation of the work -up leading to prostate cancer diagnosis by county, Main reason for initiation of the work-up leading to prostate cancer diagnosis by hospital, Serum PSA-level (µg/l) at diagnosis by year of diagnosis, Proportion of men, 75 years old or younger, with T1c prostate cancer that underwent 1 or more needle biopsies at the diagnostic biopsy session by county, Proportion of men, 75 years old or younger, with T1c prostate cancer that underwent 1 or more needle biopsies at the diagnostic biopsy session by hospital, Proportion of men given active surveillance as primary treatment that underwent an additional biopsy session before treatment decision by county, Proportion of men given active surveillance as primary treatment that underwent an additional biopsy session before treatment decision by hospital, Proportion of men with a dispensation for antibiotics for urinary tract infection as an indication of infection due to TRUS during diagnostic biopsy session by hospital, January-November Proportion of men with a dispensation for antibiotics for urinary tract infection as an indication of infection due to TRUS during diagnostic biopsy session by healthcare region and year of diagnosis, January-November Proportion of men with T1-2, PSA < µg/l and Gleason score 6 or less that underwent bone scan by county, 3 and Proportion of men (8 years or younger) with Gleason score 8-1 and/or T3 and/or PSA -5 µg/l (but not T4 or PSA > 5 µg/l) that was examined by bone scan by county, 3 and Proportion of men (older than 8 years) with Gleason score 8-1 and/or T3 and/or PSA -5 µg/l (but not T4 or PSA > 5 µg/l) that was examined by bone scan by county, 3 and Proportion of men by risk category and year of diagnosis, Proportion of men by risk categories and county, Proportion of men with prostate cancer of low risk, intermediate risk, high risk or with regional metastasis given second opinion by oncologist by county, Proportion of men (8 years or younger) with localized high risk prostate cancer discussed at a multidisciplinary team conference ahead of treatment decision by county, Treatment strategy for men 75 years or younger by risk category and year of diagnosis, Treatment strategy for men older than 75 years by risk category and year of diagnosis, Treatment strategy by risk category and age group,

8 FIGURES 44 Proportion of men younger than 7 years with low risk prostate cancer (T1-2, Gleason score 6 or less and PSA < 1 µg/l) with active surveillance as primary treatment by county, Proportion of men younger than 7 years with low risk prostate cancer (T1-2, Gleason score 6 or less and PSA < 1 µg/l) with active surveillance as primary treatment by hospital, Proportion of men 7-8 years with low risk prostate cancer (T1-2, Gleason score 6 or less and PSA < 1 µg/l) with active surveillance as primary treatment by county, Proportion of men 7-8 years with low risk prostate cancer (T1-2, Gleason score 6 or less and PSA < 1 µg/l) with active surveillance as primary treatment by hospital, Proportion of men 7 years or younger with very low risk prostate cancer (T1c, Gleason score 6 or less and PSA < 1 µg/l, no more than 4 cores with cancer, and total length of cancer in biopsies 8 mm, at least 8 cores examined and PSA-density < 15 µg/l/ml) with active surveillance as primary treatment by county, Proportion of men 7 years or younger with very low risk prostate cancer (T1c, Gleason score 6 or less and PSA < 1 µg/l, no more than 4 cores with cancer, and total length of cancer in biopsies 8 mm, at least 8 cores examined and PSA-density < 15 µg/l/ml) with active surveillance as primary treatment by hospital, Proportion of men younger than 7 years with intermediate risk prostate cancer given curative therapy by county, Proportion of men younger than 7 years with intermediate risk prostate cancer given curative therapy by hospital, Proportion of men 7-8 years with intermediate risk prostate cancer given curative therapy by county, Proportion of men 7-8 years with intermediate risk prostate cancer given curative therapy by hospital, Proportion of men younger than 7 years with high risk prostate cancer given curative therapy by county, Proportion of men younger than 7 years with high risk prostate cancer given curative therapy by hospital, Proportion of men 7-8 years with high risk prostate cancer given curative therapy by county, Proportion of men 7-8 years with high risk prostate cancer given curative therapy by hospital, Number of radical prostatectomies (primary treatment) by county and year of