Regional Cancer Centre, Uppsala Örebro University hospital SE UPPSALA

inom cancersjukvården

Prostate cancer

Report from the National Prostate Cancer Register, 2014

SE-751 85 UPPSALA

Each year approximately 10 000 men are di- agnosed with prostate cancer in Sweden. All cases of prostate cancer diagnosed in Swe- den are registered in The National Prostate Cancer Register (NPCR) Sweden since 1998 in the six health care regions with a cap- ture ratio of more than 98% compared to The Swedish Cancer Register to which regi- stration is mandatory and regulated by law.

NPCR contains data on tumour characte- ristics and treatment delivered or decided upon up to six months after date of diagno- sis. 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 demograp- hic databases has been performed in the research project Prostate cancer data Base Sweden (PCBaSe). A full description of the- se data sets as well as the output from this project was recently published (1).

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This version of the report contains all ta- bles and figures from the full report in Swe- dish. The Swedish version contains a com- prehensive commentary text that is not pro- vided in the English version.

1. Cohort Profile: The National Prostate Cancer Register (NPCR) of Sweden and Prostate Cancer data Base Swe- den (PCBaSe) 2.0. M Van Hemelrijck, A Wigertz, F Sandin, H Garmo, K Hellstr¨ om, 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.

30 September 2015

P¨ ar Stattin, Fredrik Sandin, David Robin- son, Ingela Franck Lissbrant and Marie Hj¨ alm Eriksson for the steering group of NPCR.

Fredrik Sandin, Regional cancer centre,

Uppsala ¨ Orebro, performed data manage-

ment and statistical analysis for this re-

port.

TABLE OF CONTENTS

1 FOREWORD . . . . 3

2 INTRODUCTION . . . . 13

2.1 Background . . . . 13

3 RESULTS . . . . 14

3.1 Quality indicators . . . . 14

3.2 Diagnostics . . . . 21

3.3 Tumour data . . . . 30

3.4 Treatment . . . . 34

3.5 Waiting times . . . . 75

3.6 Prostate cancer-specific mortality . . . . 83

3.7 PROM/PREM . . . . 84

4 RESEARCH . . . . 88

4.1 Publications based on NPCR from the past five years . . . . 88

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, 1998-2014. . . . 21 2 Number of cases and capture ratio (%) in NPCR by county, for year of diagnosis

2014. . . . 21 3 Main reason for the initiation of the medical investigation that led to the prostate

cancer diagnosis by year of diagnosis, 2004-2014. . . . 23 4 Serum PSA-level (µg/L) by year of diagnosis, 1998-2014. . . . 25 5 Number of cores obtained per diagnostic session by year of diagnosis, 2007-2014. . . 26 6 Comparison of number of cases in the risk category ”very low risk” according to the

old and new definition, 2014. . . . 30 7 Number of cases (%) by county and risk category, 2014. . . . 32 8 Number of cases (%) by year of diagnosis and risk category, 1998-2014. . . . 33 9 Number and percentages of men with the primary treatment type registered within

six months following diagnosis by health care region and year, 2007-2014. . . . 34 10 Treatment strategy for men in the risk category ”very low risk” by county, 2014. . . . 37 11 Treatment strategy for men in the risk category ”low risk” by county, 2014. . . . . . 37 12 Treatment strategy for men in the risk category ”intermediate risk” by county, 2014. . 38 13 Treatment strategy for men in the risk category ”localized high risk” by county, 2014. 38 14 Treatment strategy for men in the risk category ”locally advanced” by county, 2014. . 39 15 Treatment strategy for men with regional metastases by county, 2014. . . . 39 16 Treatment strategy for men with distant metastases by county, 2014. . . . . 40 17 Type of radical prostatectomy (primary treatment) by year of diagnosis, 1998-2014. . 48 18 Type of radical prostatectomy (primary treatment) by year of treatment, 2009-2014. 48 19 Type of radical prostatectomy (primary treatment) by hospital, year of treatment

