Regional Cancer Centre, Uppsala Örebro University Hospital SE-751 85 UPPSALA

Landstingens och regionernas nationella samverkansgrupp inom cancersjukvården Prostate cancer Report from the National Prostate Cancer Register, 213 September 214

Regional Cancer Centre, Uppsala Örebro University Hospital SE-751 85 UPPSALA 2 Prostate cancer - National report, 213

TABLE OF CONTENTS TABLE OF CONTENTS 1 FOREWORD 11 2 BACKGROUND 12 3 NUMBER OF CASES AND CAPTURE RATIO, TRENDS 12 4 QUALITY INDICATORS 14 5 TIMELINESS 2 6 CLASSIFICATION OF RISK CATEGORIES 21 7 WAITING TIMES 25 8 DIAGNOSTICS 33 9 PRIMARY TREATMENT 38 1 PROSTATE CANCER-SPECIFIC MORTALITY 8 11 PUBLICATIONS BASED ON NPCR FROM THE PAST FIVE YEARS 81 3

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, 1998-213 12 2 Number of cases and capture ratio (%) in NPCR by county, for year of diagnosis 213 13 3 Comparison of number of cases in the risk category very low risk according to the old and new definition, 213 22 4 Number of cases (%) by county and risk category, 213 23 5 Number of cases (%) by year of diagnosis and risk category, 1998-213 24 6 Main reason for the initiation of the medical investigation that led to the prostate cancer diagnosis by year of diagnosis, 24-213 33 7 Serum PSA-level (µg/l) by year of diagnosis, 1998-213 34 8 Number of cores obtained per diagnostic session by year of diagnosis, 27-213 35 9 Number and percentages of men with the primary treatment type registered within six months following diagnosis by health care region and year, 27-213 38 1 Treatment strategy for men in the risk category very low risk by county, 213 4 11 Treatment strategy for men in the risk category low risk by county, 213 4 12 Treatment strategy for men in the risk category intermediate risk by county, 213 41 13 Treatment strategy for men in the risk category high risk by county, 213 41 14 Treatment strategy for men with regional metastases by county, 213 42 15 Treatment strategy for men with distant metastases by county, 213 42 16 Type of radical prostatectomy (primary treatment) by year of diagnosis, 1998-213 5 17 Type of radical prostatectomy (primary treatment) by year of treatment, 29-213 5 18 Type of radical prostatectomy (primary treatment) by hospital, year of treatment 213 51 19 Preoperative nerve sparing intent by year of treatment, 29-213 53 2 Preoperative nerve sparing intent by risk category (low, intermediate and high risk), year of treatment 213 53 21 Pathological T-stage (pt-stage) by year of treatment, 29-213 55 22 Positive surgical margin by year of treatment, 29-213 58 23 Adjuvant therapy following radical prostatectomy by year of treatment, 29-213 63 24 Adjuvant therapy following radical prostatectomy by hospital, year of treatment 213 63 25 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, 28-213 65 26 Number of performed radiotherapy treatments per year of treatment, 29-213 65 27 Number of registered performed radiotherapy treatments by hospital, year of treatment 213 66 28 Type of primary/secondary radiotherapy by hospital, year of treatment 213 66 29 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 213 67 3 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 213 67 31 Number of men with Patient Reported Outcome Measures (PROM) data at baseline and one year after curatively intended treatment 74 32 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 213 75 33a Type of hormonal treatment for men with M1 or PSA 1 µg/l by hospital, 213 76 4 Prostate cancer - National report, 213

FIGURES 33b Type of hormonal treatment for men with M1 or PSA 1 µg/l by hospital, 213, cont d 77 34a Type of hormonal treatment for men with M/MX and PSA 1 µg/l by hospital, 213 78 34b Type of hormonal treatment for men with M/MX and PSA 1 µg/l by hospital, 213, cont d 79 FIGURES 1 Age-standardized prostate cancer incidence and mortality per 1 men, Sweden 197-212 12 2 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, 213 14 3 Participation in multidisciplinary team conference concerning curative treatment for men with prostate cancer of high risk by health care region, 213 14 4 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, 213 14 5 Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by health care region, 213 14 6 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, 213 14 7 Proportion of men (7 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by health care region, 213 15 8 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, 213 15 9 Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by health care region, 213 15 1 Proportion of men with pathologic pt2-tumour after radical prostatectomy having negative surgical margins by health care region, 213 15 11 Proportion of men reported to NPCR within a month from the time point when diagnostic information was given to the patient by hospital, 213 16 12 Participation in multidisciplinary team conference concerning curative treatment for men with prostate cancer of high risk by hospital, 213 16 13 Proportion of men with time between date of referral and first visit at a specialist clinic being 6 days or less by hospital, 213 17 14 Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by hospital, 213 17 15 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, 213 18 16 Proportion of men (7 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by hospital, 213 18 17 Proportion of men (75 years or younger at time of diagnosis) with localized high risk prostate cancer given curative primary treatment by hospital, 213 18 18 Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by hospital 213 19 19 Proportion of men with pathologic pt2-tumour after radical prostatectomy having negative surgical margins by hospital, 213 19 2 Time (months) between date of diagnosis and reporting to the NPCR for cases diagnosed 213 and 28 2 5

FIGURES 21 Time (months) between date of diagnosis and reporting to the NPCR for cases diagnosed 213 and 28 by health care region 2 22 Proportion of men by risk category and year of diagnosis, 1998-213 21 23 Proportion of men by risk categories and county, 213 22 24 Number of days between date of referral and first visit at a specialist clinic by county, year of diagnosis 213 25 25 MAP - Number of days between date of referral and first visit at a specialist clinic by county, year of diagnosis 213 25 26 Median number of days between date of referral and first visit at a specialist clinic by year of diagnosis and health care region, 29-213 25 27 Number of days between date of referral and first visit at a specialist clinic by hospital, year of diagnosis 213 26 28 Number of days between diagnostic biopsy and date when patient was informed of the result by county, 213 27 29 MAP - Number of days between diagnostic biopsy and date when patient was informed of the result by county, 213 27 3 Median number of days between diagnostic biopsy and date when patient was informed of the result by year of diagnosis and health care region, 21-213 27 31 Number of days between treatment decision and radical prostatectomy by county, 213 28 32 MAP - Number of days between treatment decision and radical prostatectomy by county, 213 28 33 Median number of days between treatment decision and radical prostatectomy year of surgery and health care region, 28-213 28 34 Number of days between treatment decision and radical prostatectomy by hospital, 213 28 35 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 213 29 36 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 213 29 37 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 213 29 38 Number of days between decision by oncologist of salvage radiotherapy and start of radiotherapy by county, 213 29 39 Different time intervals from referral to date of prostatectomy among men with prostatectomy as primary treatment by county, year of treatment 212-213 3 4 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 212-213 3 41 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 212-213 31 42 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 213 32 43 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 213 32 6 Prostate cancer - National report, 213