treatment, Proportion of men with low risk prostate cancer among men treated with radical prostatectomy, year of treatment Proportion of men that are missing information on preoperative nerve sparing intent by hospital, year of treatment Nerve sparing intention by hospital, year of treatment Nerve sparing intention for men with low- or intermediate risk prostate cancer with T1c, PSA < 1 ng/ml by hospital, Proportion of men missing information on pathological T-stage by hospital, Proportion of pt2 tumors by hospital, Proportion of pt2 tumors among preoperative low risk cancers (T1c, Gleason score 6, PSA < µg/l) by hospital, Proportion of pt2 tumors among preoperative intermediate risk cancers by hospital, Prostate cancer - National report, 14

9 FIGURES 67 Proportion of pt2 tumors among preoperative localized high risk cancers by hospital, Proportion of men with uncertain or missing information on surgical margin status by hospital, Proportion of positive surgical margin by hospital, Proportion of positive surgical margin (all radical prostatectomies) vs number of prostatectomies by type and hospital, Proportion of positive surgical margin among pt2-tumors by hospital, Proportion of positive surgical margin among pt2-tumors vs number of prostatectomies by type and hospital, Proportion of positive surgical margin after retropubic radical prostatectomy of pt2-tumors by hospital, Proportion of positive surgical margin after robot assisted laparoscopic radical prostatectomy of pt2-tumors by hospital, Proportion of positive surgical margin among preoperative intermediate risk tumors by hospital, Proportion of positive surgical margin among preoperative low- or intermediate risk tumors by hospital, Proportion of men being re-admitted within 3 days following a radical prostatectomy by hospital, 14 (January-November) 6 78 Proportion of men with localized high risk or locally advanced tumors treated with radiotherapy that received treatment with radiation fields that included lymph nodes by county, Proportion of men treated with primary external radiotherapy where marking technique has been used by county, Proportion of men treated with primary radiotherapy where MRI or PET-CT has been used for definition of target by county, Proportion of men with low risk prostate cancers treated with radiotherapy that received neoadjuvant hormonal therapy by county, Proportion of men with localized high risk or locally advanced tumors treated with primary radiotherapy that received neoadjuvant hormonal therapy by antiandrogens, GnRH or TAB by county, Type of neoadjuvant hormonal therapy among men with localized high risk or locally advanced tumors treated with primary radiotherapy by county, Proportion of men with localized high risk or locally advanced tumors treated with primary radiotherapy that received adjuvant hormonal therapy by county, Type of adjuvant hormonal therapy among men with localized high risk or locally advanced tumors treated with primary radiotherapy by county, Duration of adjuvant hormonal therapy treatment for men with localized high risk or locally advanced tumors treated with primary radiotherapy by county, Proportion of men treated with primary radiotherapy participating in a clinical treatment study (according to the radiotherapy form) by county, Type of treatment for men 75 years or younger at time of diagnosis with locally advanced prostate cancer by county, Proportion of men 75 years or younger at time of diagnosis with locally advanced prostate cancer that received neoadjuvant hormonal therapy and radiotherapy by county, Type of treatment for men 76-8 years at time of diagnosis with locally advanced prostate cancer by county,

10 FIGURES 91 Proportion of men 76-8 years at time of diagnosis with locally advanced prostate cancer that received neoadjuvant hormonal therapy and radiotherapy by county, Type of treatment for men 75 years or younger at time of diagnosis with regional metastases (N1 and/or T4 and/or PSA 5-1 µg/l, not M1) by county, Proportion of men 75 years or younger at time of diagnosis with regional metastases (N1 and/or T4 and/or PSA 5-1 µg/l, not M1) that received neoadjuvant hormonal therapy and radiotherapy by county, Observed 1-years survival among men in the general population not diagnosed with prostate cancer (matched for age and place of residence with men with high risk prostate cancer) by age, comorbidity and educational level Observed 1-years survival among men in the general population not diagnosed with prostate cancer (matched for age and