Landstingens och regionernas nationella samverkansgrupp inom cancersjukvården Prostate cancer National quality report for the year of diagnosis 10 from the National Prostate Cancer Register (NPCR) May 12
Regional cancer centre, Uppsala Örebro University hospital SE-751 85 UPPSALA 2 Prostatacancer - Nationell kvalitetsrapport, 10
List of 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, 1998-10.... 8 2 Number of cases and capture ratio (%) in NPCR by county, 10........... 9 3 Number of cases by year of diagnosis and risk category, 1998-10.......... 14 4 Main reason for the initiation of the medical investigation that led to the prostate cancer diagnosis, by year of diagnosis, 04-10.................... 21 5 Serum PSA level (µg/l) by year of diagnosis, 1998-10................ 24 6 Number of core biopsies taken per diagnostic session, by year of diagnosis, 07-10. 26 7 Number and percentages of patients with the primary treatment type registered within six months following diagnosis, by health care region and year, 07-10....... 30 8 Type of radical prostatectomy, by year of diagnosis, 1998-10............. 38 9 Type of radical prostatectomy, by hospital, 08-10................. 39 10 Preoperative nerve sparing intent, by year of diagnosis, 08-10........... 11 Preoperative nerve sparing intent by risk category (low, intermediate, and high risk), 08-10......................................... 12 Preoperative nerve sparing intent, by hospital, 08-10................ 41 13 Preoperative nerve sparing intent, by hospital, for low risk category (T1c, Gleason score 6 or less, PSA less than µg/l), 08-10................... 42 14 Postoperative T-stage (pt-stage), by year of diagnosis, 08-10........... 43 15 Postoperative T-stage (pt-stage), by hospital, 08-10............... 44 16 Postoperative T-stage (pt-stage) for preoperative low risk category (T1c, Gleason score 6 or less, PSA less than µg/l), by hospital, 08-10............ 45 17 Positive surgical margin, by year of diagnosis, 08-10................ 46 18 Positive surgical margin, by hospital, 08-10..................... 47 19 Positive surgical margin (pt2-tumors), by hospital, 08-10............. 48 Positive surgical margin (intermediate risk tumors), by hospital, 08-10...... 49 21 Adjuvant therapy following radical prostatectomy, by hospital, 08-10....... 50 22 Type of radiotherapy, by year of diagnosis, 1998-10.................. 51 23 Type of radiotherapy, by hospital, 08-10...................... 52 24 Number of patients with Patient Related Outcome Measures (PROM) data at baseline and one year after treatment (retropubic prostatectomy, robot assisted prostatectomy and external radiotherapy)................................ 57 25a Type of hormonal therapy, by hospital, 08-10.................... 25b Type of hormonal therapy, by hospital, 08-10, cont d................. 61 List of Figures 1 Age-standardized prostate cancer incidence and mortality per 100 000 men, 1970-10. 7 2 Time (months) from diagnosis to reporting to the National Prostate Cancer Register for cases diagnosed 10................................. 10 3 Time (months) from diagnosis to reporting to the National Prostate Cancer Register for cases diagnosed 10, by health care region..................... 11 4 Proportion of patients by risk category and year of diagnosis, 1998-10....... 12 5 Proportion of patients by risk category and county, 10................ 13 6 Number of days between date of referral and the first visit at a specialist clinic, by county, 09 and 10.................................. 15 7 Number of days between date of referral and the first visit at a specialist clinic, by hospital, 10....................................... 16 Prostatacancer - Nationell kvalitetsrapport, 10 3
8 Number of days between date of biopsy and date of information to patient, by county, 10............................................ 17 9 Number of days between date of treatment decision and date of radical prostatectomy, by county, 09 and 10................................ 18 10 Number of days between date of treatment decision and date of radical prostatectomy, by hospital, 10..................................... 19 11 Number of days between date of core biopsies and date of treatment decision in patients with metastatic disease (M1 or PSA 100 µg/l) and treatment with noncurative intent, by county, 09 and 10........................ 12 Main reason for initiation of work-up leading to prostate cancer diagnosis, by county, 10............................................ 22 13 Main reason for initiation of work-up leading to prostate cancer diagnosis, by hospital, 10............................................ 23 14 Serum PSA level at diagnosis, by year, 1998-10.................... 25 15 Proportion of men with PSA level between 3 and 4 µg/l, by year of diagnosis, 1998-10............................................ 25 16 Number of core biopsies at diagnostic session (median number and proportion according to category), by county, 08-10......................... 26 17 Proportion of patients with clinically localized T1-2, PSA less than µg/l and Gleason score 6 or less who underwent bone scintigraphy, by county, 03 and 10. 27 18 Proportion of patients 75 years or younger at diagnosis with Gleason score 8-10 and/or T3 and/or PSA -50 µg/l that underwent bone scintigraphy, by county, 03 and 10............................................ 28 19 Proportion of patients older than 75 years at diagnosis with Gleason score 8-10 and/or T3 and/or PSA -50 µg/l that underwent bone scintigraphy, by county, 03 and 10............................................ 29 Treatment strategy, by risk category and year of diagnosis, 1998-10......... 31 21 Treatment strategy for patients 75 years or younger at diagnosis, by risk category and year of diagnosis, 07-10............................... 32 22 Treatment strategy for patients older than 75 years at diagnosis, by risk category and year of diagnosis, 07-10............................... 33 23 Treatment strategy, by risk category and age group, 08-10............ 34 24 Proportion of men with very low risk tumors (PSA 10 µg/l or less, T1c, Gleason score 6 or less, no more than 2 biopsy cores with cancer, total cancer length in biopsy cores less than 4 mm, age 75 years or younger) that received active surveillance as primary treatment, by county, 10........................... 35 25 Proportion of patients with intermediate/high risk tumors (75 years or younger at time of diagnosis) that received treatment with curative intent, by county, 10... 36 26 Proportion of patients with intermediate/high risk tumors (75 years or younger at time of diagnosis) that received treatment with curative intent, by hospital, 10... 37 27 Proportion of patients with low risk tumors who underwent radiotherapy that received neoadjuvant hormonal therapy, by county, 10..................... 53 28 Proportion of patients with intermediate/high risk tumors who underwent external radiotherapy that received 78 Gy, by county, 10.................... 54 29 Type of treatment for patients 75 years or younger at time of diagnosis with locally advanced prostate cancer (T3 or PSA -50 µg/l, not N1 or M1), by county, 10. 55 30 Type of treatment for patients 76-80 years of age at time of diagnosis with locally advanced prostate cancer (T3 or PSA -50 µg/l, not N1 or M1), by county, 10. 56 31 Level of stress urinary incontinence at baseline and one year following treatment according to postal questionnaire............................ 58 4 Prostatacancer - Nationell kvalitetsrapport, 10
32 Level of erectile dysfunction (ED) baseline and one year following treatment according to postal questionnaire................................ 59 33 3-year prostate cancer specific mortality among men 70 years or younger with distant metastases at time of diagnosis, by county, 1998-10................. 62 Prostatacancer - Nationell kvalitetsrapport, 10 5