FIGURES 44 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, 28-213 32 45 Incidence and main reason for initiation of the work -up leading to prostate cancer diagnosis by county, 213 33 46 Main reason for initiation of the work-up leading to prostate cancer diagnosis by hospital, 213 33 47 Serum PSA-level (µg/l) at diagnosis by year of diagnosis, 1998-213 34 48 Number of men, 75 years old or younger, with T1c prostate cancer that underwent 8 or more needle biopsies at the diagnostic biopsy session by county, 213 35 49 Number of men, 75 years old or younger, with T1c prostate cancer that underwent 8 or more needle biopsies at the diagnostic biopsy session by hospital, 213 35 5 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 213 36 51 Proportion of men with T1-2, PSA < 2 µg/l and Gleason score 6 or less that underwent bone scan by county, 23 and 213 37 52 Proportion of men (8 years or younger) with Gleason score 8-1 and/or T3 and/or PSA 2-5 µg/l (but not T4 or PSA > 5 µg/l) that was examined by bone scan by county, 23 and 213 37 53 Proportion of men (older than 8 years) with Gleason score 8-1 and/or T3 and/or PSA 2-5 µg/l (but not T4 or PSA > 5 µg/l) that was examined by bone scan by county, 23 and 213 37 54 Proportion of men with prostate cancer of low risk, intermediate risk, high risk or with regional metastasis given second opinion by oncologist by county, 213 38 55 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, 213 38 56 Treatment strategy by risk category and year of diagnosis, 1998-213 39 57 Treatment strategy for men 75 years or younger by risk category and year of diagnosis, 27-213 39 58 Treatment strategy for men older than 75 years by risk category and year of diagnosis, 27-213 39 59 Treatment strategy by risk category and age group, 28-213 39 6 Proportion of men younger than 65 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, 213 43 61 Proportion of men younger than 65 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, 213 43 62 Proportion of men 65-75 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, 213 44 63 Proportion of men 65-75 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, 213 44 64 Proportion of men 75 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, 213 45 7

FIGURES 65 Proportion of men 75 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, 213 45 66 Proportion of men younger than 7 years with intermediate risk prostate cancer given curative therapy by county, 213 46 67 Proportion of men younger than 7 years with intermediate risk prostate cancer given curative therapy by hospital, 213 46 68 Proportion of men 7-8 years with intermediate risk prostate cancer given curative therapy by county, 213 47 69 Proportion of men 7-8 years with intermediate risk prostate cancer given curative therapy by hospital, 213 47 7 Proportion of men younger than 7 years with highrisk prostate cancer given curative therapy by county, 213 48 71 Proportion of men younger than 7 years with highrisk prostate cancer given curative therapy by hospital, 213 48 72 Proportion of men 7-8 years with high risk prostate cancer given curative therapy by county, 213 49 73 Proportion of men 7-8 years with high risk prostate cancer given curative therapy by hospital, 213 49 74 Number of radical prostatectomies (primary treatment) by county and year of treatment, 21-213 52 75 Proportion of men with low risk prostate cancer among men treated with radical prostatectomy, year of treatment 213 52 76 Proportion of men that are missing information on preoperative nerve sparing intent by hospital, year of treatment 213 53 77 Nerve sparing intention by hospital, year of treatment 213 53 78 Nerve sparing intention for men with low- or intermediate risk prostate cancer with T1c, PSA < 1 ng/ml by hospital, 213 54 79 Proportion of men missing information on pathological T-stage by hospital, 213 55 8 Proportion of pt2 tumors by hospital, 213 55 81 Proportion of pt2 tumors among preoperative low risk cancers (T1c, Gleason score 6, PSA < 2 µg/l) by hospital, 213 56 82 Proportion of pt2 tumors among preoperative intermediate risk cancers by hospital, 213 56 83 Proportion of pt2 tumors among preoperative localized high risk cancers by hospital, 213 57 84 Proportion of men with uncertain or missing information on surgical margin status by hospital, 213 58 85 Proportion of positive surgical margin by hospital, 213 58 86 Proportion of positive surgical margin (all radical prostatectomies) vs number of prostatectomies by type and hospital, 213 58 87 Proportion of positive surgical margin among pt2-tumors by hospital, 213 59 88 Proportion of positive surgical margin among pt2-tumors vs number of prostatectomies by type and hospital, 213 59 89 Proportion of positive surgical margin after retropubic radical prostatectomy of pt2- tumors by hospital, 213 59 9 Proportion of positive surgical margin after robot assisted laparoscopic radical prostatectomy of pt2-tumors by hospital, 213 6 91 Proportion of positive surgical margin among preoperative intermediate risk tumors by hospital, 213 6 8 Prostate cancer - National report, 213

FIGURES 92 Proportion of positive surgical margin among preoperative low- or intermediate risk tumors by hospital, 213 61 93 Proportion of men being re-admitted within 3 days following a radical prostatectomy by hospital, 212 (January-November) 62 94 Proportion of men with pt3 tumors and/or positive surgical margin that received adjuvant radiotherapy following radical prostatectomy by hospital, 213 64 95 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, 213 68 96 Proportion of men treated with primary external radiotherapy where marking technique has been used by county, 213 68 97 Proportion of men treated with primary radiotherapy where MRI or PET-CT has been used for definition of target by county, 213 68 98 Proportion of men with low risk prostate cancers treated with radiotherapy that received neoadjuvant hormonal therapy by county, 212-213 68 99 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, 213 69 1 Type of neoadjuvant hormonal therapy among men with localized high risk or locally advanced tumors treated with primary radiotherapy by county, 213 69 11 Proportion of men with localized high risk or locally advanced tumors treated with primary radiotherapy that received adjuvant hormonal therapy by county, 213 69 12 Type of adjuvant hormonal therapy among men with localized high risk or locally advanced tumors treated with primary radiotherapy by county, 213 69 13 Duration of adjuvant hormonal therapy treatment for men with localized high risk or locally advanced tumors treated with primary radiotherapy by county, 213 7 14 Proportion of men treated with primary radiotherapy participating in a clinical treatment study (according to the radiotherapy form) by county, 213 7 15 Type of treatment for men 75 years or younger at time of diagnosis with locally advanced prostate cancer by county, 212-213 71 16 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, 212-213 71 17 Type of treatment for men 76-8 years at time of diagnosis with locally advanced prostate cancer by county, 212-213 71 18 Proportion of men 76-8 years at time of diagnosis with locally advanced prostate cancer that received neoadjuvant hormonal therapy and radiotherapy by county, 212-213 71 19 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, 212-213 72 11 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, 212-213 72 111 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 72 112 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 73 9