place of residence with men with high risk prostate cancer) and proportion curatively treated men among the prostate cancer cases by age group and comorbidity 7 96 Median serum PSA-level (µg/l) at diagnosis among men with verified distant metastases (M1) by year of diagnosis, Number of days between date of referral and first visit at a specialist clinic by county, year of diagnosis MAP - Number of days between date of referral and first visit at a specialist clinic by county, year of diagnosis Median number of days between date of referral and first visit at a specialist clinic by year of diagnosis and health care region, Number of days between date of referral and first visit at a specialist clinic by hospital, year of diagnosis Number of days between diagnostic biopsy and date when patient was informed of the result by county, MAP - Number of days between diagnostic biopsy and date when patient was informed of the result by county, Median number of days between diagnostic biopsy and date when patient was informed of the result by year of diagnosis and health care region, Number of days between treatment decision and radical prostatectomy by county, MAP - Number of days between treatment decision and radical prostatectomy by county, Median number of days between treatment decision and radical prostatectomy year of surgery and health care region, Number of days between treatment decision and radical prostatectomy by hospital, Number of days between date of referral from urologist to oncology department and decision by oncologist that radiotherapy will be the primary treatment by county, year of treatment Number of days between treatment decision by oncologist that radiotherapy will be the primary treatment and start of radiotherapy among men not receiving neoadjuvant hormonal therapy by county, year of treatment Number of days between treatment decision and start of neoadjuvant hormonal therapy ahead of primary radiotherapy among men with localized high risk prostate cancer or locally advanced prostate cancer by county, year of treatment Number of days between decision by oncologist of salvage radiotherapy and start of radiotherapy by county, Prostate cancer - National report, 14

11 FIGURES 112 Different time intervals from referral to date of prostatectomy among men with prostatectomy as primary treatment by county, year of treatment Different time intervals from referral to start of radiotherapy among men treated with radiotherapy as primary treatment (excluding men given neoadjuvant hormonal therapy) by county, year of treatment Different time intervals from referral to start of neoadjuvant hormonal therapy among men given neoadjuvant hormonal therapy and radiotherapy as primary treatment by county, year of treatment Number of days between diagnostic biopsy and treatment decision among men with M1 or PSA 1 µg/l given non-curative therapy by county, year of diagnosis MAP - Number of days between diagnostic biopsy and treatment decision among men with M1 or PSA 1 µg/l given non-curative therapy by county, year of diagnosis Median number of days between diagnostic biopsy and treatment decision among men with M1 or PSA 1 µg/l given non-curative therapy by year of diagnosis and health care region, Cumulative mortality from prostate cancer and other causes by risk category and age groupp, period analysis Urinary incontinence - at baseline and one year following treatment according to postal questionnaire 84 1 Fecal incontinence - at baseline and one year following treatment according to postal questionnaire Erectile dysfunction (ED) - at baseline and one year following treatment according to postal questionnaire Erectile dysfunction (ED) - one year following treatment among men with no ED at baseline according to postal questionnaire Urinary incontinence - one year following treatment among men with missing baseline data and treated the first three months Fecal incontinence - one year following treatment among men with missing baseline data and treated the first three months Erectile dysfunction (ED) - one year following treatment among men with missing baseline data and treated the first three months

12 FIGURES Figure 1 Patient overview Prostate Cancer (PPC) shows treatment, lab values (PSA, Hb), imaging, general condition and adverse effects (ECOG WHO, SRE) 12 Prostate cancer - National report, 14