1 Foreword Each year approximately 10 000 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). Since the report for the diagnostic year of 09 that was published in 11 data from each health care provider is reported in NPCR. 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). 1. Cohort Profile: The National Prostate Cancer Register (NPCR) of Sweden and Prostate Cancer data Base Sweden (PCBaSe) 2.0. 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. May 23, 12 Pär Stattin, Fredrik Sandin, Hans Garmo, Ola Bratt, Anders Widmark, Jan Adolfsson och Jan- Erik Damber for the steering group of NPCR. Fredrik Sandin, Regional cancer center, Uppsala Örebro, performed data management and statistical analysis for this report. Annette Wigertz, Regional cancer center, Uppsala Örebro, coordinated, edited, and proof read this report. 6 Prostatacancer - Nationell kvalitetsrapport, 10
Age standardized incidence/mortality per 100 000 men 250 0 150 100 50 0 Incidence Mortality 1970 1975 1980 1985 1990 1995 00 05 10 Year Figure 1. Age-standardized prostate cancer incidence and mortality per 100 000 men, 1970-10. Age-standardized according to the population in Sweden (incidence) or the Nordic countries (mortality) in the year 00. Source: The National Board of Health and Welfare (incidence), www.socialstyrelsen.se, and NORDCAN (mortality), www.ancr.nu. Prostatacancer - Nationell kvalitetsrapport, 10 7
Table 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, 1998-10. North South Stockholm/ Gotland Southeast Uppsala/ Örebro West Total Year of diagnosis 1998 756 (100) 1154 (100) 746 (69) 716 (100) 1370 (98) 1379 (98) 6121 (94) 1999 825 (100) 1333 (99) 1130 (92) 791 (100) 1580 (99) 1487 (99) 7146 (98) 00 746 (100) 1412 (100) 1187 (84) 776 (100) 1519 (100) 1586 (98) 7226 (96) 01 706 (100) 1518 (100) 1303 (90) 778 (100) 1587 (100) 1581 (98) 7473 (98) 02 812 (100) 1482 (99) 1344 (86) 853 (100) 1655 (100) 1470 (99) 7616 (97) 03 914 (100) 1655 (100) 1698 (95) 905 (100) 1909 (100) 1771 (99) 8852 (99) 04 1049 (100) 1808 (100) 1899 (95) 1030 (100) 22 (100) 1936 (99) 9744 (99) 05 947 (100) 1793 (99) 1964 (95) 1142 (100) 1980 (100) 1904 (100) 9730 (99) 06 805 (100) 1697 (99) 1670 (86) 1126 (100) 1917 (100) 1897 (100) 9112 (97) 07 870 (100) 1627 (98) 1658 (98) 1099 (100) 1826 (100) 1790 (100) 8870 (99) 08 930 (100) 1734 (98) 1586 (92) 1048 (100) 1829 (100) 1688 (100) 8815 (98) 09 1029 (100) 1867 (99) 14 (96) 1396 (100) 2247 (100) 1939 (100) 10492 (99) 10 1072 (100) 1630 (96) 1864 (97) 1227 (99) 1915 (100) 19 (100) 9648 (98) Total 11461 (100) 710 (99) 063 (91) 12887 (100) 23356 (100) 22368 (99) 110845 (98) 8 Prostatacancer - Nationell kvalitetsrapport, 10
Table 2. Number of cases and capture ratio (%) in NPCR by county, 10. Registered in NPCR Total County Jämtland 1 (100) 1 Norrbotten 267 (100) 267 Västerbotten 325 (99) 327 Västernorrland 309 (99) 311 Gävleborg 251 (99) 253 Dalarna 256 (100) 256 Södermanland 268 (100) 269 Uppsala 264 (100) 264 Värmland 232 (100) 232 Västmanland 262 (100) 262 Örebro 264 (100) 264 Västra Götaland 15 (100) 16 Halland 283 (100) 283 Jönköping 374 (100) 374 Kalmar 8 (100) 8 Östergötland 497 (100) 497 Blekinge 175 (100) 175 Kronoberg 245 (100) 245 Skåne 845 (95) 890 Stockholm 713 (99) 722 Gotland 45 (100) 45 Others/private 1952 (95) 51 Prostatacancer - Nationell kvalitetsrapport, 10 9
100 Cumulative proportion (%) reported to NPCR 80 11.7% 30.9% 70.5% 0 0 3 6 9 12 15 18 21 24 Number of months since diagnosis Figure 2. Time (months) from diagnosis to reporting to the National Prostate Cancer Register for cases diagnosed 10. 10 Prostatacancer - Nationell kvalitetsrapport, 10
100 North 100 South Cumulative proportion (%) reported to NPCR 80 0 38.1% 18.0% 75.4% Cumulative proportion (%) reported to NPCR 80 0 23.7% 5.0% 81.2% 0 3 6 9 12 15 18 21 24 0 3 6 9 12 15 18 21 24 Number of months since diagnosis Number of months since diagnosis 100 Stockholm/Gotland 100 Southeast Cumulative proportion (%) reported to NPCR 80 0 17.1% 8.4% 39.5% Cumulative proportion (%) reported to NPCR 80 0 31.3% 9.8% 77.7% 0 3 6 9 12 15 18 21 24 0 3 6 9 12 15 18 21 24 Number of months since diagnosis Number of months since diagnosis 100 Uppsala/Örebro 100 West Cumulative proportion (%) reported to NPCR 80 0 35.6% 13.8% 77.0% Cumulative proportion (%) reported to NPCR 80 0 41.5% 16.0% 77.7% 0 3 6 9 12 15 18 21 24 0 3 6 9 12 15 18 21 24 Number of months since diagnosis Number of months since diagnosis Figure 3. Time (months) from diagnosis to reporting to the National Prostate Cancer Register for cases diagnosed 10, by health care region. Prostatacancer - Nationell kvalitetsrapport, 10 11
100 80 1998 1999 00 01 02 03 04 05 06 07 08 09 10 6. Missing 5. Distant metastases 4. Regionally metastatic 3. High risk 2. Intermediate risk 1c. Low risk (missing) 1b. Low risk (B) 1a. Low risk (A) 1. Low risk 0 Figure 4. Proportion of patients by risk category and year of diagnosis, 1998-10. 1. Low risk: T1-2, Gleason score 6 or lower and PSA < 10 µg/l. 1a. Low risk (A): PSA < 10 µg/l, T1c, Gleason score 6 or lower, no more than 2 biopsy cores with cancer, total length of biopsies with cancer < 4mm, age 75. 1b. Low risk (B): Low risk that is not categorized to 1a. 1c. Low risk (missing): Missing information for categorization of low risk according to 1a/b. 2. Intermediate risk: T1-2, Gleason score 7 and/or 10 PSA < µg/l. 3. High risk: T3 and/or Gleason score 8-10 and/or PSA < 50 µg/l. 4. Regionally metastatic: T4 and/or N1 and/or 50 PSA < 100 µg/l, no distant metastases (M0 or MX). 5. Distant metastases: M1 and/or PSA 100 µg/l. 6. Missing: Missing information for categorization according to above. 12 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing 161 265 327 309 256 263 2 248 236 244 262 1425 271 375 7 497 173 246 8 652 46 85 1a. Low risk (A) 1b. Low risk (B) 1c. Low risk (missing) 2. Intermediate risk 3. High risk 4. Regionally metastatic 5. Distant metastases 6. Missing 0 80 100 Figure 5. Proportion of patients by risk category and county, 10. Prostatacancer - Nationell kvalitetsrapport, 10 13
14 Prostatacancer - Nationell kvalitetsrapport, 10 1. Low risk Table 3. Number of cases by year of diagnosis and risk category, 1998-10. 2. Intermediate risk 3. High risk 4. Regionally metastatic 5. Distant metastases 6. Missing Total Year of diagnosis 1998 831 (14) 1064 (17) 1785 (29) 709 (12) 1545 (25) 187 (3) 6121 1999 1083 (15) 1380 (19) 96 (29) 805 (11) 15 (22) 222 (3) 7146 00 1294 (18) 1441 () 61 (29) 7 (10) 1488 (21) 2 (3) 7226 01 1589 (21) 1524 () 16 (27) 747 (10) 1383 (19) 214 (3) 7473 02 1735 (23) 1626 (21) 21 (27) 700 (9) 1370 (18) 164 (2) 7616 03 94 (24) 2116 (24) 2281 (26) 764 (9) 12 (16) 195 (2) 8852 04 2756 (28) 2310 (24) 28 (25) 754 (8) 1291 (13) 225 (2) 9744 05 2777 (29) 2380 (24) 2449 (25) 713 (7) 1215 (12) 196 (2) 9730 06 2610 (29) 2297 (25) 2115 (23) 692 (8) 1106 (12) 292 (3) 9112 07 2571 (29) 2312 (26) 24 (23) 645 (7) 1077 (12) 241 (3) 8870 08 2480 (28) 2426 (28) 37 (23) 554 (6) 1084 (12) 234 (3) 8815 09 2975 (28) 3117 (30) 2361 (23) 585 (6) 1176 (11) 278 (3) 10492 10 2717 (28) 29 (30) 2157 (22) 545 (6) 1075 (11) 234 (2) 9648 Total 27512 (25) 26913 (24) 27811 (25) 8953 (8) 16772 (15) 2884 (3) 110845 1. Low risk: T1-2, Gleason score 6 or lower and PSA < 10 µg/l. 3. High risk: T3 and/or Gleason score 8-10 and/or PSA < 50 µg/l. 5. Distant metastases: M1 and/or PSA 100 µg/l. 2. Intermediate risk: T1-2, Gleason score 7 and/or 10 PSA < µg/l. 4. Regionally metastatic: T4 and/or N1 and/or 50 PSA < 100 µg/l, no distant metastases (M0 or MX). 6. Missing: Missing information for categorization according to above.