FIGURES 113 Urinary incontinence - at baseline and one year following treatment according to postal questionnaire 74 114 Fecal incontinence - at baseline and one year following treatment according to postal questionnaire 74 115 Erectile dysfunction (ED) - at baseline and one year following treatment according to postal questionnaire 74 116 Erectile dysfunction (ED) - one year following treatment among men with no ED at baseline according to postal questionnaire 74 117 Urinary incontinence - one year following treatment among men with missing baseline data and treated the first three months 213 75 118 Fecal incontinence - one year following treatment among men with missing baseline data and treated the first three months 213 75 119 Erectile dysfunction (ED) - one year following treatment among men with missing baseline data and treated the first three months 213 75 12 Median serum PSA-level (µg/l) at diagnosis among men with verified distant metastases (M1) by year of diagnosis, 1998-213 76 121 Cumulative mortality from prostate cancer, cardiovascular diseases, and other reasons by risk category and age group for men treated noncuratively 8 1 Prostate cancer - National report, 213

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) 2 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 22561842 26 september 214 Pär Stattin, Fredrik Sandin, Ola Bratt, Jan- Erik Damber, Camilla Thellenberg Karlsson, 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 Annette Wigertz, Regional cancer centre, Uppsala Örebro, edited and proof read this report 11

3 NUMBER OF CASES AND CAPTURE RATIO, TRENDS 2 BACKGROUND Age standardized incidence/mortality per 1 men 25 2 15 1 5 197 1975 Incidence Mortality 198 1985 199 Year Figur 1 Age-standardized prostate cancer incidence and mortality per 1 men, Sweden 197-212 Age-standardized according to the population in Sweden (incidence) and the Nordic countries (mortality) in the year 2 Source: The Board of Health and Welfare (incidence), wwwsocialstyrelsense, and NORDCAN (mortality), wwwancrnu 1995 2 25 21 3 NUMBER OF CASES AND CAPTURE RATIO, TRENDS Tabell 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, 1998-213 Stockholm- Gotland Uppsala- Örebro Southeast South West North Total Year of dx 1998 748 (69) 137 (98) 716 (1) 1153 (1) 1381 (98) 772 (1) 614 (94) 1999 114 (92) 158 (99) 791 (1) 1334 (99) 1487 (99) 835 (1) 7167 (98) 2 1193 (84) 1519 (1) 776 (1) 1411 (1) 1587 (98) 756 (1) 7242 (96) 21 1285 (9) 1587 (1) 778 (1) 1517 (1) 1581 (98) 712 (1) 746 (98) 22 1344 (86) 1655 (1) 853 (1) 148 (99) 1473 (99) 828 (1) 7633 (97) 23 172 (95) 199 (1) 95 (1) 1653 (1) 1778 (99) 927 (1) 8874 (99) 24 1927 (95) 222 (99) 13 (1) 187 (1) 1939 (99) 156 (1) 9781 (99) 25 1974 (95) 1979 (99) 1145 (1) 1794 (99) 197 (1) 957 (1) 9756 (99) 26 1686 (86) 1918 (99) 1126 (1) 1717 (99) 197 (1) 827 (1) 9181 (97) 27 1676 (98) 1828 (99) 199 (1) 163 (98) 183 (1) 869 (1) 895 (99) 28 1611 (93) 1829 (1) 149 (1) 173 (98) 173 (1) 93 (1) 8852 (98) 29 214 (96) 2253 (1) 1397 (1) 1878 (99) 1947 (1) 128 (1) 1517 (99) 21 1884 (98) 1927 (1) 1236 (1) 1681 (98) 1949 (1) 178 (1) 9755 (99) 211 1787 (91) 1957 (1) 129 (1) 1791 (97) 1853 (1) 972 (1) 9569 (98) 212 1852 (96) 173 (1) 1119 (1) 1633 (92) 1541 (1) 121 (1) 8896 (98) 213 2166 (88) 1886 (99) 1137 (1) 1561 (89) 1525 (99) 969 (99) 9244 (95) Total 25989 (92) 28949 (99) 16366 (1) 2577 (98) 27361 (99) 14537 (1) 138972 (98) 12 Prostate cancer - National report, 213

Tabell 2 Number of cases and capture ratio (%) in NPCR by county, for year of diagnosis 213 Cancer register NPCR Capture ratio (%) County Blekinge 184 184 (1) Jämtland 219 219 (1) Kalmar 253 253 (1) Västra Götaland 878 878 (1) Östergötland 344 344 (1) Övriga/privat - Norra 5 5 (1) Övriga/privat - Sydöstra 185 185 (1) Övriga/privat - Västra 451 45 (1) Jönköping 346 345 (1) Halland 316 315 (1) Uppsala 238 237 (1) Kronoberg 225 224 (1) Södermanland 27 26 (1) Norrbotten 198 197 (99) Örebro 187 186 (99) Västmanland 288 286 (99) Gävleborg 35 32 (99) Västerbotten 24 237 (99) Dalarna 272 268 (99) Värmland 251 247 (98) Västernorrland 296 29 (98) Övriga/privat - Södra 38 37 (97) Övriga/privat - Uppsala-Örebro 126 122 (97) Gotland 58 56 (97) Stockholm 541 484 (89) Övriga/privat - Stockholm-Gotland 1877 1648 (88) Skåne 1193 17 (84) Since year of diagnosis is taken from the Swedish Cancer Register, the numbers may differ slightly from the previous table 13

4 QUALITY INDICATORS 4 QUALITY INDICATORS West North Uppsala Örebro Southeast South Stockholm Gotland 211 212 1 213 No of cases 1 688 of 1421 429 of 939 781 of 178 458 of 1122 3565 of 888 524 of 152 685 of 226 41 % 4 34 % 34 % 48 % 46 % 44 % 2 4 6 8 1 Figur 2 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, 213 Uppsala Örebro South North West Stockholm Gotland 211 212 1 213 Southeast No of cases 1 21 of 422 113 of 273 524 of 1614 54 of 175 53 of 239 55 of 275 39 of 23 22 % 2 17 % 32 % 31 % 41 % 5 2 4 6 8 1 Figur 3 Participation in multidisciplinary team conference concerning curative treatment for men with prostate cancer of high risk by health care region, 213 Stockholm Gotland Southeast West North Uppsala Örebro 211 212 1 213 South No of cases 1 919 of 183 957 of 1177 662 of 824 837 of 162 4756 of 6233 496 of 698 885 of 1389 71 % 64 % 81 % 8 79 % 76 % 85 % 2 4 6 8 1 Figur 4 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, 213 Uppsala Örebro Stockholm Gotland 211 212 1 213 South West North Southeast No of cases 1 415 of 153 291 of 1421 31 of 1779 1413 of 8925 146 of 939 187 of 2133 73 of 1123 9 % 7 % 2 17 % 16 % 16 % 27 % 2 4 6 8 1 Figur 5 Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by health care region, 213 Uppsala Örebro Stockholm Gotland 212 1 213 Southeast South North West No of cases 1 169 of 23 33 of 388 173 of 1463 187 of 255 121 of 17 157 of 236 136 of 211 71 % 67 % 64 % 78 % 73 % 73 % 83 % 2 4 6 8 1 Figur 6 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, 213 14 Prostate cancer - National report, 213