13 2 INTRODUCTION 21 Background Age standardised incidence/mortality per 1 men Incidence Mortality Year Figure 2 Age-standardized prostate cancer incidence and mortality per 1 men, Sweden Age-standardized according to the population in Sweden (incidence) and the Nordic countries (mortality) in the year Source: The Board of Health and Welfare (incidence), wwwsocialstyrelsense, and NORDCAN (mortality), wwwancrnu

14 3 RESULTS 3 RESULTS 31 Quality indicators North West Uppsala Örebro South east Stockholm Gotland South No of cases of of of of of of of % 54% 51% 44% 41% 36% 36% Figure 3 Proportion of men reported to NPCR within a month from the time point when diagnostic information was given to the patient by health care region, 14 West South Stockholm Gotland Uppsala Örebro South east North No of cases 892 of of of of of of of % 6 55% 53% 43% 37% 36% Figure 4 Proportion of men assigned a navigator nurse by health care region, 14 South east West Stockholm Gotland South Uppsala Örebro North No of cases of of of of of of of % 79% 76% 75% 72% 62% 6 Figure 5 Proportion of men with time between date of referral and first visit at a specialist clinic being 6 days or less by health care region, 14 Uppsala Örebro North South east Stockholm Gotland South West No of cases of of of of of of of % 18% 14% 14% 14% 12% Figure 6 Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by health care region, 14 Uppsala Örebro Stockholm Gotland South east South North West No of cases of of of of of 18 7 of of Figure 7 Proportion of men with expected survival exceeding 5 years (age at diagnosis 8 years) with high risk or locally advanced prostate cancer examined with bone scan or other bone investigation by health care region, 14 Stockholm Gotland Uppsala Örebro South east West North South No of cases 1 52 of of of of of of of % 84% 83% 75% 74% 74% 65% 6 95% 94% 93% 92% 89% 88% 82% Figure 8 Proportion of men (75 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by health care region, Prostate cancer - National report, 14

15 31 Quality indicators Uppsala Örebro South West North South east Stockholm Gotland No of cases of of of of 9 61 of of of % 49% 43% 43% 41% 36% 24% Figure 9 Participation in multidisciplinary team conference concerning curative treatment for men (8 years or younger at time of diagnosis) with prostate cancer of high risk by health care region, 14 South Stockholm Gotland Uppsala Örebro North South east West No of cases of of of of 7 67 of of of % 86% 86% 85% 84% 81% Figure 1 Proportion of men (75 years or younger at time of diagnosis) with localized high risk prostate cancer given curative primary treatment by health care region, 14 Stockholm Gotland South east West South North Uppsala Örebro No of cases 1 75 of of of of of of of % 91% 87% 86% 85% 83% 73% Figure 11 Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by health care region, 14 Stockholm Gotland Uppsala Örebro West North South South east No of cases of of of of of of of % 87% 85% 84% % Figure 12 Proportion of men with pathologic pt2- tumour after radical prostatectomy having negative surgical margins by health care region, 14 15

16 3 RESULTS Hallands sjukhus Kungsbacka Ängelholms sjukhus South Älvsborgs Sjukhus Borås Östersunds sjukhus Kärnsjukhuset i Skövde Akademiska sjukhuset Lasarettet Trelleborg Norrlands universitetssjukhus Umeå Sunderby sjukhus Västmanlands sjukhus Västerås Sahlgrenska Universitetssjukhuset Kullbergska sjukhuset/mälarsjukhuset Centralsjukhuset i Karlstad Alingsås lasarett Blekingesjukhuset Karlskrona Universitetssjukhuset i Linköping/Vrinnevisjukhuset Mora lasarett Nyköpings lasarett Lycksele lasarett Piteå älvdals sjukhus Sjukhuset i Bollnäs Capio S:t Görans sjukhus Urologisektionen Lindesbergs lasarett Skellefteå lasarett Örnsköldsviks sjukhus Helsingsborgs lasarett Höglandssjukhuset Gällivare sjukhus Uddevalla sjukhus Private practice West Södersjukhuset Västerviks sjukhus Visby lasarett Private practice Stockholm Gotland Länssjukhuset i Kalmar Danderyds sjukhus Skånes universitetssjukhus Lund/Malmö Private practice South east Kalix sjukhus Falu lasarett/ludvika lasarett Centrallasarettet Växjö Lasarettet i Ystad Oskarshamns sjukhus Others Sjukhuset i Arvika Hallands sjukhus Halmstad Private practice Uppsala Örebro Kiruna sjukhus Sjukhuset i Hudiksvall Varbergs sjukhus Universitetssjukhuset Örebro Länssjukhuset i Sundsvall Ljungby lasarett Private practice South South Älvsborgs Sjukhus Skene Karolinska universitetssjukhuset Solna Norrtälje sjukhus Värnamo sjukhus Sollefteå sjukhus Sjukhuset i Gävle Karolinska universitetssjukhuset Huddinge Centralsjukhuset Kristianstad Sjukhuset i Lidköping Karlskoga lasarett Lasarettet i Enköping Länssjukhuset Ryhov Simrishamns