2014. . . . 49 20 Preoperative nerve sparing intent by year of treatment, 2009-2014. . . . 51 21 Preoperative nerve sparing intent by risk category (low, intermediate and high risk),

year of treatment 2014. . . . 51 22 Pathological T-stage (pT-stage) by year of treatment, 2009-2014. . . . 53 23 Positive surgical margin by year of treatment, 2009-2014. . . . 56 24 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, 2008-2014. . . . . 61 25 Number of performed radiotherapy treatments per year of treatment, 2009-2014. . . 61 26 Number of registered performed radiotherapy treatments by hospital, year of treat-

ment 2014. . . . 62 27 Type of primary/secondary radiotherapy by hospital, year of treatment 2014. . . . . 62 28 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 2014. . . . 63 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 high risk (at time of

diagnosis) by hospital, year of treatment 2014. . . . 63 30a Type of hormonal treatment for men with M1 or PSA ≥ 100 µg/L by hospital, 2014. 71 30b Type of hormonal treatment for men with M1 or PSA ≥ 100 µg/L by hospital,

2014, cont’d... . . . 72 31a Type of hormonal treatment for men with M0/MX and PSA ≥ 100 µg/L by hospi-

tal, 2014. . . . 73

31b Type of hormonal treatment for men with M0/MX and PSA ≥ 100 µg/L by hospi- tal, 2014, cont’d... . . . 74 32 Number of men with Patient Reported Outcome Measures (PROM) data at baseli-

ne and one year after curatively intended treatment. . . . 84 33 PREM - Patient Reported Experience Measures -reported experience of participation

in treatment decision and information about the disease among men with prosta-

tectomy or radiotherapy as primary treatment, year of diagnosis 2014. . . . 87

FIGURES

1 Patient overview Prostate Cancer (PPC) shows treatment, lab values (PSA, Hb),

imaging, general condition and adverse effects (ECOG WHO, SRE). . . . 12 2 Age-standardized prostate cancer incidence and mortality per 100 000 men, Sweden

1970-2013. . . . 13 3 Proportion of men reported to NPCR within a month from the time point when

diagnostic information was given to the patient by health care region, 2014. . . . 14 4 Proportion of men assigned a navigator nurse by health care region, 2014. . . . 14 5 Proportion of men with time between date of referral and first visit at a specialist

clinic being 60 days or less by health care region, 2014. . . . 14 6 Proportion of men with time between diagnostic biopsy and information of result

being 18 days or less by health care region, 2014. . . . 14 7 Proportion of men with expected survival exceeding 5 years (age at diagnosis ≤ 80

years) with high risk or locally advanced prostate cancer examined with bone scan

or other bone investigation by health care region, 2014. . . . 14 8 Proportion of men (75 years or younger at time of diagnosis) with prostate cancer

of very low risk given active surveillance as primary treatment by health care region, 2014. . . . 14 9 Participation in multidisciplinary team conference concerning curative treatment for

men (80 years or younger at time of diagnosis) with prostate cancer of high risk by health care region, 2014. . . . 15 10 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, 2014. . . 15 11 Proportion of men with prostate cancer planned for a prostatectomy with uni- or

bilateral nerve sparing intent by health care region, 2014. . . . 15 12 Proportion of men with pathologic pT2-tumour after radical prostatectomy having

negative surgical margins by health care region, 2014. . . . 15 13 Proportion of men reported to NPCR within a month from the time point when

diagnostic information was given to the patient by hospital, 2014. . . . 16 14 Proportion of men assigned a navigator nurse by hospital, 2014. . . . 16 15 Proportion of men with time between date of referral and first visit at a specialist

clinic being 60 days or less by hospital, 2014. . . . . 17 16 Proportion of men with time between diagnostic biopsy and information of result

being 18 days or less by hospital, 2014. . . . 17 17 Proportion of men with expected survival exceeding 5 years (age at diagnosis ≤ 80

years) with high risk or locally advanced prostate cancer examined with bone scan

or other bone investigation by hospital, 2014. . . . 18 18 Proportion of men (75 years or younger at time of diagnosis) with prostate cancer

of very low risk given active surveillance as primary treatment by hospital, 2014. . . 18 19 Participation in multidisciplinary team conference concerning curative treatment for

men (80 years or younger at time of diagnosis) with prostate cancer of high risk by

hospital, 2014. . . . 19

20 Proportion of men (75 years or younger at time of diagnosis) with localized high

risk prostate cancer given curative primary treatment by hospital, 2014. . . . 19 21 Proportion of men with prostate cancer planned for a prostatectomy with uni- or