South Southeast North Stockholm Gotland Uppsala Örebro 211 212 1 213 West No of cases 1 99 of 19 46 of 51 45 of 51 26 of 239 556 of 647 83 of 11 77 of 96 86 % 86 % 82 % 8 91 % 9 88 % 2 4 6 8 1 Figur 7 Proportion of men (7 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by health care region, 213 North Stockholm Gotland South Uppsala Örebro 211 212 1 213 Southeast West No of cases 1 52 of 57 13 of 116 111 of 128 141 of 172 544 of 666 71 of 92 66 of 11 65 % 82 % 82 % 77 % 91 % 89 % 87 % 2 4 6 8 1 Figur 8 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, 213 Stockholm Gotland South West North Southeast Uppsala Örebro 211 212 1 213 No of cases 1 533 of 632 136 of 1883 219 of 333 221 of 342 61 of 1 173 of 285 99 of 191 52 % 66 % 65 % 61 % 61 % 69 % 84 % 2 4 6 8 1 Figur 9 Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by health care region, 213 Stockholm Gotland Uppsala Örebro 211 212 1 213 North West South Southeast No of cases 1 64 of 68 22 of 225 35 of 46 138 of 123 117 of 141 166 of 27 139 of 183 84 % 83 % 8 76 % 94 % 9 86 % 2 4 6 8 1 Figur 1 Proportion of men with pathologic pt2- tumour after radical prostatectomy having negative surgical margins by health care region, 213 15

4 QUALITY INDICATORS Hallands sjukhus Kungsbacka Ludvika lasarett Vrinnevisjukhuset i Norrköping Ängelholms sjukhus Helsingsborgs lasarett Lindesbergs lasarett Visby lasarett Höglandssjukhuset Norrlands universitetssjukhus Umeå Alingsås lasarett Örnsköldsviks sjukhus Kärnsjukhuset i Skövde Södersjukhuset Specialistsjukvården Falkenberg Södra Älvsborgs Sjukhus Borås Capio S:t Görans sjukhus Urologisektionen Skellefteå lasarett Lycksele lasarett Södertälje sjukhus Lasarettet Trelleborg Akademiska sjukhuset Sahlgrenska Universitetssjukhuset Others Centrallasarettet Växjö Västmanlands sjukhus Västerås Centralsjukhuset i Karlstad Sjukhuset i Bollnäs Piteå älvdals sjukhus Norrtälje sjukhus Universitetssjukhuset Örebro Sjukhuset i Arvika Karolinska universitetssjukhuset Solna Östersunds sjukhus Universitetssjukhuset i Linköping Varbergs sjukhus Kiruna sjukhus Kullbergska sjukhuset/mälarsjukhuset Blekingesjukhuset Karlskrona Nyköpings lasarett Private practice Länssjukhuset i Sundsvall Sjukhuset i Lidköping Ljungby lasarett Sjukhuset i Hudiksvall Hallands sjukhus Halmstad Västerviks sjukhus Sjukhuset i Falköping Länssjukhuset i Kalmar Oskarshamns sjukhus Gällivare sjukhus Sjukhuset i Gävle Sunderby sjukhus Falu lasarett Danderyds sjukhus Uddevalla sjukhus Blekingesjukhuset Karlshamn Skånes universitetssjukhus Lund/Malmö Värnamo sjukhus Länssjukhuset Ryhov Sjukhuset i Torsby Sollefteå sjukhus Kalix sjukhus Karolinska universitetssjukhuset Huddinge Södra Älvsborgs Sjukhus Skene Karlskoga lasarett Mora lasarett Lasarettet i Ystad Lasarettet i Enköping Simrishamns sjukhus No of cases 59 of 59 54 of 54 15 of 154 99 of 11 115 of 131 37 of 43 46 of 56 94 of 116 89 of 111 54 of 68 63 of 81 83 of 19 44 of 61 5 of 7 4 of 56 4 of 57 51 of 75 3 of 45 53 of 8 35 of 53 115 of 176 175 of 275 5 of 8 14 of 167 173 of 278 128 of 211 37 of 61 12 of 22 29 of 57 53 of 15 4 of 8 19 of 39 99 of 217 83 of 189 35 of 81 3565 of 888 1 of 25 43 of 12 42 of 125 24 of 8 755 of 2588 48 of 167 19 of 67 16 of 57 23 of 88 32 of 127 19 of 76 5 of 23 3 of 14 8 of 38 3 of 17 26 of 149 2 of 115 19 of 115 9 of 58 29 of 2 3 of 24 36 of 329 9 of 91 1 of 133 1 of 14 3 of 43 1 of 15 4 of 68 1 of 26 1 of 3 2 of 78 2 of 94 of 44 of 24 11 % 1 8 % 7 % 7 % 7 % 6 % 4 % 3 % 3 % 2 % 22 % 21 % 21 % 18 % 17 % 17 % 17 % 16 % 14 % 12 % 36 % 34 % 3 29 % 29 % 28 % 28 % 26 % 25 % 25 % 5 5 49 % 46 % 44 % 43 % 4 4 2 4 6 8 61 % 61 % 55 % 51 % 72 % 71 % 71 % 7 68 % 67 % 66 % 66 % 65 % 64 % 62 % 62 % 62 % 86 % 82 % 81 % 8 79 % 78 % 76 % Figur 11 Proportion of men reported to NPCR within a month from the time point when diagnostic information was given to the patient by hospital, 213 97 % 9 88 % Nyköpings lasarett Södersjukhuset Kullbergska sjukhuset/mälarsjukhuset Sjukhuset i Bollnäs Centrallasarettet Växjö Sjukhuset i Hudiksvall Centralsjukhuset i Karlstad Sjukhuset i Gävle Länssjukhuset i Sundsvall Blekingesjukhuset Karlskrona Höglandssjukhuset Ljungby lasarett Mora lasarett Helsingsborgs lasarett Kärnsjukhuset i Skövde Universitetssjukhuset Örebro Akademiska sjukhuset Lasarettet i Ystad Simrishamns sjukhus Sjukhuset i Lidköping Värnamo sjukhus Kiruna sjukhus Örnsköldsviks sjukhus Hallands sjukhus Halmstad Sahlgrenska Universitetssjukhuset Lasarettet Trelleborg Länssjukhuset Ryhov Västmanlands sjukhus Västerås Norrlands universitetssjukhus Umeå Danderyds sjukhus Skånes universitetssjukhus Lund/Malmö Uddevalla sjukhus Östersunds sjukhus Ängelholms sjukhus Gällivare sjukhus Others Piteå älvdals sjukhus Kalix sjukhus Karolinska universitetssjukhuset Solna Alingsås lasarett Capio S:t Görans sjukhus Urologisektionen Oskarshamns sjukhus Sunderby sjukhus Universitetssjukhuset i Linköping Länssjukhuset i Kalmar Vrinnevisjukhuset i Norrköping Västerviks sjukhus Private practice Falu lasarett Hallands sjukhus Kungsbacka Karolinska universitetssjukhuset Huddinge Lasarettet i Enköping Lindesbergs lasarett Ludvika lasarett Norrtälje sjukhus Sjukhuset i Falköping Skellefteå lasarett Varbergs sjukhus No of cases 18 of 2 31 of 35 3 of 35 5 of 6 22 of 28 14 of 18 42 of 58 24 of 34 21 of 33 14 of 23 15 of 25 3 of 5 12 of 21 16 of 3 8 of 15 13 of 26 33 of 7 6 of 13 4 of 9 5 of 12 5 of 12 2 of 5 8 of 21 11 of 29 2 of 55 5 of 15 4 of 12 17 of 52 524 of 1614 9 of 28 3 of 1 23 of 78 16 of 62 6 of 24 3 of 14 1 of 5 5 of 25 2 of 11 1 of 6 9 of 56 3 of 19 2 of 14 1 of 7 4 of 3 5 of 41 5 of 42 3 of 4 1 of 17 13 of 229 1 of 26 of 9 of 15 of 8 of 12 of 22 of 13 of 7 of 9 of 18 14 % 14 % 13 % 12 % 12 % 8 % 6 % 6 % 4 % 26 % 25 % 21 % 2 2 18 % 17 % 16 % 16 % 38 % 38 % 36 % 33 % 33 % 33 % 32 % 32 % 3 29 % 5 47 % 46 % 44 % 42 % 42 % 4 2 4 6 8 Figur 12 Participation in multidisciplinary team conference concerning curative treatment for men with prostate cancer of high risk by hospital, 213 64 % 61 % 6 6 57 % 53 % 53 % 79 % 78 % 72 % 71 % 9 89 % 86 % 83 % 16 Prostate cancer - National report, 213