sjukhus Södertälje sjukhus No of cases 64 of 7 82 of 9 84 of of of of of of of 1 5 of of of of of 7 92 of of of 74 3 of 5 22 of of of of of 3 42 of of of of of 26 9 of of of of 65 of of of of of of of of of 17 5 of of 19 7 of 25 3 of 11 3 of of of of of of of of of of of 42 5 of 34 8 of of 87 6 of of of 72 4 of 44 8 of 94 2 of 38 3 of 69 1 of 1 of 31 of 62 8 Figure 13 Proportion of men reported to NPCR within a month from the time point when diagnostic information was given to the patient by hospital, 14 91% 91% 84% 84% 82% 82% 8 79% 78% 77% 76% 75% 74% 7 69% 68% 68% 6 58% 58% 56% 55% 53% 51% 5 49% 48% 46% 45% 44% 43% 42% 39% 38% 38% 38% 37% 33% 33% 32% 3 29% 29% 28% 27% 27% 27% 27% 26% 25% 23% % 17% 15% 14% 14% 11% 11% 1 9% 9% 5% 4% 1% Hallands sjukhus Kungsbacka Skellefteå lasarett Varbergs sjukhus Sjukhuset i Lidköping Lindesbergs lasarett Helsingsborgs lasarett Södertälje sjukhus Karlskoga lasarett Simrishamns sjukhus Uddevalla sjukhus Norrtälje sjukhus Centrallasarettet Växjö Hallands sjukhus Halmstad Blekingesjukhuset Karlskrona Ängelholms sjukhus Norrlands universitetssjukhus Umeå Karolinska universitetssjukhuset Solna Sahlgrenska Universitetssjukhuset Danderyds sjukhus Private practice West Universitetssjukhuset i Linköping/Vrinnevisjukhuset Universitetssjukhuset Örebro South Älvsborgs Sjukhus Borås Centralsjukhuset i Karlstad Nyköpings lasarett Private practice South Centralsjukhuset Kristianstad Östersunds sjukhus Kullbergska sjukhuset/mälarsjukhuset Private practice South east Karolinska universitetssjukhuset Huddinge Private practice Stockholm Gotland Ljungby lasarett Sjukhuset i Arvika Kärnsjukhuset i Skövde Mora lasarett Kiruna sjukhus Falu lasarett/ludvika lasarett Lasarettet i Ystad Private practice Uppsala Örebro Västmanlands sjukhus Västerås Others Sunderby sjukhus Södersjukhuset Akademiska sjukhuset Oskarshamns sjukhus Skånes universitetssjukhus Lund/Malmö Lasarettet Trelleborg Värnamo sjukhus Lasarettet i Enköping Sjukhuset i Hudiksvall Sjukhuset i Gävle Capio S:t Görans sjukhus Urologisektionen Höglandssjukhuset Västerviks sjukhus Länssjukhuset Ryhov Sjukhuset i Bollnäs Länssjukhuset i Sundsvall Alingsås lasarett Gällivare sjukhus Visby lasarett Kalix sjukhus Lycksele lasarett Länssjukhuset i Kalmar Piteå älvdals sjukhus Sollefteå sjukhus South Älvsborgs Sjukhus Skene Örnsköldsviks sjukhus No of cases 41 of of of of 7 22 of of of of of of of of of of of of of of of of of of of of of of of 5 68 of of of of of of of 35 3 of 6 43 of of 47 9 of 52 of of of of 1 1 of 3 3 of of of of of of of 82 8 of 42 1 of of of of 95 8 of of of of of 42 1 of 18 2 of 45 of 21 of 26 of 111 of 14 of 12 of 23 of 71 8 Figure 14 Proportion of men assigned a navigator nurse by hospital, 14 96% 96% 95% 95% 94% 93% 93% 92% 88% 87% 86% 85% 79% 79% 77% 76% 74% 73% 66% 63% 61% 6 58% 57% 56% 54% 54% 53% 51% 5 47% 47% 45% 39% 37% 35% 35% 33% 33% 32% 3 28% 26% 21% 2 19% 13% 13% 12% 11% 1 1 9% 8% 7% 6% 4% 16 Prostate cancer - National report, 14

17 31 Quality indicators Hallands sjukhus Kungsbacka Kalix sjukhus Karlskoga lasarett Karolinska universitetssjukhuset Huddinge South Älvsborgs Sjukhus Borås Lycksele lasarett Universitetssjukhuset i Linköping/Vrinnevisjukhuset Södertälje sjukhus Länssjukhuset Ryhov Private practice South east Danderyds sjukhus Karolinska universitetssjukhuset Solna Södersjukhuset Private practice Uppsala Örebro Norrtälje sjukhus Hallands sjukhus Halmstad Alingsås lasarett Lasarettet Trelleborg Capio S:t Görans sjukhus Urologisektionen Varbergs sjukhus Visby lasarett Kullbergska sjukhuset/mälarsjukhuset Helsingsborgs lasarett Private practice South Private practice West Lindesbergs lasarett Skånes universitetssjukhus Lund/Malmö Nyköpings lasarett Akademiska sjukhuset Värnamo sjukhus Sunderby sjukhus Länssjukhuset i Kalmar Universitetssjukhuset Örebro Uddevalla sjukhus Centrallasarettet Växjö Sjukhuset i Bollnäs South Älvsborgs Sjukhus Skene Oskarshamns sjukhus Blekingesjukhuset Karlskrona Piteå älvdals sjukhus Private practice Stockholm Gotland Gällivare sjukhus Sahlgrenska Universitetssjukhuset Höglandssjukhuset Kärnsjukhuset i Skövde Lasarettet i Ystad Västerviks sjukhus Skellefteå lasarett Sjukhuset i Lidköping Sjukhuset i Hudiksvall Sollefteå sjukhus Centralsjukhuset i Karlstad Kiruna sjukhus Falu lasarett/ludvika lasarett Norrlands universitetssjukhus Umeå Centralsjukhuset Kristianstad Östersunds sjukhus Simrishamns sjukhus Sjukhuset i Arvika Länssjukhuset i Sundsvall Others Lasarettet i Enköping Västmanlands sjukhus Västerås Ängelholms sjukhus Örnsköldsviks