bilateral nerve sparing intent by hospital 2014. . . . 20 22 Proportion of men with pathologic pT2-tumour after radical prostatectomy having

negative surgical margins by hospital, 2014. . . . 20 23 Time (months) between date of diagnosis and reporting to the NPCR for cases dia-

gnosed 2014. . . . 22 24 Time (months) between date of diagnosis and reporting to the NPCR for cases dia-

gnosed 2014 by health care region. . . . 22 25 Incidence and main reason for initiation of the work -up leading to prostate cancer

diagnosis by county, 2014. . . . 24 26 Main reason for initiation of the work-up leading to prostate cancer diagnosis by

hospital, 2014. . . . 24 27 Serum PSA-level (µg/L) at diagnosis by year of diagnosis, 1998-2014. . . . 25 28 Proportion of men, 75 years old or younger, with T1c prostate cancer that under-

went 10 or more needle biopsies at the diagnostic biopsy session by county, 2014. . . 26 29 Proportion of men, 75 years old or younger, with T1c prostate cancer that under-

went 10 or more needle biopsies at the diagnostic biopsy session by hospital, 2014. . 26 30 Proportion of men given active surveillance as primary treatment that underwent an

additional biopsy session before treatment decision by county, 2014. . . . 27 31 Proportion of men given active surveillance as primary treatment that underwent an

additional biopsy session before treatment decision by hospital, 2014. . . . . 27 32 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 2014. . . . 28 33 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 health-

care region and year of diagnosis, January-November 2014. . . . 28 34 Proportion of men with T1-2, PSA < 20 µg/L and Gleason score 6 or less that un-

derwent bone scan by county, 2003 and 2014. . . . 28 35 Proportion of men (80 years or younger) with Gleason score 8-10 and/or T3 and/or

PSA 20-50 µg/L (but not T4 or PSA > 50 µg/L) that was examined by bone scan by county, 2003 and 2014. . . . . 29 36 Proportion of men (older than 80 years) with Gleason score 8-10 and/or T3 and/or

PSA 20-50 µg/L (but not T4 or PSA > 50 µg/L) that was examined by bone scan by county, 2003 and 2014. . . . . 29 37 Proportion of men by risk category and year of diagnosis, 1998-2014. . . . . 30 38 Proportion of men by risk categories and county, 2014. . . . 31 39 Proportion of men with prostate cancer of low risk, intermediate risk, high risk or

with regional metastasis given second opinion by oncologist by county, 2014. . . . . 35 40 Proportion of men (80 years or younger) with localized high risk prostate cancer

discussed at a multidisciplinary team conference ahead of treatment decision by

county, 2014. . . . . 35 41 Treatment strategy for men 75 years or younger by risk category and year of diagno-

sis, 2007-2014. . . . 36 42 Treatment strategy for men older than 75 years by risk category and year of diagno-

sis, 2007-2014. . . . 36

43 Treatment strategy by risk category and age group, 2008-2014. . . . 36

44 Proportion of men younger than 70 years with low risk prostate cancer (T1-2, Gle- ason score 6 or less and PSA < 10 µg/L) with active surveillance as primary treat- ment by county, 2014. . . . 41 45 Proportion of men younger than 70 years with low risk prostate cancer (T1-2, Gle-

ason score 6 or less and PSA < 10 µg/L) with active surveillance as primary treat- ment by hospital, 2014. . . . 41 46 Proportion of men 70-80 years with low risk prostate cancer (T1-2, Gleason sco-

re 6 or less and PSA < 10 µg/L) with active surveillance as primary treatment by

county, 2014. . . . . 42 47 Proportion of men 70-80 years with low risk prostate cancer (T1-2, Gleason score 6

or less and PSA < 10 µg/L) with active surveillance as primary treatment by hospi- tal, 2014. . . . 42 48 Proportion of men 70 years or younger with very low risk prostate cancer (T1c, Gle-

ason score 6 or less and PSA < 10 µg/L, no more than 4 cores with cancer, and to- tal length of cancer in biopsies ≤ 8 mm, at least 8 cores examined and PSA-density

< 0.15 µg/L/ml) with active surveillance as primary treatment by county, 2014. . . 43 49 Proportion of men 70 years or younger with very low risk prostate cancer (T1c, Gle-

ason score 6 or less and PSA < 10 µg/L, no more than 4 cores with cancer, and to- tal length of cancer in biopsies ≤ 8 mm, at least 8 cores examined and PSA-density