Blekingesjukhuset Karlshamn Kalix sjukhus Karlskoga lasarett Specialistsjukvården Falkenberg Södra Älvsborgs Sjukhus Skene Alingsås lasarett Danderyds sjukhus Simrishamns sjukhus Södersjukhuset Capio S:t Görans sjukhus Urologisektionen Hallands sjukhus Kungsbacka Hallands sjukhus Halmstad Karolinska universitetssjukhuset Solna Södra Älvsborgs Sjukhus Borås Vrinnevisjukhuset i Norrköping Länssjukhuset Ryhov Gällivare sjukhus Norrtälje sjukhus Karolinska universitetssjukhuset Huddinge Universitetssjukhuset i Linköping Varbergs sjukhus Visby lasarett Sunderby sjukhus Helsingsborgs lasarett Sahlgrenska Universitetssjukhuset Södertälje sjukhus Värnamo sjukhus Skånes universitetssjukhus Lund/Malmö Sjukhuset i Lidköping Akademiska sjukhuset Ängelholms sjukhus Ljungby lasarett Lycksele lasarett Sjukhuset i Bollnäs Skellefteå lasarett Lasarettet i Ystad Private practice Höglandssjukhuset Kärnsjukhuset i Skövde Sollefteå sjukhus Centrallasarettet Växjö Blekingesjukhuset Karlskrona Norrlands universitetssjukhus Umeå Lindesbergs lasarett Länssjukhuset i Sundsvall Kullbergska sjukhuset/mälarsjukhuset Nyköpings lasarett Lasarettet Trelleborg Västmanlands sjukhus Västerås Sjukhuset i Hudiksvall Ludvika lasarett Universitetssjukhuset Örebro Västerviks sjukhus Others Östersunds sjukhus Örnsköldsviks sjukhus Uddevalla sjukhus Lasarettet i Enköping Länssjukhuset i Kalmar Piteå älvdals sjukhus Falu lasarett Oskarshamns sjukhus Sjukhuset i Falköping Sjukhuset i Gävle Centralsjukhuset i Karlstad Sjukhuset i Torsby Kiruna sjukhus Mora lasarett Sjukhuset i Arvika No of cases 14 of 14 13 of 13 18 of 18 6 of 6 25 of 25 56 of 57 55 of 56 25 of 26 5 of 52 22 of 23 38 of 4 15 of 112 3 of 32 45 of 48 115 of 124 7 of 76 1 of 11 3 of 33 49 of 54 124 of 137 57 of 63 49 of 55 71 of 8 67 of 76 189 of 215 54 of 62 54 of 63 159 of 186 52 of 61 98 of 115 79 of 93 37 of 44 35 of 42 4 of 49 52 of 65 59 of 74 1178 of 1485 72 of 93 55 of 72 4756 of 6233 22 of 29 96 of 128 78 of 15 71 of 97 24 of 33 66 of 92 7 of 98 46 of 65 24 of 34 152 of 217 5 of 73 31 of 47 54 of 82 4 of 61 5 of 8 99 of 16 39 of 69 88 of 156 17 of 31 69 of 127 9 of 17 48 of 95 17 of 34 8 of 16 58 of 116 84 of 187 2 of 5 8 of 21 23 of 72 1 of 8 12 % 4 38 % 32 % 51 % 5 5 5 45 % 2 4 6 8 62 % 62 % 57 % 56 % 55 % 54 % 53 % 76 % 76 % 76 % 75 % 74 % 73 % 73 % 72 % 71 % 71 % 71 % 7 68 % 66 % 66 % 66 % 88 % 88 % 87 % 86 % 85 % 85 % 85 % 85 % 84 % 83 % 82 % 8 8 79 % 77 % Figur 13 Proportion of men with time between date of referral and first visit at a specialist clinic being 6 days or less by hospital, 213 98 % 98 % 96 % 96 % 96 % 95 % 94 % 94 % 94 % 93 % 92 % 91 % 91 % 91 % 91 % 9 89 % 89 % Ludvika lasarett Helsingsborgs lasarett Hallands sjukhus Kungsbacka Blekingesjukhuset Karlshamn Blekingesjukhuset Karlskrona Södersjukhuset Ängelholms sjukhus Gällivare sjukhus Universitetssjukhuset Örebro Sahlgrenska Universitetssjukhuset Skellefteå lasarett Lindesbergs lasarett Centrallasarettet Växjö Karolinska universitetssjukhuset Solna Varbergs sjukhus Västmanlands sjukhus Västerås Lycksele lasarett Norrtälje sjukhus Others Östersunds sjukhus Lasarettet i Ystad Sollefteå sjukhus Norrlands universitetssjukhus Umeå Sjukhuset i Gävle Karolinska universitetssjukhuset Huddinge Danderyds sjukhus Skånes universitetssjukhus Lund/Malmö Örnsköldsviks sjukhus Sjukhuset i Torsby Ljungby lasarett Centralsjukhuset i Karlstad Hallands sjukhus Halmstad Kalix sjukhus Lasarettet Trelleborg Falu lasarett Sjukhuset i Falköping Kullbergska sjukhuset/mälarsjukhuset Nyköpings lasarett Visby lasarett Kiruna sjukhus Mora lasarett Lasarettet i Enköping Uddevalla sjukhus Private practice Länssjukhuset i Sundsvall Västerviks sjukhus Sjukhuset i Lidköping Capio S:t Görans sjukhus Urologisektionen Akademiska sjukhuset Höglandssjukhuset Värnamo sjukhus Länssjukhuset Ryhov Alingsås lasarett Länssjukhuset i Kalmar Vrinnevisjukhuset i Norrköping Simrishamns sjukhus Kärnsjukhuset i Skövde Sjukhuset i Hudiksvall Södra Älvsborgs Sjukhus Borås Piteå älvdals sjukhus Sunderby sjukhus Universitetssjukhuset i Linköping Södertälje sjukhus Sjukhuset i Bollnäs Oskarshamns sjukhus Karlskoga lasarett Sjukhuset i Arvika Specialistsjukvården Falkenberg Södra Älvsborgs Sjukhus Skene No of cases 38 of 54 89 of 131 34 of 59 13 of 24 63 of 125 29 of 61 49 of 11 7 of 17 34 of 15 89 of 275 24 of 75 12 of 43 46 of 167 1 of 39 19 of 81 62 of 278 1 of 45 12 of 57 2 of 1 39 of 217 16 of 94 7 of 43 18 of 111 24 of 149 11 of 69 1413 of 8925 9 of 57 51 of 329 12 of 81 2 of 14 8 of 57 29 of 21 17 of 127 2 of 15 7 of 53 15 of 115 3 of 23 15 of 119 1 of 8 7 of 56 3 of 25 9 of 78 5 of 44 22 of 2 292 of 2699 17 of 167 7 of 76 6 of 67 5 of 57 14 of 176 9 of 116 7 of 91 1 of 133 5 of 68 1 of 14 11 of 154 2 of 3 7 of 19 5 of 88 3 of 56 1 of 22 5 of 115 8 of 189 3 of 8 2 of 61 1 of 38 of 3 of 8 of 7 of 26 9 % 9 % 9 % 8 % 8 % 8 % 8 % 7 % 7 % 7 % 7 % 6 % 6 % 5 % 5 % 4 % 4 % 4 % 3 % 3 % 21 % 2 18 % 17 % 16 % 16 % 16 % 16 % 16 % 16 % 16 % 15 % 14 % 14 % 14 % 13 % 13 % 13 % 13 % 13 % 13 % 12 % 12 % 12 % 12 % 11 % 11 % 11 % 1 32 % 32 % 32 % 28 % 28 % 26 % 23 % 22 % 22 % 5 48 % 45 % 41 % 2 4 6 8 Figur 14 Proportion of men with time between diagnostic biopsy and information of result being 18 days or less by hospital, 213 58 % 54 % 7 68 % 17