sjukhus Sjukhuset i Gävle Mora lasarett Ljungby lasarett No of cases 38 of of of of of of 37 9 of of 5 91 of of of of of 7 7 of of of of of of 3 65 of of of of of 245 of 292 of of of of of of of of of of of of of of 73 of of of of of of of of 7 47 of of of 8 49 of of of of of of of of of 24 4 of 8 61 of of 9 21 of of 6 3 of of of of of 41 8 Figure 15 Proportion of men with time between date of referral and first visit at a specialist clinic being 6 days or less by hospital, 14 99% 97% 97% 96% 95% 93% 93% 93% 93% 92% 92% 92% 91% % 89% 87% 87% 86% 84% 83% 83% 82% 82% 77% 77% 75% 74% 73% 73% 72% 72% 71% 7 69% 69% 69% 68% 66% 64% 64% 64% 64% 63% 61% 6 58% 57% 52% % 44% 44% 43% 42% 41% 4 38% 37% Helsingsborgs lasarett Hallands sjukhus Kungsbacka Ängelholms sjukhus Södersjukhuset Blekingesjukhuset Karlskrona Sahlgrenska Universitetssjukhuset Falu lasarett/ludvika lasarett Lindesbergs lasarett Centrallasarettet Växjö Karolinska universitetssjukhuset Solna Others Värnamo sjukhus Universitetssjukhuset Örebro Länssjukhuset Ryhov Capio S:t Görans sjukhus Urologisektionen Norrlands universitetssjukhus Umeå Lasarettet i Ystad Skellefteå lasarett Lasarettet Trelleborg Mora lasarett Private practice South Lycksele lasarett Örnsköldsviks sjukhus Hallands sjukhus Halmstad Sollefteå sjukhus Karolinska universitetssjukhuset Huddinge Private practice Uppsala Örebro Varbergs sjukhus Nyköpings lasarett Kullbergska sjukhuset/mälarsjukhuset Uddevalla sjukhus Gällivare sjukhus Länssjukhuset i Kalmar Centralsjukhuset i Karlstad Skånes universitetssjukhus Lund/Malmö Private practice West Västmanlands sjukhus Västerås Lasarettet i Enköping Östersunds sjukhus Private practice South east Kärnsjukhuset i Skövde Kalix sjukhus Ljungby lasarett Norrtälje sjukhus Höglandssjukhuset Centralsjukhuset Kristianstad Länssjukhuset i Sundsvall Västerviks sjukhus Sjukhuset i Gävle Alingsås lasarett Sunderby sjukhus Danderyds sjukhus Sjukhuset i Bollnäs Visby lasarett Sjukhuset i Hudiksvall Universitetssjukhuset i Linköping/Vrinnevisjukhuset Södertälje sjukhus South Älvsborgs Sjukhus Skene Private practice Stockholm Gotland Oskarshamns sjukhus Kiruna sjukhus South Älvsborgs Sjukhus Borås Akademiska sjukhuset Karlskoga lasarett Sjukhuset i Lidköping Piteå älvdals sjukhus Simrishamns sjukhus Sjukhuset i Arvika No of cases 97 of of 7 43 of 9 29 of of of of 17 9 of 3 5 of 17 1 of 34 3 of of of 11 3 of 1 12 of 53 3 of of of of of 74 7 of of of of 86 9 of of of of 97 8 of 5 23 of of 1 4 of 26 of of of of of of of of of of 91 3 of 28 6 of 56 6 of of of of of of of 7 1 of 1 4 of 51 6 of 77 3 of 47 6 of of of 62 2 of of of 25 1 of 27 3 of 1 4 of of 38 2 of 94 of 19 of 31 of 11 8 Figure 16 Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by hospital, % 48% 45% 42% 34% 32% 3 29% 29% 27% 26% 25% 25% 23% 22% 22% % 17% 17% 17% 17% 17% 16% 16% 16% 15% 15% 15% 14% 12% 12% 12% 12% 12% 12% 11% 11% 11% 11% 11% 1 9% 9% 9% 9% 9% 8% 8% 8% 6% 6% 6% 5% 5% 4% 4% 4% 3% 3% 3% 2% 17

18 3 RESULTS Höglandssjukhuset Oskarshamns sjukhus Västerviks sjukhus Sjukhuset i Gävle Lasarettet Trelleborg Blekingesjukhuset Karlskrona Centralsjukhuset i Karlstad Danderyds sjukhus Värnamo sjukhus Norrlands universitetssjukhus Umeå Länssjukhuset i Kalmar Karlskoga lasarett Karolinska universitetssjukhuset Solna Norrtälje sjukhus Others Länssjukhuset i Sundsvall Sjukhuset i Hudiksvall Universitetssjukhuset Örebro Kullbergska sjukhuset/mälarsjukhuset Östersunds sjukhus Falu lasarett/ludvika lasarett Sollefteå sjukhus Västmanlands sjukhus Västerås Helsingsborgs lasarett Hallands sjukhus Halmstad Kalix sjukhus Sjukhuset i Bollnäs South Älvsborgs Sjukhus Borås Universitetssjukhuset i Linköping/Vrinnevisjukhuset Private practice South east Skånes universitetssjukhus Lund/Malmö Centrallasarettet Växjö Alingsås lasarett Södersjukhuset Akademiska sjukhuset Mora lasarett Kärnsjukhuset i Skövde Private practice Uppsala Örebro Länssjukhuset Ryhov Karolinska universitetssjukhuset Huddinge Ljungby lasarett Södertälje sjukhus Sjukhuset i Lidköping Lasarettet i Ystad Nyköpings lasarett Skellefteå lasarett South Älvsborgs Sjukhus Skene Ängelholms sjukhus Private practice South Private practice Stockholm Gotland Lindesbergs lasarett Örnsköldsviks sjukhus Sunderby sjukhus Uddevalla sjukhus Sahlgrenska Universitetssjukhuset Varbergs sjukhus Centralsjukhuset Kristianstad Lasarettet i Enköping Lycksele lasarett Private practice West Hallands sjukhus Kungsbacka Piteå älvdals sjukhus Capio S:t Görans sjukhus Urologisektionen Visby lasarett Simrishamns sjukhus No of cases 17 