No. of cases (10) Median (10) Halland Stockholm Others/private/missing Skåne Västra Götaland Blekinge Södermanland Västerbotten SWEDEN Gotland Örebro Östergötland Jönköping Värmland Kronoberg Västernorrland Norrbotten Uppsala Västmanland Gävleborg Kalmar Dalarna Jämtland 248 473 1427 550 1186 153 189 303 7427 42 195 471 301 187 148 194 216 211 158 231 190 223 131 28 30 35 35 35.5 38 38.5 41 41 44 46 48.5 49 50 50 50.5 55 58 59 85 09 10 0 80 100 1 1 1 Median and interquartile range (days) Figure 6. Number of days between date of referral and the first visit at a specialist clinic, by county, 09 and 10. Prostatacancer - Nationell kvalitetsrapport, 10 15
Södersjukhuset Kungsbacka sjukhus Hallands sjukhus Halmstad Danderyds sjukhus Kärnsjukhuset Skövde Borås lasarett Härnösands sjukhus Sahlgrenska Universitetssjukhuset Kalix lasarett Lidköping, (Bas)sjukhuset Mariestads sjukhus Kullbergska sjukhuset Universitetssjukhuset MAS Varbergs sjukhus Lindesbergs lasarett Trelleborgs lasarett Huddinge Karolinska universitetssjukhuset Kiruna lasarett Universitetssjukhuset i Lund Vrinnevisjukhuset i Norrköping Ängelholm, sjukhuset Karolinska sjukhuset Private practice Lycksele lasarett Nyköpings lasarett Others/missing Höglandssjukhuset (Eksjö Nässjö lasarett) Blekingesjukhuset Karlskrona Central sjukhuset i Karlstad Karlshamns lasarett Södertälje sjukhus Värnamo sjukhus (lasarett) Umeå Norrlands universitetssjukhus SWEDEN Simrishamn, sjukhuset Visby lasarett Falköping, Bas(sjukhuset) Helsingsborgs lasarett Kungälvs sjukhus Lundby sjukhus Örebro Universitetssjukhus Mora lasarett Hässleholm, sjukhuset Växjö lasarett Mälarsjukhuset, Eskilstuna Skene lasarett Sundsvalls sjukhus Bollnäs sjukhus Oskarshamns sjukhus (lasarett) Sollefteå sjukhus Hudiksvall Lasarettet i Enköping Uddevalla sjukhus Universitetssjukhuset i Linköping Ystads lasarett Akademiska sjukhuset Alingsås lasarett Centrallasarettet i Västerås Norrtälje sjukhus Sunderby sjukhus Gällivare lasarett Karlskoga lasarett Kalmar länssjukhus Ljungby lasarett Ludvika lasarett Skellefteå lasarett Piteå lasarett Sjukhuset i Torsby Centrum, vårdcentralen Västerviks sjukhus Gävle sjukhus Örnsköldsviks sjukhus S:t Görans sjukhus AB Ryhov, länssjukhuset (Jönköpings lasarett) Sjukhuset i Arvika Östersunds sjukhus Falu lasarett No. of cases 63 57 78 103 97 70 4 343 25 74 27 50 188 96 33 25 70 12 32 197 109 59 1424 94 58 3 124 108 135 45 81 75 144 7427 8 42 26 117 67 143 121 77 16 85 81 41 82 66 41 39 63 32 191 274 55 179 107 158 121 41 41 84 63 54 65 17 19 17 65 102 69 57 102 33 131 92 Median 18 19 22 26 27.5 27.5 28 29 30 30 32.5 32.5 32.5 33 33 34 34 34 34 34 35 35 35.5 36 36 36.5 38 38 38 39 39 39.5.5.5 41 41 41 41 41 42 42.5 44 45 45 46 47.5 48 48 49 49 49 49 49 50 50 50.5 51 53 54 54 55.5 56 56 56 61 63 65 65 70 71 72 73.5 77 85 86.5 0 80 1 1 0 Median and interquartile range (days) Figure 7. Number of days between date of referral and the first visit at a specialist clinic, by hospital, 10. 16 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Median Örebro 235 18 Kronoberg 233 Blekinge 165 21 Uppsala 222 21 Jämtland 143 22 Södermanland 225 25 Dalarna 249 27 Skåne 804 27 Västerbotten 289 27 Västernorrland 284 27 Kalmar 2 28 Norrbotten 251 28 Others/private/missing 1931 28 Västra Götaland 1241 28 SWEDEN 8825 28 Jönköping 359 30 Värmland 225 30 Gotland 41 31 Halland 2 31 Stockholm 554 32 Gävleborg 232 35 Östergötland 472 Västmanland 8 41 0 Median and interquartile range (days) Figure 8. Number of days between date of biopsy and date of information to patient, by county, 10. Prostatacancer - Nationell kvalitetsrapport, 10 17
No. of cases (10) Median (10) Blekinge Others/private/missing Örebro Kalmar Västmanland Gävleborg Södermanland Dalarna Stockholm Västra Götaland SWEDEN Kronoberg Skåne Jönköping Halland Värmland Norrbotten Uppsala Västernorrland Östergötland Gotland Västerbotten Jämtland 59 132 42 54 51 27 61 16 590 457 2391 29 331 62 124 55 10 50 10 134 10 54 33 30 32.5 34.5 35 37 38 41 44 48 49 50 50 53.5 54.5 56 63.5 64.5 67 78.5 80.5 88 90 09 10 0 80 100 1 1 Median and interquartile range (days) Figure 9. Number of days between date of treatment decision and date of radical prostatectomy, by county, 09 and 10. 18 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Median Danderyds sjukhus 44 28 Private practice 96 28 Lidköping, (Bas)sjukhuset 18 28.5 S:t Görans sjukhus AB 104 29 Västerviks sjukhus 22 29.5 Blekingesjukhuset Karlskrona 59 30 Alingsås lasarett 32 33.5 Varbergs sjukhus 57 34 Örebro Universitetssjukhus 42 34.5 Centrallasarettet i Västerås 51 37 Gävle sjukhus 27 38 Kärnsjukhuset Skövde 57 39 Nyköpings lasarett 25 39 Falu lasarett 16 41 Lundby sjukhus 42 41 Mälarsjukhuset, Eskilstuna 36 42 Södersjukhuset 31 42 Borås lasarett 77 43 Helsingsborgs lasarett 66 43 Others/missing 37 44 Kalmar länssjukhus 32 45 Uddevalla sjukhus 75 46 SWEDEN 2391 49 Huddinge Karolinska universitetssjukhuset 73 50 Växjö lasarett 29 50 Karolinska sjukhuset 338 51.5 Kristianstad, centralsjukhuset 9 53 Ryhov, länssjukhuset (Jönköpings lasarett) 62 53.5 Mariestads sjukhus 1 54 Universitetssjukhuset MAS 256 54 Central sjukhuset i Karlstad 55 56 Kungälvs sjukhus 14 61.5 Sahlgrenska Universitetssjukhuset 141 62 Vrinnevisjukhuset i Norrköping 33 63 Sunderby sjukhus 10 63.5 Akademiska sjukhuset 50 64.5 Sundsvalls sjukhus 10 67 Hallands sjukhus Halmstad 66 75.5 Visby lasarett 10 80.5 Universitetssjukhuset i Linköping 101 86 Umeå Norrlands universitetssjukhus 54 88 Östersunds sjukhus 33 90 0 80 100 1 Median and interquartile range (days) Figure 10. Number of days between date of treatment decision and date of radical prostatectomy, by hospital, 10. Prostatacancer - Nationell kvalitetsrapport, 10 19