< 0.15 µg/L/ml) with active surveillance as primary treatment by hospital, 2014. . . 43 50 Proportion of men younger than 70 years with intermediate risk prostate cancer gi-

ven curative therapy by county, 2014. . . . . 44 51 Proportion of men younger than 70 years with intermediate risk prostate cancer gi-

ven curative therapy by hospital, 2014. . . . 44 52 Proportion of men 70-80 years with intermediate risk prostate cancer given curative

therapy by county, 2014. . . . . 45 53 Proportion of men 70-80 years with intermediate risk prostate cancer given curative

therapy by hospital, 2014. . . . 45 54 Proportion of men younger than 70 years with high risk prostate cancer given cura-

tive therapy by county, 2014. . . . 46 55 Proportion of men younger than 70 years with high risk prostate cancer given cura-

tive therapy by hospital, 2014. . . . 46 56 Proportion of men 70-80 years with high risk prostate cancer given curative therapy

by county, 2014. . . . 47 57 Proportion of men 70-80 years with high risk prostate cancer given curative therapy

by hospital, 2014. . . . 47 58 Number of radical prostatectomies (primary treatment) by county and year of treat-

ment, 2011-2014. . . . 50 59 Proportion of men with low risk prostate cancer among men treated with radical

prostatectomy, year of treatment 2014. . . . 50 60 Proportion of men that are missing information on preoperative nerve sparing intent

by hospital, year of treatment 2014. . . . . 52 61 Nerve sparing intention by hospital, year of treatment 2014. . . . . 52 62 Nerve sparing intention for men with low- or intermediate risk prostate cancer with

T1c, PSA < 10 ng/ml by hospital, 2014. . . . 53 63 Proportion of men missing information on pathological T-stage by hospital, 2014. . . 53 64 Proportion of pT2 tumors by hospital, 2014. . . . 54 65 Proportion of pT2 tumors among preoperative low risk cancers (T1c, Gleason score

≤ 6, PSA < 20 µg/L) by hospital, 2014. . . . 54 66 Proportion of pT2 tumors among preoperative intermediate risk cancers by hospital,

2014. . . . 55

67 Proportion of pT2 tumors among preoperative localized high risk cancers by hospi- tal, 2014. . . . 55 68 Proportion of men with uncertain or missing information on surgical margin status

by hospital, 2014. . . . 56 69 Proportion of positive surgical margin by hospital, 2014. . . . . 57 70 Proportion of positive surgical margin (all radical prostatectomies) vs. number of

prostatectomies by type and hospital, 2014. . . . 57 71 Proportion of positive surgical margin among pT2-tumors by hospital, 2014. . . . 57 72 Proportion of positive surgical margin among pT2-tumors vs. number of prosta-

tectomies by type and hospital, 2014. . . . . 57 73 Proportion of positive surgical margin after retropubic radical prostatectomy of

pT2-tumors by hospital, 2014. . . . . 58 74 Proportion of positive surgical margin after robot assisted laparoscopic radical pro-

statectomy of pT2-tumors by hospital, 2014. . . . 58 75 Proportion of positive surgical margin among preoperative intermediate risk tumors

by hospital, 2014. . . . 59 76 Proportion of positive surgical margin among preoperative low- or intermediate risk

tumors by hospital, 2014. . . . 59 77 Proportion of men being re-admitted within 30 days following a radical prosta-

tectomy by hospital, 2014 (January-November). . . . 60 78 Proportion of men with localized high risk or locally advanced tumors treated with

radiotherapy that received treatment with radiation fields that included lymph nodes by county, 2014. . . . 64 79 Proportion of men treated with primary external radiotherapy where marking techni-

que has been used by county, 2014. . . . . 64 80 Proportion of men treated with primary radiotherapy where MRI or PET-CT has

been used for definition of target by county, 2014. . . . 64 81 Proportion of men with low risk prostate cancers treated with radiotherapy that

received neoadjuvant hormonal therapy by county, 2013-2014. . . . . 65 82 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, 2014. . . . 65 83 Type of neoadjuvant hormonal therapy among men with localized high risk or local-

ly advanced tumors treated with primary radiotherapy by county, 2014. . . . . 66 84 Proportion of men with localized high risk or locally advanced tumors treated with

