Sophie D. Fosså

Study Type – Therapy (individual cohort) Level of Evidence 2b OBJECTIVE: Improving a country’s management of cancer patients requires continuous evaluation, and requires the availability of population‐based prognostic and therapeutic variables. We aimed to document the national diagnostic and therapeutic tasks in Norwegian patients with prostate cancer diagnosed in 2004, with the 2003 European Association of Urology (EAU) guidelines representing the background. PATIENTS AND METHODS: The Norwegian Prostate Cancer Registry (NoPCR) was established in 2004, and data collected during this first year were reviewed. The Tumour‐Node‐Metastasis group, prostate‐specific antigen (PSA) level and Gleason score were recorded as basic diagnostic variables, with the initial treatment. Patients with nonmetastatic T1‐T3 tumours were separated from those with advanced disease (T4 and/or N+ and/or M+). Patients with T1‐T3 tumours, aged ≤75 years, and in good health were candidates for curative local treatment (‘CurCands’) and were allocated to risk groups. RESULTS: The compliance rate to the NoPCR was 96%; 2693 (72%) of 3744 eligible patients had T1‐T3 tumours and 833 (22%) had advanced disease (not classifiable in 218, 6%). Of 1650 CurCands (low‐risk 500; intermediate‐risk 453; high‐risk 697), 62% had radical prostatectomy or radiotherapy with or without hormone therapy, with the remaining 23% and 10% managed by, respectively, hormone therapy only or observation (other/unknown treatment, 6%).Only 64% of CurCands in the combined intermediate/high‐risk group had local treatment. In the low‐risk group local treatment was used in 57% of the patients, mainly in men with T2 tumours. In intermediate‐ and high‐risk CurCands, PSA was the strongest factor determining the performance of curative treatment. Adjuvant radiotherapy after radical prostatectomy was used in four of 142 patients with tumour‐involved margins. CONCLUSION: In 2004 the initial management of prostate cancer in Norway was largely in accordance with the 2003 EAU guidelines, though there was some evidence of ‘over‐treatment’ of low‐risk patients and ‘under‐treatment’ of intermediate‐ and high‐risk patients. Some improvement of data collection by the NoPCR is warranted. National prostate cancer registries can contribute to improving the medical care of these patients.

Patients with testicular cancer are at risk of having severe short‐term and life‐threatening long‐term effects; we reviewed previous reports of these sequelae. After orchidectomy and before further treatment patients have major mental distress which gradually decreases during the treatment phase. Gastrointestinal side‐effects dominate during both chemo‐ and radiotherapy, with the risk of severe haematological, infectious and thromboembolic complications during chemotherapy. Long‐term sequelae comprise second cancers, cardiovascular morbidity/mortality and gonadal dysfunction. Nevertheless, 70% of patients who attempt paternity after treatment are successful. About 20% of patients develop long‐term neuro‐ and/or ototoxicity. The long‐term quality of life of survivors of testicular cancer is comparable to that of controls. Risk‐adapted treatment of patients with testicular cancer and adequate follow‐up of those at risk of life‐threatening toxicity are ways to reduce the short‐ and long‐term morbidity in survivors. Patients should be informed about these potential complications and the importance of adjusting their lifestyle (e.g. smoking habits, physical activity and weight control).

Purpose: Most studies on postcancer reproduction are limited in patient numbers and lack of control group. We have computed 10-year first postdiagnosis cumulative reproduction rates (10-PDRs) and hazard ratios (HRs) avoiding these limitations. Patients and Methods: Six thousand seventy-one patients with cancer age 15 to 45 years at diagnosis, treated from 1971 to 1997, and 30,355 controls from the general population, all born after 1950, were observed from the true (patients) or assigned (controls) date of diagnosis for a median of 10 years (range, 0 to 35). The primary focus of the study was the 10-PDR before and after 1988+ based on data from the Medical Birth Registry of Norway. Cox proportional hazards regression models were adjusted for age and calendar year at diagnosis, stratified by sex and prediagnosis parenthood. Results: Across all cancer types, HRs of females were approximately 50% lower than those of the controls, the comparable percentage for male patients being approximately 30%, with some improvement after 1988+ for selected diagnoses. The highest 10-PDRs were observed in childless patients, with more favorable HRs in male than in female patients. In survivors with at least one child at diagnosis, the post-1988+ HRs improved significantly in patients with testicular and localized cervical cancer compared to pre-1988+ reproduction, with borderline improvement in localized ovarian cancer. Conclusion: Postcancer reproduction is lower than that of the general population and influenced by sex, age at diagnosis, prediagnosis parenthood, and diagnostic period with more favorable rates in males than in females. Post-1988+ fertility-saving strategies may have improved the reproduction rates for select genital cancers.