No. of cases (10) Median (10) Dalarna Stockholm Örebro Västmanland Västernorrland Södermanland Skåne Halland Jämtland Uppsala SWEDEN Kronoberg Västerbotten Blekinge Jönköping Västra Götaland Others/private/missing Norrbotten Gotland Kalmar Gävleborg Östergötland Värmland 35 100 41 19 34 39 104 26 14 41 983 23 31 22 49 162 51 31 7 27 48 49 30 2 7 8 10 12.5 15 15.5 16 16 16 17 18 18 21 22 26 28 29 29 32 09 10 0 Median and interquartile range (days) Figure 11. Number of days between date of core biopsies and date of treatment decision in patients with metastatic disease (M1 or PSA 100 µg/l) and treatment with non-curative intent, by county, 09 and 10. Prostatacancer - Nationell kvalitetsrapport, 10
Table 4. Main reason for the initiation of the medical investigation that led to the prostate cancer diagnosis, by year of diagnosis, 04-10. Health control LUTS Other symptoms/ other reason Missing Total Year of diagnosis 04 2775 (28) 3468 (36) 3099 (32) 2 (4) 9744 05 2727 (28) 4114 (42) 2383 (24) 506 (5) 9730 06 2577 (28) 3927 (43) 2122 (23) 486 (5) 9112 07 2897 (33) 3674 (41) 1901 (21) 398 (4) 8870 08 3066 (35) 3639 (41) 1783 () 327 (4) 8815 09 4447 (42) 3814 (36) 1909 (18) 322 (3) 10492 10 72 (42) 3434 (36) 1897 () 245 (3) 9648 Prostatacancer - Nationell kvalitetsrapport, 10 21
No. of cases Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing SWEDEN 161 265 327 309 256 263 2 248 236 244 262 1425 271 375 7 497 173 246 8 652 46 85 9648 0 80 100 Health control LUTS Other symptoms Missing Figure 12. Main reason for initiation of work-up leading to prostate cancer diagnosis, by county, 10. 22 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Stockholm/Gotland South Southeast West Uppsala/Örebro North Gällivare lasarett Härnösands sjukhus Kalix lasarett Kiruna lasarett Lycksele lasarett Piteå lasarett Skellefteå lasarett Sollefteå sjukhus Sunderby sjukhus Sundsvalls sjukhus Umeå Norrlands universitetssjukhus Örnsköldsviks sjukhus Östersunds sjukhus Private practice Others/missing Akademiska sjukhuset Bollnäs sjukhus Central sjukhuset i Karlstad Centrallasarettet i Västerås Falu lasarett Gävle sjukhus Hudiksvall Karlskoga lasarett Kullbergska sjukhuset Lasarettet i Enköping Lindesbergs lasarett Ludvika lasarett Mora lasarett Mälarsjukhuset, Eskilstuna Nyköpings lasarett Sjukhuset i Arvika Sjukhuset i Torsby Örebro Universitetssjukhus Private practice Alingsås lasarett Borås lasarett Centrum, vårdcentralen Falköping, Bas(sjukhuset) Kungsbacka sjukhus Kungälvs sjukhus Kärnsjukhuset Skövde Lidköping, (Bas)sjukhuset Lundby sjukhus Mariestads sjukhus Sahlgrenska Universitetssjukhuset Skene lasarett Uddevalla sjukhus Varbergs sjukhus Private practice Höglandssjukhuset (Eksjö Nässjö lasarett) Kalmar länssjukhus Oskarshamns sjukhus (lasarett) Ryhov, länssjukhuset (Jönköpings lasarett) Universitetssjukhuset i Linköping Vrinnevisjukhuset i Norrköping Värnamo sjukhus (lasarett) Västerviks sjukhus Private practice Others/missing Blekingesjukhuset Karlskrona Hallands sjukhus Halmstad Helsingsborgs lasarett Hässleholm, sjukhuset Karlshamns lasarett Kristianstad, centralsjukhuset Ljungby lasarett Simrishamn, sjukhuset Trelleborgs lasarett Universitetssjukhuset i Lund Universitetssjukhuset MAS Växjö lasarett Ystads lasarett Ängelholm, sjukhuset Private practice Others/missing Danderyds sjukhus Huddinge Karolinska universitetssjukhuset Karolinska sjukhuset Norrtälje sjukhus S:t Görans sjukhus AB Södersjukhuset Södertälje sjukhus Visby lasarett Private practice Others/missing SWEDEN 51 25 29 18 98 79 43 147 147 150 94 161 7 1 5 83 175 244 116 105 68 56 52 43 43 57 90 97 91 39 22 163 172 118 81 19 29 58 81 151 83 178 31 4 50 219 104 303 137 99 41 132 281 216 106 67 139 1 121 90 190 63 52 78 71 13 26 39 265 175 126 286 1 117 82 104 62 100 86 101 1173 46 2 9648 0 80 100 Health control LUTS Other symptoms Missing Figure 13. Main reason for initiation of work-up leading to prostate cancer diagnosis, by hospital, 10. Prostatacancer - Nationell kvalitetsrapport, 10 23
Table 5. Serum PSA level (µg/l) by year of diagnosis, 1998-10. Median First quartile Third quartile Missing (%) Total Year of diagnosis 1998 23 10 70 229 (4) 6121 1999 9 58 265 (4) 7146 00 18 8.9 52 229 (3) 7226 01 16 8 47 218 (3) 7473 02 15 7.5 44 169 (2) 7616 03 13.6 7.1 37 186 (2) 8852 04 12 6.8 29 194 (2) 9744 05 11 6 28 173 (2) 9730 06 11 6 28 251 (3) 9112 07 10 6 27 186 (2) 8870 08 10 5.9 26 176 (2) 8815 09 9.5 5.7 22 236 (2) 10492 10 9.1 5.6 21.2 225 (2) 9648 Total 12 6.6 34 2737 (2) 110845 24 Prostatacancer - Nationell kvalitetsrapport, 10
50 30 10 1998 1999 00 01 02 03 04 05 06 07 08 09 10 0 PSA < 3 3 PSA<4 4 PSA<10 10 PSA< PSA<100 PSA 100 Missing Figure 14. Serum PSA level at diagnosis, by year, 1998-10. 10 8 6 4 1998 1999 00 01 02 03 04 05 06 07 08 09 10 2 0 Figure 15. Proportion of men with PSA level between 3 and 4 µg/l, by year of diagnosis, 1998-10. Prostatacancer - Nationell kvalitetsrapport, 10 25