primary radiotherapy that received adjuvant hormonal therapy by county, 2014. . . . 66 85 Type of adjuvant hormonal therapy among men with localized high risk or locally

advanced tumors treated with primary radiotherapy by county, 2014. . . . 66 86 Duration of adjuvant hormonal therapy treatment for men with localized high risk

or locally advanced tumors treated with primary radiotherapy by county, 2014. . . . . 66 87 Proportion of men treated with primary radiotherapy participating in a clinical treat-

ment study (according to the radiotherapy form) by county, 2014. . . . 67 88 Type of treatment for men 75 years or younger at time of diagnosis with locally ad-

vanced prostate cancer by county, 2013-2014. . . . 68 89 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, 2013-2014. . . . . 68 90 Type of treatment for men 76-80 years at time of diagnosis with locally advanced

prostate cancer by county, 2013-2014. . . . 68

91 Proportion of men 76-80 years at time of diagnosis with locally advanced prosta- te cancer that received neoadjuvant hormonal therapy and radiotherapy by county,

2013-2014. . . . 68 92 Type of treatment for men 75 years or younger at time of diagnosis with regional

metastases (N1 and/or T4 and/or PSA 50-100 µg/L, not M1) by county, 2013-2014. 69 93 Proportion of men 75 years or younger at time of diagnosis with regional metasta-

ses (N1 and/or T4 and/or PSA 50-100 µg/L, not M1) that received neoadjuvant

hormonal therapy and radiotherapy by county, 2013-2014. . . . 69 94 Observed 10-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. . . . 69 95 Observed 10-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. . . . 70 96 Median serum PSA-level (µg/L) at diagnosis among men with verified distant me-

tastases (M1) by year of diagnosis, 1998-2014. . . . 71 97 Number of days between date of referral and first visit at a specialist clinic by county,

year of diagnosis 2014. . . . . 75 98 MAP - Number of days between date of referral and first visit at a specialist clinic

by county, year of diagnosis 2014. . . . . 75 99 Median number of days between date of referral and first visit at a specialist clinic

by year of diagnosis and health care region, 2009-2014. . . . 75 100 Number of days between date of referral and first visit at a specialist clinic by hospi-

tal, year of diagnosis 2014. . . . 76 101 Number of days between diagnostic biopsy and date when patient was informed of

the result by county, 2014. . . . 77 102 MAP - Number of days between diagnostic biopsy and date when patient was infor-

med of the result by county, 2014. . . . 77 103 Median number of days between diagnostic biopsy and date when patient was infor-

med of the result by year of diagnosis and health care region, 2010-2014. . . . . 77 104 Number of days between treatment decision and radical prostatectomy by county,

2014. . . . 78 105 MAP - Number of days between treatment decision and radical prostatectomy by

county, 2014. . . . . 78 106 Median number of days between treatment decision and radical prostatectomy year

of surgery and health care region, 2008-2014. . . . 78 107 Number of days between treatment decision and radical prostatectomy by hospital,

2014. . . . 78 108 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 2014. . . . 79 109 Number of days between treatment decision by oncologist that radiotherapy will be

the primary treatment and start of radiotherapy among men not receiving neoadju- vant hormonal therapy by county, year of treatment 2014. . . . . 79 110 Number of days between treatment decision and start of neoadjuvant hormonal the-

rapy ahead of primary radiotherapy among men with localized high risk prostate

cancer or locally advanced prostate cancer by county, year of treatment 2014. . . . . 79 111 Number of days between decision by oncologist of salvage radiotherapy and start of

radiotherapy by county, 2014. . . . 79

112 Different time intervals from referral to date of prostatectomy among men with pro- statectomy as primary treatment by county, year of treatment 2013-2014. . . . 80 113 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 2013-2014. . . . 80 114 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 2013-2014. . . . 81 115 Number of days between diagnostic biopsy and treatment decision among men with