4 QUALITY INDICATORS Blekingesjukhuset Karlshamn Hallands sjukhus Kungsbacka Karlskoga lasarett Oskarshamns sjukhus Sjukhuset i Bollnäs Länssjukhuset i Kalmar Kärnsjukhuset i Skövde Sjukhuset i Lidköping Sjukhuset i Hudiksvall Alingsås lasarett Nyköpings lasarett Norrlands universitetssjukhus Umeå Kalix sjukhus Värnamo sjukhus Helsingsborgs lasarett Länssjukhuset Ryhov Sahlgrenska Universitetssjukhuset Lasarettet i Enköping Falu lasarett Centralsjukhuset i Karlstad Sjukhuset i Gävle Centrallasarettet Växjö Karolinska universitetssjukhuset Solna Norrtälje sjukhus Mora lasarett Kullbergska sjukhuset/mälarsjukhuset Vrinnevisjukhuset i Norrköping Höglandssjukhuset Universitetssjukhuset Örebro Skellefteå lasarett Östersunds sjukhus Universitetssjukhuset i Linköping Danderyds sjukhus Ljungby lasarett Simrishamns sjukhus Others Lasarettet i Ystad Lasarettet Trelleborg Länssjukhuset i Sundsvall Västerviks sjukhus Akademiska sjukhuset Skånes universitetssjukhus Lund/Malmö Västmanlands sjukhus Västerås Blekingesjukhuset Karlskrona Hallands sjukhus Halmstad Ängelholms sjukhus Örnsköldsviks sjukhus Private practice Sunderby sjukhus Karolinska universitetssjukhuset Huddinge Södertälje sjukhus Uddevalla sjukhus Ludvika lasarett Lycksele lasarett Piteå älvdals sjukhus Södersjukhuset Varbergs sjukhus Lindesbergs lasarett Gällivare sjukhus Sjukhuset i Falköping No of cases 5 of 5 5 of 5 5 of 5 6 of 6 11 of 11 37 of 39 13 of 14 11 of 12 2 of 22 16 of 18 15 of 17 22 of 25 6 of 7 12 of 14 17 of 2 11 of 13 33 of 4 9 of 11 26 of 32 42 of 52 29 of 36 16 of 2 4 of 5 8 of 1 15 of 19 22 of 28 22 of 28 18 of 23 14 of 18 1 of 13 19 of 25 22 of 29 6 of 8 9 of 12 6 of 8 14 of 19 173 of 1463 11 of 15 11 of 15 22 of 3 11 of 15 42 of 58 47 of 65 27 of 38 12 of 17 11 of 16 1 of 15 13 of 2 221 of 344 17 of 27 5 of 8 3 of 5 21 of 37 11 of 21 3 of 6 4 of 8 3 of 6 5 of 11 3 of 7 2 of 5 2 of 5 5 5 5 45 % 43 % 4 4 2 4 6 8 63 % 62 % 6 57 % 52 % 75 % 75 % 75 % 74 % 73 % 73 % 73 % 73 % 73 % 72 % 72 % 71 % 71 % 69 % 67 % 65 % 64 % 86 % 86 % 85 % 85 % 82 % 82 % 81 % 81 % 81 % 8 8 8 79 % 79 % 79 % 78 % 78 % 77 % 76 % 76 % Figur 15 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, 213 95 % 93 % 92 % 91 % 89 % 88 % 88 % Kullbergska sjukhuset/mälarsjukhuset Lasarettet i Ystad Universitetssjukhuset i Linköping Varbergs sjukhus Ängelholms sjukhus Västmanlands sjukhus Västerås Centrallasarettet Växjö Others Hallands sjukhus Halmstad Private practice Sahlgrenska Universitetssjukhuset Höglandssjukhuset Vrinnevisjukhuset i Norrköping Östersunds sjukhus Helsingsborgs lasarett Akademiska sjukhuset Länssjukhuset i Sundsvall Hallands sjukhus Kungsbacka Ludvika lasarett Värnamo sjukhus Skånes universitetssjukhus Lund/Malmö Uddevalla sjukhus Länssjukhuset Ryhov Capio S:t Görans sjukhus Urologisektionen Karolinska universitetssjukhuset Solna Norrlands universitetssjukhus Umeå Kärnsjukhuset i Skövde Södersjukhuset Universitetssjukhuset Örebro Centralsjukhuset i Karlstad No of cases 5 of 5 5 of 5 11 of 11 6 of 6 9 of 9 27 of 28 23 of 24 62 of 66 12 of 13 22 of 242 18 of 2 8 of 9 8 of 9 15 of 17 7 of 8 13 of 15 556 of 647 12 of 14 5 of 6 4 of 5 4 of 5 13 of 17 16 of 21 6 of 8 1 of 14 15 of 24 3 of 5 4 of 7 9 of 16 2 of 5 4 of 13 4 31 % 2 4 6 8 1 62 % 6 57 % 56 % 8 8 76 % 76 % 75 % 71 % 92 % 91 % 9 89 % 89 % 88 % 88 % 87 % 86 % 86 % 83 % Figur 16 Proportion of men (7 years or younger at time of diagnosis) with prostate cancer of very low risk given active surveillance as primary treatment by hospital, 213 Capio S:t Görans sjukhus Urologisektionen Centrallasarettet Växjö Falu lasarett Norrlands universitetssjukhus Umeå Norrtälje sjukhus Sunderby sjukhus Sjukhuset i Gävle Karolinska universitetssjukhuset Solna Centralsjukhuset i Karlstad Länssjukhuset i Kalmar Helsingsborgs lasarett Skånes universitetssjukhus Lund/Malmö Södersjukhuset Universitetssjukhuset i Linköping Länssjukhuset i Sundsvall Örnsköldsviks sjukhus Akademiska sjukhuset Höglandssjukhuset Lasarettet Trelleborg Sahlgrenska Universitetssjukhuset Ängelholms sjukhus Blekingesjukhuset Karlskrona Västmanlands sjukhus Västerås Lasarettet i Ystad Nyköpings lasarett Sjukhuset i Hudiksvall Östersunds sjukhus Hallands sjukhus Halmstad Mora lasarett Others Karolinska universitetssjukhuset Huddinge Västerviks sjukhus Länssjukhuset Ryhov Universitetssjukhuset Örebro Private practice Kullbergska sjukhuset/mälarsjukhuset Uddevalla sjukhus Oskarshamns sjukhus Varbergs sjukhus Alingsås lasarett Vrinnevisjukhuset i Norrköping No of cases 7 of 7 15 of 15 1 of 1 15 of 15 6 of 6 8 of 8 17 of 18 41 of 44 12 of 13 21 of 23 1 of 11 4 of 44 1 of 11 1 of 11 8 of 9 6 of 7 4 of 47 1 of 12 5 of 6 25 of 3 5 of 6 9 of 11 9 of 11 544 of 666 8 of 1 4 of 5 12 of 15 4 of 5 11 of 14 7 of 9 39 of 51 6 of 8 8 of 11 5 of 7 7 of 1 47 of 68 1 of 16 16 of 26 3 of 5 3 of 5 7 of 12 8 of 14 2 4 6 8 1 62 % 62 % 6 6 58 % 57 % 73 % 71 % 7 69 % 83 % 83 % 83 % 83 % 82 % 82 % 82 % 8 8 8 8 79 % 78 % 76 % 75 % 96 % 96 % 94 % 94 % 93 % 92 % 91 % 91 % 91 % 91 % 91 % 89 % 86 % 85 % Figur 17 Proportion of men (75 years or younger at time of diagnosis) with localized high risk prostate cancer given curative primary treatment by hospital, 213 18 Prostate cancer - National report, 213