Table 6. Number of core biopsies taken per diagnostic session, by year of diagnosis, 07-10. Median <6 6-9 10-12 13+ Missing Total Year of diagnosis 07 8 543 (8) 4169 (58) 1641 (23) 76 (1) 783 (11) 7212 08 8 588 (7) 88 (46) 3156 (36) 109 (1) 874 (10) 8815 09 10 586 (6) 3755 (36) 5041 (48) 211 (2) 899 (9) 10492 10 10 473 (5) 2893 (30) 5102 (53) 330 (3) 850 (9) 9648 The Stockholm/Gotland region is excluded for 07. No. of cases Median Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing SWEDEN 448 770 907 882 783 865 723 692 736 742 815 4101 835 1241 737 19 465 8 2825 1874 170 95 28955 8 8 10 8 8 8 8 10 10 10 8 10 10 12 8 10 10 9 10 10 10 10 10 0 80 100 <6 6 9 10 12 13+ Missing Figure 16. Number of core biopsies at diagnostic session (median number and proportion according to category), by county, 08-10. 26 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing SWEDEN 53 74 38 89 83 102 82 122 33 63 75 95 44 79 98 95 96 70 70 91 105 83 505 533 101 96 69 118 95 105 163 32 47 32 74 432 278 2 164 9 13 478 868 3037 3357 03 10 0 80 100 Figure 17. Proportion of patients with clinically localized T1-2, PSA less than µg/l and Gleason score 6 or less who underwent bone scintigraphy, by county, 03 and 10. Prostatacancer - Nationell kvalitetsrapport, 10 27
No. of cases Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing SWEDEN 38 27 66 73 62 67 88 62 85 77 65 65 76 63 104 65 77 47 67 70 262 1 44 51 67 57 43 56 63 109 35 49 39 53 222 186 304 137 19 15 229 269 2109 1865 03 10 0 80 100 Figure 18. Proportion of patients 75 years or younger at diagnosis with Gleason score 8-10 and/or T3 and/or PSA -50 µg/l that underwent bone scintigraphy, by county, 03 and 10. 28 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing SWEDEN 33 16 46 27 49 61 73 64 74 61 65 51 66 43 28 56 38 55 43 71 48 284 199 42 42 74 59 37 92 114 26 33 17 30 191 138 190 90 8 8 161 248 17 1491 03 10 0 80 100 Figure 19. Proportion of patients older than 75 years at diagnosis with Gleason score 8-10 and/or T3 and/or PSA -50 µg/l that underwent bone scintigraphy, by county, 03 and 10. Prostatacancer - Nationell kvalitetsrapport, 10 29
Table 7. Number and percentages of patients with the primary treatment type registered within six months following diagnosis, by health care region and year, 07-10. North South Stockholm/ Gotland Southeast Uppsala/ Örebro West Total Year of diagnosis 07 867 (100) 1510 (93) 1364 (82) 1094 (100) 1814 (99) 1754 (98) 83 (95) 08 923 (99) 1718 (99) 1442 (91) 1009 (96) 1821 (100) 1688 (100) 81 (98) 09 1023 (99) 1850 (99) 1958 (97) 1393 (100) 2241 (100) 1939 (100) 104 (99) 10 1055 (98) 1614 (99) 1809 (97) 1172 (96) 1902 (99) 1939 (100) 9491 (98) 30 Prostatacancer - Nationell kvalitetsrapport, 10
100 1. Low risk 100 2. Intermediate risk 80 1998 1999 00 01 02 03 04 05 06 07 08 09 10 80 1998 1999 00 01 02 03 04 05 06 07 08 09 10 0 Conservative therapy Curative therapy Hormonal therapy 0 Conservative therapy Curative therapy Hormonal therapy 100 3. High risk 100 4. Regionally metastatic 80 1998 1999 00 01 02 03 04 05 06 07 08 09 10 80 1998 1999 00 01 02 03 04 05 06 07 08 09 10 0 Conservative therapy Curative therapy Hormonal therapy 0 Conservative therapy Curative therapy Hormonal therapy 100 5. Distant metastases 80 1998 1999 00 01 02 03 04 05 06 07 08 09 10 0 Conservative therapy Curative therapy Hormonal therapy Figure. Treatment strategy, by risk category and year of diagnosis, 1998-10. Prostatacancer - Nationell kvalitetsrapport, 10 31
100 1. Low risk 100 2. Intermediate risk 80 80 07 08 09 10 07 08 09 10 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 100 3. High risk 100 4. Regionally metastatic 80 80 07 08 09 10 07 08 09 10 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 100 5. Distant metastases 80 07 08 09 10 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy Figure 21. Treatment strategy for patients 75 years or younger at diagnosis, by risk category and year of diagnosis, 07-10. 32 Prostatacancer - Nationell kvalitetsrapport, 10
100 1. Low risk 100 2. Intermediate risk 80 80 07 08 09 10 07 08 09 10 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 100 3. High risk 100 4. Regionally metastatic 80 80 07 08 09 10 07 08 09 10 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 100 5. Distant metastases 80 07 08 09 10 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy Figure 22. Treatment strategy for patients older than 75 years at diagnosis, by risk category and year of diagnosis, 07-10. Prostatacancer - Nationell kvalitetsrapport, 10 33
100 1. Low risk 100 2. Intermediate risk 80 80 < 64 65 69 70 74 75+ < 64 65 69 70 74 75+ 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 100 3. High risk 100 4. Regionally metastatic 80 80 < 64 65 69 70 74 75+ < 64 65 69 70 74 75+ 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy 100 5. Distant metastases 80 < 64 65 69 70 74 75+ 0 Active surveillance Watchful waiting Curative therapy Hormonal therapy Figure 23. Treatment strategy, by risk category and age group, 08-10. 34 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing SWEDEN 7 16 6 16 7 13 4 23 4 9 2 15 1 13 11 6 14 5 12 3 19 44 138 2 21 8 6 12 9 22 2 8 4 13 30 54 44 62 1 2 50 110 256 632 Age Age > 0 80 100 Figure 24. Proportion of men with very low risk tumors (PSA 10 µg/l or less, T1c, Gleason score 6 or less, no more than 2 biopsy cores with cancer, total cancer length in biopsy cores less than 4 mm, age 75 years or younger) that received active surveillance as primary treatment, by county, 10. Prostatacancer - Nationell kvalitetsrapport, 10 35