M1 or PSA ≥ 100 µg/L given non-curative therapy by county , year of diagnosis

2014. . . . 82 116 MAP - Number of days between diagnostic biopsy and treatment decision among

men with M1 or PSA≥100 µg/L given non-curative therapy by county, year of dia- gnosis 2014. . . . 82 117 Median number of days between diagnostic biopsy and treatment decision among

men with M1 or PSA≥100 µg/L given non-curative therapy by year of diagnosis

and health care region, 2008-2014. . . . 82 118 Cumulative mortality from prostate cancer and other causes by risk category and

age groupp, period analysis 2009-2013. . . . 83 119 Urinary incontinence - at baseline and one year following treatment according to

postal questionnaire. . . . 84 120 Fecal incontinence - at baseline and one year following treatment according to postal

questionnaire. . . . 84 121 Erectile dysfunction (ED) - at baseline and one year following treatment according

to postal questionnaire. . . . 85 122 Erectile dysfunction (ED) - one year following treatment among men with no ED at

baseline according to postal questionnaire. . . . 85 123 Urinary incontinence - one year following treatment among men with missing baseli-

ne data and treated the first three months 2013. . . . . 85 124 Fecal incontinence - one year following treatment among men with missing baseline

data and treated the first three months 2013. . . . 86 125 Erectile dysfunction (ED) - one year following treatment among men with missing

baseline data and treated the first three months 2013. . . . 86

Figure 1. Patient overview Prostate Cancer (PPC) shows treatment, lab values (PSA, Hb), imaging, general condi-

tion and adverse effects (ECOG WHO, SRE).

2.1 Background

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

Year 0

50 100 150 200 250

Age−standardised incidence/mortality per 100 000 men

Incidence Mortality

Figure 2. Age-standardized prostate cancer incidence and mortality per 100 000 men, Sweden 1970-2013.

Age-standardized according to the population in Sweden (incidence) and the Nordic countries (mortality) in the year 2000. Source: The Board of Health and Welfare

(incidence), www.socialstyrelsen.se, and NORDCAN (mortality), www.ancr.nu.

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3 ^RESULTS

3.1 Quality indicators

0 20 40 60 80 100

Percent South

Stockholm−Gotland South east SWEDEN Uppsala−Örebro West North

No. of cases¹

599 of 1663 1038 of 2874 479 of 1175 4410 of 10077 960 of 1893 798 of 1488 536 of 984

36%

36%

41%

44%

51%

54%

54%

2012 2013

1

2014

Figure 3. Proportion of men reported to NPCR within a month from the time point when dia- gnostic information was given to the patient by health care region, 2014.

0 20 40 60 80 100

Percent North

South east Uppsala−Örebro SWEDEN Stockholm−Gotland South West

No. of cases

254 of 704 360 of 962 645 of 1491 4297 of 8131 1329 of 2425 817 of 1362 892 of 1187

36%

37%

43%

53%

55%

60%

75%

Figure 4. Proportion of men assigned a navigator nur- se by health care region, 2014.

0 20 40 60 80 100

Percent North

Uppsala−Örebro SWEDEN South Stockholm−Gotland West South east

No. of cases¹

447 of 745 878 of 1420 4629 of 6396 850 of 1127 922 of 1215 847 of 1076 685 of 813

60%

62%

72%

75%

76%

79%

84%

2012 2013

1

2014

Figure 5. Proportion of men with time between date of referral and first visit at a specialist clinic being 60 days or less by health care region, 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 20 40 60 80 100

Percent Stockholm−Gotland

South east North SWEDEN Uppsala−Örebro West South

No. of cases¹

178 of 2874 143 of 1175 135 of 984 1412 of 10077 267 of 1893 262 of 1488 427 of 1663

6%

12%

14%

14%

14%

18%

26%

2012 2013

1

2014

Figure 6. Proportion of men with time between di- agnostic biopsy and information of result being 18 days or less by health care region, 2014.

0 20 40 60 80 100

Percent West

Stockholm−Gotland North SWEDEN South Uppsala−Örebro South east

No. of cases¹

145 of 241 207 of 320 133 of 180 1287 of 1739 233 of 312 384 of 465 185 of 221

60%

65%

74%

74%

75%

83%

84%

2012 2013

1

2014

Figure 7. Proportion of men with expected survival exceeding 5 years (age at diagnosis ≤ 80 years) with high risk or locally advanced prostate cancer examined with bone scan or other bone investigation by health care region, 2014.