Länssjukhuset i Kalmar Capio S:t Görans sjukhus UroClinic Capio S:t Görans sjukhus Urologisektionen Karolinska universitetssjukhuset Solna Kärnsjukhuset i Skövde Länssjukhuset i Sundsvall Kullbergska sjukhuset/mälarsjukhuset Skånes universitetssjukhus Lund/Malmö Carlanderska sjukhuset Sahlgrenska Universitetssjukhuset Södra Älvsborgs Sjukhus Borås Länssjukhuset Ryhov Akademiska sjukhuset Hallands sjukhus Halmstad Norrlands universitetssjukhus Umeå Karolinska universitetssjukhuset Huddinge Others Universitetssjukhuset i Linköping Falu lasarett Visby lasarett Varbergs sjukhus Östersunds sjukhus Capio Lundby Närsjukhus Centrallasarettet Växjö Helsingsborgs lasarett Sjukhuset i Gävle Centralsjukhuset i Karlstad Västmanlands sjukhus Västerås Nyköpings lasarett Vrinnevisjukhuset i Norrköping Uddevalla sjukhus Blekingesjukhuset Karlskrona Södersjukhuset Västerviks sjukhus Danderyds sjukhus No of cases 4 of 42 96 of 16 91 of 11 318 of 364 24 of 28 12 of 14 23 of 29 136 of 177 49 of 64 98 of 13 12 of 16 56 of 78 136 of 1883 25 of 38 37 of 57 2 of 31 18 of 28 7 of 11 63 of 13 6 of 1 7 of 13 21 of 4 28 of 54 3 of 6 24 of 48 16 of 33 3 of 7 34 of 84 3 of 8 4 of 11 12 of 38 14 of 58 3 of 15 2 of 11 1 of 23 of 7 4 % 24 % 2 18 % 4 38 % 36 % 32 % 52 % 52 % 5 5 48 % 43 % 2 4 6 8 Figur 18 Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by hospital 213 65 % 65 % 64 % 64 % 61 % 6 54 % 77 % 77 % 75 % 75 % 72 % 69 % 66 % 9 87 % 86 % 86 % 79 % 95 % 91 % Falu lasarett Helsingsborgs lasarett Norrlands universitetssjukhus Umeå Nyköpings lasarett Others Södersjukhuset Östersunds sjukhus Varbergs sjukhus Carlanderska sjukhuset Västmanlands sjukhus Västerås Blekingesjukhuset Karlskrona Hallands sjukhus Halmstad Centralsjukhuset i Karlstad Capio S:t Görans sjukhus Urologisektionen Sahlgrenska Universitetssjukhuset Capio S:t Görans sjukhus UroClinic Kärnsjukhuset i Skövde Uddevalla sjukhus Västerviks sjukhus Karolinska universitetssjukhuset Solna Länssjukhuset Ryhov Södra Älvsborgs Sjukhus Borås Capio Lundby Närsjukhus Länssjukhuset i Kalmar Karolinska universitetssjukhuset Huddinge Centrallasarettet Växjö Kullbergska sjukhuset/mälarsjukhuset Sjukhuset i Gävle Skånes universitetssjukhus Lund/Malmö Universitetssjukhuset i Linköping Länssjukhuset i Sundsvall Akademiska sjukhuset Visby lasarett Vrinnevisjukhuset i Norrköping Universitetssjukhuset Örebro No of cases 7 of 7 8 of 8 21 of 21 5 of 5 14 of 14 5 of 5 32 of 33 25 of 26 46 of 48 16 of 17 11 of 12 33 of 36 43 of 47 69 of 78 72 of 82 64 of 73 14 of 16 32 of 37 6 of 7 187 of 219 138 of 123 47 of 57 9 of 11 4 of 5 18 of 23 14 of 18 2 of 26 16 of 21 6 of 8 93 of 124 51 of 7 7 of 1 21 of 31 4 of 6 15 of 24 3 of 5 2 4 6 8 7 68 % 67 % 62 % 6 82 % 82 % 8 78 % 78 % 77 % 76 % 75 % 75 % 73 % 94 % 92 % 92 % 91 % 88 % 88 % 88 % 88 % 86 % 86 % 85 % 84 % Figur 19 Proportion of men with pathologic pt2- tumour after radical prostatectomy having negative surgical margins by hospital, 213 97 % 96 % 96 % 19