No. of cases Jämtland Norrbotten Västerbotten Västernorrland Gävleborg Dalarna Södermanland Uppsala Värmland Västmanland Örebro Västra Götaland Halland Jönköping Kalmar Östergötland Blekinge Kronoberg Skåne Stockholm Gotland Others/private/missing SWEDEN 50 106 129 94 98 81 75 89 102 90 92 594 130 151 92 192 73 94 368 575 22 332 3629 0 80 100 Figure 25. Proportion of patients with intermediate/high risk tumors (75 years or younger at time of diagnosis) that received treatment with curative intent, by county, 10. 36 Prostatacancer - Nationell kvalitetsrapport, 10
No. of cases Stockholm/Gotland South Southeast West Uppsala/Örebro North Gällivare lasarett Härnösands sjukhus Kalix lasarett Lycksele lasarett Piteå lasarett Skellefteå lasarett Sollefteå sjukhus Sunderby sjukhus Sundsvalls sjukhus Umeå Norrlands universitetssjukhus Örnsköldsviks sjukhus Östersunds sjukhus Private practice Akademiska sjukhuset Bollnäs sjukhus Central sjukhuset i Karlstad Centrallasarettet i Västerås Falu lasarett Gävle sjukhus Hudiksvall Karlskoga lasarett Kullbergska sjukhuset Lasarettet i Enköping Lindesbergs lasarett Ludvika lasarett Mora lasarett Mälarsjukhuset, Eskilstuna Nyköpings lasarett Sjukhuset i Arvika Sjukhuset i Torsby Örebro Universitetssjukhus Private practice Alingsås lasarett Borås lasarett Centrum, vårdcentralen Falköping, Bas(sjukhuset) Kungsbacka sjukhus Kungälvs sjukhus Kärnsjukhuset Skövde Lidköping, (Bas)sjukhuset Lundby sjukhus Mariestads sjukhus Sahlgrenska Universitetssjukhuset Skene lasarett Uddevalla sjukhus Varbergs sjukhus Private practice Höglandssjukhuset (Eksjö Nässjö lasarett) Kalmar länssjukhus Oskarshamns sjukhus (lasarett) Ryhov, länssjukhuset (Jönköpings lasarett) Universitetssjukhuset i Linköping Vrinnevisjukhuset i Norrköping Värnamo sjukhus (lasarett) Västerviks sjukhus Private practice Others/missing Blekingesjukhuset Karlskrona Hallands sjukhus Halmstad Helsingsborgs lasarett Hässleholm, sjukhuset Karlshamns lasarett Kristianstad, centralsjukhuset Ljungby lasarett Simrishamn, sjukhuset Trelleborgs lasarett Universitetssjukhuset i Lund Universitetssjukhuset MAS Växjö lasarett Ystads lasarett Ängelholm, sjukhuset Private practice Danderyds sjukhus Huddinge Karolinska universitetssjukhuset Karolinska sjukhuset Norrtälje sjukhus S:t Görans sjukhus AB Södersjukhuset Södertälje sjukhus Visby lasarett Private practice Others/missing SWEDEN 5 6 12 29 11 9 78 58 80 21 50 2 85 15 78 90 45 53 30 14 16 4 17 15 21 29 30 16 8 61 41 71 4 4 25 27 58 30 67 9 190 5 93 41 69 48 37 17 63 111 81 38 21 1 50 96 13 23 22 16 2 3 19 187 78 6 28 67 98 241 8 59 86 16 22 168 2 3629 0 80 100 Figure 26. Proportion of patients with intermediate/high risk tumors (75 years or younger at time of diagnosis) that received treatment with curative intent, by hospital, 10. Prostatacancer - Nationell kvalitetsrapport, 10 37
Table 8. Type of radical prostatectomy, by year of diagnosis, 1998-10. Retropubic Laparoscopic Robot assisted Laparoscopic/ robot assisted Total Year of diagnosis 1998 450 (100) 0 (0) 450 1999 655 (100) 0 (0) 655 00 735 (98) 12 (2) 747 01 869 (95) 49 (5) 918 02 1021 (89) 126 (11) 1147 03 1329 (84) 244 (16) 1573 04 1789 (85) 328 (15) 2117 05 1677 (78) 486 (22) 2163 06 1419 (72) 558 (28) 1977 08 1235 (55) 121 (5) 875 (39) 996 (45) 2231 09 1336 (48) 123 (4) 1319 (47) 1442 (52) 2778 10 1185 (49) 110 (5) 1105 (46) 1215 (51) The information is not available for Stockholm for 07, and this year is therefore excluded from the table. 38 Prostatacancer - Nationell kvalitetsrapport, 10
Table 9. Type of radical prostatectomy, by hospital, 08-10. Retropubic Laparoscopic Robot assisted laparoscopic Total North Sunderby sjukhus 33 (100) 0 (0) 0 (0) 33 Sundsvalls sjukhus 30 (100) 0 (0) 0 (0) 30 Umeå - Norrlands universitetssjukhus 153 (99) 2 (1) 0 (0) 155 Östersunds sjukhus 86 (99) 1 (1) 0 (0) 87 Private practice 1 (100) 0 (0) 0 (0) 1 Others/missing 0 (0) 0 (0) 1 (100) 1 Uppsala/Örebro Akademiska sjukhuset 92 (47) 105 (53) 0 (0) 197 Central sjukhuset i Karlstad 49 (35) 91 (65) 0 (0) 1 Centrallasarettet i Västerås 139 (99) 0 (0) 1 (1) 1 Falu lasarett 74 (100) 0 (0) 0 (0) 74 Gävle sjukhus 82 (100) 0 (0) 0 (0) 82 Kullbergska sjukhuset 1 (100) 0 (0) 0 (0) 1 Mälarsjukhuset, Eskilstuna () 78 (80) 0 (0) 98 Nyköpings lasarett 72 (100) 0 (0) 0 (0) 72 Örebro Universitetssjukhus 125 (99) 1 (1) 0 (0) 126 Others/missing 1 (50) 0 (0) 1 (50) 2 West Alingsås lasarett 106 (98) 2 (2) 0 (0) 108 Borås lasarett 152 (100) 0 (0) 0 (0) 152 Kungälvs sjukhus 59 (100) 0 (0) 0 (0) 59 Kärnsjukhuset Skövde 138 (100) 0 (0) 0 (0) 138 Lidköping, (Bas)sjukhuset (100) 0 (0) 0 (0) Lundby sjukhus 131 (100) 0 (0) 0 (0) 131 Mariestads sjukhus 1 (100) 0 (0) 0 (0) 1 Sahlgr Univ Sjh/Östra 0 (0) 0 (0) 1 (100) 1 Sahlgrenska Universitetssjukhuset 111 (23) 0 (0) 365 (77) 476 Uddevalla sjukhus 214 (100) 0 (0) 1 (0) 215 Varbergs sjukhus 27 (15) 1 (1) 148 (84) 176 Private practice 224 (100) 0 (0) 1 (0) 225 Others/missing 4 (50) 1 (12) 3 (38) 8 Southeast Höglandssjukhuset (Eksjö-Nässjö lasarett) 5 (100) 0 (0) 0 (0) 5 Kalmar länssjukhus 5 (100) 1 (0) 0 (0) 6 Oskarshamns sjukhus (lasarett) 1 (100) 0 (0) 0 (0) 1 Ryhov, länssjukhuset (Jönköpings lasarett) 22 (9) 7 (3) 7 (88) 236 Universitetssjukhuset i Linköping 22 (9) 2 (1) 221 (90) 245 