of 17 5 of 5 25 of of 46 of of of of 15 9 of 1 24 of of 42 7 of 8 7 of 8 7 of 8 7 of 8 of of 21 3 of of of of 49 5 of 6 53 of of of 16 7 of 9 7 of 9 14 of of of 6 of of 3 9 of 12 6 of 8 29 of of of of of of 27 7 of 1 9 of 13 9 of of of 18 6 of 9 12 of 18 8 of of of 5 15 of of of of of 3 16 of 28 8 of 14 4 of 8 8 of 16 3 of 6 36 of 73 3 of 7 3 of 7 5 of 12 2 of 7 2 of % 96% 95% 95% 94% 93% 9 89% 88% 88% 88% 88% 88% 87% 86% 86% 85% 84% 84% 83% 83% 82% 81% 78% 78% 78% 78% 78% 77% 77% 75% 75% 74% 74% 73% 73% 73% % 69% 68% 66% 63% 62% 61% 61% 6 57% 57% % 43% 43% 42% 29% 25% Figure 17 Proportion of men with expected survival exceeding 5 years (age at diagnosis 8 years) with high risk or locally advanced prostate cancer examined with bone scan or other bone investigation by hospital, 14 Akademiska sjukhuset Falu lasarett/ludvika lasarett Höglandssjukhuset Lasarettet i Enköping Lasarettet i Ystad Norrlands universitetssjukhus Umeå Private practice South Private practice South east Sjukhuset i Hudiksvall Sjukhuset i Lidköping Skellefteå lasarett South Älvsborgs Sjukhus Borås Varbergs sjukhus Ängelholms sjukhus Private practice Stockholm Gotland Sahlgrenska Universitetssjukhuset Västmanlands sjukhus Västerås Länssjukhuset i Sundsvall Private practice West Universitetssjukhuset i Linköping/Vrinnevisjukhuset Länssjukhuset Ryhov Örnsköldsviks sjukhus Uddevalla sjukhus Others Hallands sjukhus Kungsbacka Värnamo sjukhus Centrallasarettet Växjö Kullbergska sjukhuset/mälarsjukhuset Skånes universitetssjukhus Lund/Malmö Alingsås lasarett Danderyds sjukhus Hallands sjukhus Halmstad Private practice Uppsala Örebro Blekingesjukhuset Karlskrona Sjukhuset i Gävle Helsingsborgs lasarett Södersjukhuset Centralsjukhuset i Karlstad Karolinska universitetssjukhuset Solna Östersunds sjukhus Capio S:t Görans sjukhus Urologisektionen Karlskoga lasarett No of cases 5 of 5 8 of 8 1 of 1 5 of 5 8 of 8 8 of 8 26 of 26 9 of 9 5 of 5 6 of 6 1 of 1 6 of 6 11 of 11 6 of of of of of of of of of 11 1 of of of 43 6 of 7 6 of 7 15 of 18 5 of 6 33 of 4 of 5 4 of 5 4 of 5 8 of 1 6 of 8 5 of 7 4 of 6 12 of 18 1 of of 21 4 of 7 4 of 8 2 of 5 8 Figure 18 Proportion of men (75 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by hospital, 14 98% 95% 95% 94% 93% 92% 92% 91% 91% 87% 86% 86% 86% 83% 83% 82% % 71% 59% 57% 57% Prostate cancer - National report, 14

19 31 Quality indicators Centrallasarettet Växjö Kullbergska sjukhuset/mälarsjukhuset Ljungby lasarett Sjukhuset i Hudiksvall Södersjukhuset Blekingesjukhuset Karlskrona Sjukhuset i Gävle Hallands sjukhus Halmstad Nyköpings lasarett Universitetssjukhuset Örebro Kärnsjukhuset i Skövde Höglandssjukhuset Sjukhuset i Lidköping Västerviks sjukhus Danderyds sjukhus Lasarettet i Ystad Örnsköldsviks sjukhus Centralsjukhuset i Karlstad Sahlgrenska Universitetssjukhuset Norrlands universitetssjukhus Umeå Länssjukhuset i Sundsvall Västmanlands sjukhus Västerås Länssjukhuset i Kalmar Mora lasarett Östersunds sjukhus Sjukhuset i Bollnäs Värnamo sjukhus South Älvsborgs Sjukhus Borås Ängelholms sjukhus Helsingsborgs lasarett Akademiska sjukhuset Uddevalla sjukhus Visby lasarett Sunderby sjukhus Länssjukhuset Ryhov Private practice South Karolinska universitetssjukhuset Huddinge Skånes universitetssjukhus Lund/Malmö Falu lasarett/ludvika lasarett Lasarettet Trelleborg Private practice Uppsala Örebro Varbergs sjukhus Others Universitetssjukhuset i Linköping/Vrinnevisjukhuset Alingsås lasarett Lasarettet i Enköping Piteå älvdals sjukhus Centralsjukhuset Kristianstad Karolinska universitetssjukhuset Solna Private practice Stockholm Gotland Skellefteå lasarett Private practice South east Private practice West Capio S:t Görans sjukhus Urologisektionen Hallands sjukhus Kungsbacka Kalix sjukhus Karlskoga lasarett Lindesbergs lasarett Lycksele lasarett No of cases 31 of of 22 8 of 8 18 of of 3 18 of of of 16 7 of 8 28 of of 11 of of of 23 8 of 12 8 of of of of of 3 11 of 21 3 of of of 23 1 of 21 4 of 9 3 of of of 22 6 of 15 7 of of of 34 2 of 6 7 of 22 7 of 25 6 of 22 5 of 18 of 77 9 of 39 4 of 18 2 of 9 3 of 14 4 of of 57 1 of 5 1 of 5 1 of 5 1 of 7 11 of of 9 1 of 1 1 of 26 1 of 28 of of 6 of 9 of 7 of 11 of 5 8 Figure 19 Participation in multidisciplinary team conference concerning curative treatment for men (8 years or younger at time of diagnosis) with prostate cancer of high risk by hospital, 14 97% 95% 88% 88% 88% 85% 8 79% 73% 7 62% 59% 57% 57% 52% 51% 49% 48% 48% 44% 43% 43% 41% 4 37% 35% 35% 33% 32% 28% 27% 25% 23% 23% 22% 22% 21% 21% 21% % 14% 13% 1 4% 4% Blekingesjukhuset