5 TIMELINESS 5 TIMELINESS Cumulative proportion (%) reported to NPCR 1 8 6 4 2 573% 846% 979% 3 6 9 12 Months since diagnosis 213 28 Figur 2 Time (months) between date of diagnosis and reporting to the NPCR for cases diagnosed 213 and 28 Cumulative proportion (%) reported to NPCR Cumulative proportion (%) reported to NPCR Cumulative proportion (%) reported to NPCR 1 8 6 4 2 1 8 6 4 2 1 8 6 4 2 45% 736% Stockholm Gotland 939% 3 6 9 12 645% Months since diagnosis 3 6 9 12 644% 914% 868% Sydöstra 999% Months since diagnosis Västra 986% 3 6 9 12 Months since diagnosis Cumulative proportion (%) reported to NPCR Cumulative proportion (%) reported to NPCR Cumulative proportion (%) reported to NPCR 1 8 6 4 2 1 8 6 4 2 1 8 6 4 2 635% 935% Uppsala Örebro 998% 3 6 9 12 489% 761% Months since diagnosis Södra 981% 3 6 9 12 655% 927% Months since diagnosis Norra 994% 3 6 9 12 Months since diagnosis Figur 21 Time (months) between date of diagnosis and reporting to the NPCR for cases diagnosed 213 and 28 by health care region 2 Prostate cancer - National report, 213

6 CLASSIFICATION OF RISK CATEGORIES 1 8 6 4 2 1998 1999 2 21 22 23 24 25 26 Year 27 28 29 21 211 212 213 6 Missing 5 Distant metastases 4 Regionally metastatic 3b Locally advanced 3a Localized high risk 2 Intermediate risk 1c Low risk (missing) 1b Low risk (others) 1a Very low risk 1 Low risk Figur 22 Proportion of men by risk category and year of diagnosis, 1998-213 Definitions of risk categories, based on clinical evaluation, ie palpation of the prostate, tumour differentiation according to Gleason in biopsies, and serum PSA level at diagnosis 1 Low risk T1-2, Gleason score 6 or lower and PSA < 1 µg/l 1a Very low risk T1c, PSA < 1 µg/l, Gleason score 6 or lower, no more than 4 biopsies with cancer, total length of biopsies with cancer 8 mm, a total of at least 8 biopsies taken, PSA density < 15 µg/l/ml 1b Low risk (others) Low risk that is not categorized to 1a 1c Low risk (missing) Missing information for categorization of low risk according 1a/b 2 Intermediate risk T1-2, Gleason score 7 and/or 1 PSA < 2 µg/l 3a Localized high risk T1-2, Gleason score 8-1 and/or 2 PSA < 5 µg/l 3b Locally advanced T3 and PSA < 5 µg/l 4 Regionally metastatic T4 and/or N1 and/or 5 PSA < 1 µg/l, no distant metastases (M or MX) 5 Distant metastases M1, bone scan shows signs of metastases, and/or PSA 1 µg/l 6 Missing Missing information for categorization according to above Definition of preoperative local clinical stage, lymph node status at imaging, and bone metastases at evaluation of skeleton T1a Not palpable, diagnosed at TUR-P, 5 % of resected chips contained tumour tissue T1b Not palpable, diagnosed at TUR-P, >5 % of resected chips contained tumour tissue T1c Not palpable, diagnosed at biopsy due to elevated serum PSA T2 Palpable, intracapsular ie restricted to the prostate T3 Palpable, extracapsular ie growth outside of the prostate that may include invasion of seminal vesicles or bladder neck T4 Palpable invades other structures than seminal vesicles or bladder neck N1 Regional lymph node metastases M1 Bone metastases 21