Vrinnevisjukhuset i Norrköping 77 (100) 0 (0) 0 (0) 77 Västerviks sjukhus 88 (100) 0 (0) 0 (0) 88 Private practice 2 (100) 0 (0) 0 (0) 2 Others/missing 1 (25) 0 (0) 3 (75) 4 South Blekingesjukhuset Karlskrona 152 (100) 0 (0) 0 (0) 152 Hallands sjukhus - Halmstad (21) 0 (0) 149 (79) 189 Helsingsborgs lasarett 175 (99) 1 (1) 1 (1) 177 Kristianstad, centralsjukhuset 65 (98) 0 (0) 1 (2) 66 Universitetssjukhuset i Lund 16 (9) 1 (1) 159 (90) 176 Universitetssjukhuset MAS 33 (5) 3 (0) 610 (94) 646 Växjö lasarett 90 (100) 0 (0) 0 (0) 90 Others/missing 0 (0) 0 (0) 4 (100) 4 Stockholm/Gotland Danderyds sjukhus 121 (100) 0 (0) 0 (0) 121 Huddinge - Karolinska universitetssjukhuset 193 (99) 0 (0) 1 (1) 194 Karolinska sjukhuset 17 (1) 53 (5) 1086 (94) 1156 S:t Görans sjukhus AB 0 (0) 1 (0) 331 (100) 332 Södersjukhuset 93 (99) 0 (0) 1 (1) 94 Visby lasarett 47 (100) 0 (0) 0 (0) 47 Private practice 69 (96) 3 (4) 0 (0) 72 Others/missing 57 (95) 0 (0) 3 (5) SWEDEN Total 3756 (51) 354 (5) 3299 (45) 79
Table 10. Preoperative nerve sparing intent, by year of diagnosis, 08-10. Yes, bilateral Yes, unilateral No Missing Total Year of diagnosis 08 682 (31) 582 (26) 661 (30) 306 (14) 2231 09 817 (29) 832 (30) 769 (28) 3 (13) 2778 10 702 (29) 671 (28) 7 (25) 4 (18) Table 11. Preoperative nerve sparing intent by risk category (low, intermediate, and high risk), 08-10. Yes, bilateral Yes, unilateral No Missing Total Risk group 1. Low risk 1249 (44) 787 (28) 441 (15) 376 (13) 2853 2. Intermediate risk 796 (24) 10 (31) 1023 (30) 493 (15) 3372 3. High risk 108 (11) 196 (21) 479 (51) 159 (17) 942 Prostatacancer - Nationell kvalitetsrapport, 10
Table 12. Preoperative nerve sparing intent, by hospital, 08-10. Yes, bilateral Yes, unilateral No Missing Total North Sunderby sjukhus 0 (0) 2 (6) 9 (27) 22 (67) 33 Sundsvalls sjukhus 11 (37) 5 (17) 6 () 8 (27) 30 Umeå - Norrlands universitetssjukhus 45 (29) 30 (19) 11 (7) 69 (45) 155 Östersunds sjukhus 44 (51) 13 (15) 7 (8) 23 (26) 87 Private practice 1 (100) 0 (0) 0 (0) 0 (0) 1 Others/missing 0 (0) 0 (0) 0 (0) 1 (100) 1 Uppsala/Örebro Akademiska sjukhuset 76 (39) 68 (35) 34 (17) 19 (10) 197 Central sjukhuset i Karlstad 23 (16) 52 (37) 59 (42) 6 (4) 1 Centrallasarettet i Västerås 31 (22) 36 (26) 38 (27) 35 (25) 1 Falu lasarett 5 (7) 26 (35) 10 (14) 33 (45) 74 Gävle sjukhus 7 (9) 8 (10) 17 (21) 50 (61) 82 Kullbergska sjukhuset 0 (0) 0 (0) 0 (0) 1 (100) 1 Mälarsjukhuset, Eskilstuna 29 (30) 30 (31) 21 (21) 18 (18) 98 Nyköpings lasarett 11 (15) 17 (24) 41 (57) 3 (4) 72 Örebro Universitetssjukhus 16 (13) 15 (12) 29 (23) 66 (52) 126 Others/missing 0 (0) 0 (0) 0 (0) 2 (100) 2 West Alingsås lasarett 53 (49) 24 (22) 12 (11) 19 (18) 108 Borås lasarett 77 (51) 34 (22) 11 (7) 30 () 152 Kungälvs sjukhus 23 (39) 10 (17) (34) 6 (10) 59 Kärnsjukhuset Skövde 83 () 16 (12) 33 (24) 6 (4) 138 Lidköping, (Bas)sjukhuset 7 (18) 14 (35) 18 (45) 1 (2) Lundby sjukhus 56 (43) 31 (24) 32 (24) 12 (9) 131 Mariestads sjukhus 0 (0) 0 (0) 1 (100) 0 (0) 1 Sahlgr Univ Sjh/Östra 0 (0) 0 (0) 0 (0) 1 (100) 1 Sahlgrenska Universitetssjukhuset 1 (29) 148 (31) 149 (31) 39 (8) 476 Uddevalla sjukhus (9) 22 (10) 157 (73) 16 (7) 215 Varbergs sjukhus 58 (33) 56 (32) 55 (31) 7 (4) 176 Private practice 102 (45) 59 (26) 55 (24) 9 (4) 225 Others/missing 0 (0) 1 (12) 3 (38) 4 (50) 8 Southeast Höglandssjukhuset (Eksjö-Nässjö lasarett) 0 (0) 2 () 1 () 2 () 5 Kalmar länssjukhus 113 (55) 18 (9) (10) 55 (27) 6 Oskarshamns sjukhus (lasarett) 0 (0) 0 (0) 1 (100) 0 (0) 1 Ryhov, länssjukhuset (Jönköpings lasarett) 86 (36) 92 (39) 52 (22) 6 (3) 236 Universitetssjukhuset i Linköping 50 () 108 (44) 71 (29) 16 (7) 245 Vrinnevisjukhuset i Norrköping 7 (9) 6 (8) 50 (65) 14 (18) 77 Västerviks sjukhus 3 (3) 4 (5) 73 (83) 8 (9) 88 Private practice 1 (50) 0 (0) 1 (50) 0 (0) 2 Others/missing 0 (0) 1 (25) 2 (50) 1 (25) 4 South Blekingesjukhuset Karlskrona 10 (7) 9 (6) 109 (72) 24 (16) 152 Hallands sjukhus - Halmstad (32) 68 (36) 37 () 24 (13) 189 Helsingsborgs lasarett (11) 51 (29) 54 (31) 52 (29) 177 Kristianstad, centralsjukhuset 23 (35) 12 (18) 27 (41) 4 (6) 66 Universitetssjukhuset i Lund 35 () 45 (26) 62 (35) 34 (19) 176 Universitetssjukhuset MAS 194 (30) 255 (39) 118 (18) 79 (12) 646 Växjö lasarett 6 (7) 8 (9) 75 (83) 1 (1) 90 Others/missing 2 (50) 0 (0) 0 (0) 2 (50) 4 Stockholm/Gotland Danderyds sjukhus 7 (6) 34 (28) 46 (38) 34 (28) 121 Huddinge - Karolinska universitetssjukhuset 34 (18) 89 (46) 39 () 32 (16) 194 Karolinska sjukhuset 277 (24) 477 (41) 270 (23) 132 (11) 1156 S:t Görans sjukhus AB 233 (70) 50 (15) (6) 29 (9) 332 Södersjukhuset 5 (5) 22 (23) 49 (52) 18 (19) 94 Visby lasarett 13 (28) 3 (6) 25 (53) 6 (13) 47 Private practice 56 (78) 6 (8) 6 (8) 4 (6) 72 Others/missing 48 (80) 8 (13) 1 (2) 3 (5) SWEDEN Total 21 (30) 85 (28) 37 (27) 1086 (15) 79