Karlskrona Falu lasarett/ludvika lasarett Kullbergska sjukhuset/mälarsjukhuset Lasarettet Trelleborg Mora lasarett Sjukhuset i Lidköping Skellefteå lasarett Ängelholms sjukhus Karolinska universitetssjukhuset Solna Sjukhuset i Gävle Skånes universitetssjukhus Lund/Malmö Centrallasarettet Växjö Södersjukhuset Västerviks sjukhus South Älvsborgs Sjukhus Borås Capio S:t Görans sjukhus Urologisektionen Länssjukhuset i Sundsvall Universitetssjukhuset i Linköping/Vrinnevisjukhuset Hallands sjukhus Halmstad Länssjukhuset Ryhov Norrlands universitetssjukhus Umeå Sahlgrenska Universitetssjukhuset Varbergs sjukhus Centralsjukhuset Kristianstad Centralsjukhuset i Karlstad Others Helsingsborgs lasarett Kalix sjukhus Sunderby sjukhus Östersunds sjukhus Västmanlands sjukhus Västerås Akademiska sjukhuset Kärnsjukhuset i Skövde Private practice Stockholm Gotland Örnsköldsviks sjukhus Länssjukhuset i Kalmar Uddevalla sjukhus Danderyds sjukhus Sjukhuset i Bollnäs Universitetssjukhuset Örebro Karolinska universitetssjukhuset Huddinge Höglandssjukhuset Lasarettet i Ystad Private practice South east Sjukhuset i Hudiksvall Private practice West Private practice South No of cases 13 of of of 11 6 of 6 1 of 1 5 of 5 5 of 5 7 of 7 69 of 7 25 of of of of of of 13 3 of 33 1 of of 32 8 of 9 15 of of of 41 7 of 8 75 of 87 6 of 7 22 of of 5 1 of 12 5 of 6 1 of 12 1 of of of 33 7 of 9 35 of 46 6 of 8 of of 22 5 of 7 5 of 7 1 of 14 7 of 1 6 of 9 6 of 9 8 of 12 6 of 9 9 of 14 5 of % 96% 95% 94% 94% 94% 92% 91% 91% 91% 89% 88% 88% 88% 88% 86% 86% 85% 84% 83% 83% 83% 83% 83% 82% 78% 76% 75% 74% 73% 71% 71% 71% 7 64% 56% Figure Proportion of men (75 years or younger at time of diagnosis) with localized high risk prostate cancer given curative primary treatment by hospital, 14 19

20 3 RESULTS Capio S:t Görans sjukhus Urologisektionen Nyköpings lasarett Västerviks sjukhus Capio S:t Görans sjukhus UroClinic Kärnsjukhuset i Skövde Centrallasarettet Växjö Falu lasarett/ludvika lasarett Universitetssjukhuset i Linköping/Vrinnevisjukhuset Hallands sjukhus Halmstad Danderyds sjukhus Södersjukhuset Norrlands universitetssjukhus Umeå Others Centralsjukhuset i Karlstad Uddevalla sjukhus Karolinska universitetssjukhuset Solna Sophiahemmet Carlanderska sjukhuset Varbergs sjukhus Länssjukhuset Ryhov Östersunds sjukhus Blekingesjukhuset Karlskrona Skånes universitetssjukhus Lund/Malmö Länssjukhuset i Kalmar Sahlgrenska Universitetssjukhuset Visby lasarett Sjukhuset i Hudiksvall Akademiska sjukhuset Helsingsborgs lasarett South Älvsborgs Sjukhus Borås Karolinska universitetssjukhuset Huddinge Västmanlands sjukhus Västerås Länssjukhuset i Sundsvall Kullbergska sjukhuset/mälarsjukhuset Sunderby sjukhus Sjukhuset i Gävle Universitetssjukhuset Örebro No of cases 185 of of of of of of 6 22 of of of of 39 5 of of of of of of of 8 43 of of 3 71 of 8 39 of of of of of of of 9 9 of of of of of of of 17 of 31 2 of 8 4 of 35 of 8 8 Figure 21 Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by hospital 14 98% 97% 97% 96% 96% 95% 95% 94% 94% 94% 94% 94% 93% 92% 91% 9 89% 89% 87% 84% 82% % 75% 74% 74% 73% 72% 69% 65% 55% 25% 11% Helsingsborgs lasarett Visby lasarett Capio S:t Görans sjukhus UroClinic Uddevalla sjukhus Carlanderska sjukhuset Kärnsjukhuset i Skövde Länssjukhuset Ryhov Varbergs sjukhus Danderyds sjukhus Kullbergska sjukhuset/mälarsjukhuset Capio S:t Görans sjukhus Urologisektionen Östersunds sjukhus Norrlands universitetssjukhus Umeå Falu lasarett/ludvika lasarett Sahlgrenska Universitetssjukhuset Sjukhuset i Gävle Nyköpings lasarett Hallands sjukhus Halmstad Södersjukhuset Blekingesjukhuset Karlskrona Västmanlands sjukhus Västerås Västerviks sjukhus South Älvsborgs Sjukhus Borås Sophiahemmet Sunderby sjukhus Skånes universitetssjukhus Lund/Malmö Karolinska universitetssjukhuset Solna Universitetssjukhuset i Linköping/Vrinnevisjukhuset Länssjukhuset i Sundsvall Others Centralsjukhuset i Karlstad Akademiska sjukhuset Karolinska universitetssjukhuset Huddinge Centrallasarettet Växjö Sjukhuset i Hudiksvall Länssjukhuset i Kalmar No of cases 16 of 16 8 of 8 45 of of of of of of of of of of of 3 8 of 9 85 of of 17 7 of 8 34 of of 3 25 of of of of 6 14 of of 52 4 of 5 9 of of 6 74 of 96 1 of 13 1 of of of of 27 of 39 5 of 8 8 of 17 8 Figure 22 Proportion of men with pathologic pt2- tumour after radical prostatectomy having negative surgical margins by hospital, 14 98% 97% 96% 95% 95% 95% 93% 92% 92% % 89% 88% 88% 87% 87% 86% 84% 84% 83% 82% 81% 8 78% 77% 77% 77% 77% 76% 76% 75% 69% 62% 47% Prostate cancer - National report, 14