Table 13. Preoperative nerve sparing intent, by hospital, for low risk category (T1c, Gleason score 6 or less, PSA less than µg/l), 08-10. Yes, bilateral Yes, unilateral No Missing Total North Sunderby sjukhus 0 (0) 1 (8) 3 (23) 9 (69) 13 Sundsvalls sjukhus 7 (41) 3 (18) 2 (12) 5 (29) 17 Umeå - Norrlands universitetssjukhus 22 (34) 12 (18) 2 (3) 29 (45) 65 Östersunds sjukhus (49) 4 (10) 2 (5) 15 (37) 41 Uppsala/Örebro Akademiska sjukhuset (56) 23 (32) 6 (8) 2 (3) 71 Central sjukhuset i Karlstad 14 () 7 () 12 (34) 2 (6) 35 Centrallasarettet i Västerås 12 (27) 12 (27) 9 () 12 (27) 45 Falu lasarett 2 (7) 11 (38) 3 (10) 13 (45) 29 Gävle sjukhus 4 (18) 5 (23) 2 (9) 11 (50) 22 Mälarsjukhuset, Eskilstuna 14 (41) 11 (32) 4 (12) 5 (15) 34 Nyköpings lasarett 8 (25) 11 (34) 12 (38) 1 (3) 32 Örebro Universitetssjukhus 9 (19) 6 (13) 10 (21) 22 (47) 47 Others/missing 0 (0) 0 (0) 0 (0) 1 (100) 1 West Alingsås lasarett 27 (64) 7 (17) 3 (7) 5 (12) 42 Borås lasarett 36 (61) 13 (22) 0 (0) 10 (17) 59 Kungälvs sjukhus 10 (50) 4 () 3 (15) 3 (15) Kärnsjukhuset Skövde 52 (81) 3 (5) 5 (8) 4 (6) 64 Lidköping, (Bas)sjukhuset 6 (33) 8 (44) 4 (22) 0 (0) 18 Lundby sjukhus 38 (76) 6 (12) 3 (6) 3 (6) 50 Sahlgrenska Universitetssjukhuset 97 (55) 43 (25) 22 (13) 13 (7) 175 Uddevalla sjukhus 15 (13) 14 (12) 75 (65) 11 (10) 115 Varbergs sjukhus 39 (67) 12 (21) 3 (5) 4 (7) 58 Private practice (73) 16 () 4 (5) 2 (2) 82 Others/missing 0 (0) 0 (0) 1 (33) 2 (67) 3 Southeast Höglandssjukhuset (Eksjö-Nässjö lasarett) 0 (0) 1 (50) 0 (0) 1 (50) 2 Kalmar länssjukhus 27 (71) 2 (5) 1 (3) 8 (21) 38 Oskarshamns sjukhus (lasarett) 0 (0) 0 (0) 1 (100) 0 (0) 1 Ryhov, länssjukhuset (Jönköpings lasarett) 46 () 16 (21) 14 (18) 1 (1) 77 Universitetssjukhuset i Linköping 34 (45) 25 (33) 10 (13) 6 (8) 75 Vrinnevisjukhuset i Norrköping 1 () 0 (0) 1 () 3 () 5 Västerviks sjukhus 2 (14) 2 (14) 9 (64) 1 (7) 14 Others/missing 0 (0) 1 (50) 1 (50) 0 (0) 2 South Blekingesjukhuset Karlskrona 5 (10) 5 (10) 34 (69) 5 (10) 49 Hallands sjukhus - Halmstad 27 (48) 15 (27) 8 (14) 6 (11) 56 Helsingsborgs lasarett 6 (27) 5 (23) 5 (23) 6 (27) 22 Kristianstad, centralsjukhuset 11 (55) 4 () 1 (5) 4 () Universitetssjukhuset i Lund 23 (44) 6 (12) 14 (27) 9 (17) 52 Universitetssjukhuset MAS 89 (50) 54 (30) 13 (7) 22 (12) 178 Växjö lasarett 6 (24) 4 (16) 14 (56) 1 (4) 25 Others/missing 2 (50) 0 (0) 0 (0) 2 (50) 4 Stockholm/Gotland Danderyds sjukhus 3 (8) 19 (51) 7 (19) 8 (22) 37 Huddinge - Karolinska universitetssjukhuset 14 (22) 31 (48) 5 (8) 14 (22) 64 Karolinska sjukhuset 170 (35) 189 (39) 76 (16) 53 (11) 488 S:t Görans sjukhus AB 122 (85) 13 (9) 4 (3) 5 (3) 144 Södersjukhuset 3 (10) 11 (35) 10 (32) 7 (23) 31 Visby lasarett 8 (62) 0 (0) 4 (31) 1 (8) 13 Private practice 31 (91) 1 (3) 0 (0) 2 (6) 34 Others/missing 30 (91) 2 (6) 0 (0) 1 (3) 33 SWEDEN Total 1192 (46) 638 (25) 422 (16) 350 (13) 22 42 Prostatacancer - Nationell kvalitetsrapport, 10
Table 14. Postoperative T-stage (pt-stage), by year of diagnosis, 08-10. pt2 pt3-4 Missing Total Year of diagnosis 08 1479 (67) 628 (28) 115 (5) 2222 09 1912 (69) 769 (28) 87 (3) 2768 10 1598 (67) 7 (30) 77 (3) 2395 24 patients with pt0 are excluded from the table. Prostatacancer - Nationell kvalitetsrapport, 10 43
Table 15. Postoperative T-stage (pt-stage), by hospital, 08-10. pt2 pt3-4 Missing Total North Sunderby sjukhus 17 (52) 9 (27) 7 (21) 33 Sundsvalls sjukhus 24 (80) 4 (13) 2 (7) 30 Umeå - Norrlands universitetssjukhus 81 (53) 55 (36) 18 (12) 154 Östersunds sjukhus 62 (71) 16 (18) 9 (10) 87 Private practice 1 (100) 0 (0) 0 (0) 1 Others/missing 0 (0) 1 (100) 0 (0) 1 Uppsala/Örebro Akademiska sjukhuset 1 (71) 55 (28) 2 (1) 197 Central sjukhuset i Karlstad 94 (67) 44 (31) 2 (1) 1 Centrallasarettet i Västerås 63 (45) 75 (54) 2 (1) 1 Falu lasarett 49 (66) (27) 5 (7) 74 Gävle sjukhus 47 (57) 30 (37) 5 (6) 82 Kullbergska sjukhuset 0 (0) 1 (100) 0 (0) 1 Mälarsjukhuset, Eskilstuna 53 (54) 35 (36) 10 (10) 98 Nyköpings lasarett (56) 32 (44) 0 (0) 72 Örebro Universitetssjukhus 99 (79) 18 (14) 9 (7) 126 Others/missing 0 (0) 1 (50) 1 (50) 2 West Alingsås lasarett 90 (83) 17 (16) 1 (1) 108 Borås lasarett 112 (74) 37 (24) 3 (2) 152 Kungälvs sjukhus 38 (64) (34) 1 (2) 59 Kärnsjukhuset Skövde 86 (63) 49 (36) 1 (1) 136 Lidköping, (Bas)sjukhuset 25 (62) 15 (38) 0 (0) Lundby sjukhus 96 (73) 33 (25) 2 (2) 131 Mariestads sjukhus 0 (0) 1 (100) 0 (0) 1 Sahlgr Univ Sjh/Östra 1 (100) 0 (0) 0 (0) 1 Sahlgrenska Universitetssjukhuset 357 (75) 116 (24) 3 (1) 476 Uddevalla sjukhus 157 (74) 50 (23) 6 (3) 213 Varbergs sjukhus 104 (59) 32 (18) (23) 176 Private practice 165 (74) 51 (23) 8 (4) 224 Others/missing 2 (25) 2 (25) 4 (50) 8 Southeast Höglandssjukhuset (Eksjö-Nässjö lasarett) 4 (80) 0 (0) 1 () 5 Kalmar länssjukhus 110 (54) 88 (43) 7 (3) 5 Oskarshamns sjukhus (lasarett) 1 (100) 0 (0) 0 (0) 1 Ryhov, länssjukhuset (Jönköpings lasarett) 169 (73) (26) 4 (2) 233 Universitetssjukhuset i Linköping 171 (70) 74 (30) 0 (0) 245 Vrinnevisjukhuset i Norrköping 41 (53) 36 (47) 0 (0) 77 Västerviks sjukhus 42 (49) 37 (44) 6 (7) 85 Private practice 1 (50) 1 (50) 0 (0) 2 Others/missing 3 (75) 0 (0) 1 (25) 4 South Blekingesjukhuset Karlskrona 110 (73) 37 (25) 4 (3) 151 Hallands sjukhus - Halmstad 1 (74) 43 (23) 6 (3) 189 Helsingsborgs lasarett 111 (63) 61 (34) 5 (3) 177 Kristianstad, centralsjukhuset 47 (71) 13 () 6 (9) 66 Universitetssjukhuset i Lund 108 (62) 57 (33) 10 (6) 175 Universitetssjukhuset MAS 428 (66) 4 (32) 12 (2) 644 Växjö lasarett 62 (69) 25 (28) 3 (3) 90 Others/missing 1 (25) 0 (0) 3 (75) 4 Stockholm/Gotland Danderyds sjukhus 85 (70) 35 (29) 1 (1) 121 Huddinge - Karolinska universitetssjukhuset 122 (63) 61 (31) 11 (6) 194 Karolinska sjukhuset 782 (68) 341 (30) 32 (3) 1155 S:t Görans sjukhus AB 2 (78) 69 (21) 3 (1) 332 Södersjukhuset 61 (65) 27 (29) 6 (6) 94 Visby lasarett 28 (65) 10 (23) 5 (12) 43 Private practice 50 (71) 12 (17) 8 (11) 70 Others/missing 49 (82) 7 (12) 4 (7) SWEDEN Total 4989 (68) 2117 (29) 279 (4) 7385