0 20 40 60 80 100

Percent Uppsala−Örebro

South North SWEDEN West Stockholm−Gotland South east

No. of cases¹

81 of 99 106 of 121 54 of 61 933 of 1017 112 of 121 528 of 560 52 of 55

82%

88%

89%

92%

93%

94%

95%

2012 2013

1

2014

Figure 8. Proportion of men (75 years or younger at

time of diagnosis) with prostate cancer of

very low risk given active surveillance as pri-

mary treatment by health care region, 2014.

0 20 40 60 80 100 Percent Stockholm−Gotland

South east North West SWEDEN South Uppsala−Örebro

No. of cases¹

68 of 284 70 of 195 61 of 147 89 of 209 638 of 1489 121 of 247 229 of 407

24%

36%

41%

43%

43%

49%

56%

2012 2013

1

2014

Figure 9. Participation in multidisciplinary team confe- rence concerning curative treatment for men (80 years or younger at time of diagnosis) with prostate cancer of high risk by health care region, 2014.

0 20 40 60 80 100

Percent West

South east North Uppsala−Örebro SWEDEN Stockholm−Gotland South

No. of cases¹

97 of 120 103 of 123 67 of 79 178 of 207 750 of 870 170 of 191 135 of 150

81%

84%

85%

86%

86%

89%

90%

2012 2013

1

2014

Figure 10. 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, 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 20 40 60 80 100

Percent Uppsala−Örebro

North South West SWEDEN South east Stockholm−Gotland

No. of cases¹

255 of 350 102 of 123 415 of 486 360 of 421 2177 of 2502 295 of 323 750 of 799

73%

83%

85%

86%

87%

91%

94%

2012 2013

1

2014

Figure 11. Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by health care region, 2014.

0 20 40 60 80 100

Percent South east

South Uppsala−Örebro SWEDEN Stockholm−Gotland North West

No. of cases¹

124 of 158 193 of 240 148 of 184 1165 of 1390 433 of 512 69 of 79 198 of 217

78%

80%

80%

84%

85%

87%

91%

2012 2013

1

2014

Figure 12. Proportion of men with pathologic pT2-

tumour after radical prostatectomy having

negative surgical margins by health care

region, 2014.

0 40 80 Percent Södertälje sjukhus

Simrishamns sjukhus Länssjukhuset Ryhov Lasarettet i Enköping Karlskoga lasarett Sjukhuset i Lidköping Centralsjukhuset Kristianstad Karolinska universitetssjukhuset − Huddinge Sjukhuset i Gävle Sollefteå sjukhus Värnamo sjukhus Norrtälje sjukhus Karolinska universitetssjukhuset − Solna South Älvsborgs Sjukhus − Skene Private practice − South Ljungby lasarett Länssjukhuset i Sundsvall Universitetssjukhuset Örebro Varbergs sjukhus Sjukhuset i Hudiksvall Kiruna sjukhus Private practice − Uppsala−Örebro Hallands sjukhus Halmstad Sjukhuset i Arvika Others Oskarshamns sjukhus Lasarettet i Ystad Centrallasarettet Växjö Falu lasarett/Ludvika lasarett Kalix sjukhus Private practice − South east Skånes universitetssjukhus − Lund/Malmö Danderyds sjukhus Länssjukhuset i Kalmar Private practice − Stockholm−Gotland Visby lasarett Västerviks sjukhus Södersjukhuset Private practice − West SWEDEN Uddevalla sjukhus Gällivare sjukhus Höglandssjukhuset Helsingsborgs lasarett Örnsköldsviks sjukhus Skellefteå lasarett Lindesbergs lasarett Capio S:t Görans sjukhus − Urologisektionen Sjukhuset i Bollnäs Piteå älvdals sjukhus Lycksele lasarett Nyköpings lasarett Mora lasarett Universitetssjukhuset i Linköping/Vrinnevisjukhuset Blekingesjukhuset − Karlskrona Alingsås lasarett Centralsjukhuset i Karlstad Kullbergska sjukhuset/Mälarsjukhuset Sahlgrenska Universitetssjukhuset Västmanlands sjukhus Västerås Sunderby sjukhus Norrlands universitetssjukhus Umeå Lasarettet Trelleborg Akademiska sjukhuset Kärnsjukhuset i Skövde Östersunds sjukhus South Älvsborgs Sjukhus − Borås Ängelholms sjukhus Hallands sjukhus Kungsbacka

No. of cases

0 of 62 0 of 31 1 of 120 3 of 69 2 of 38 8 of 94 4 of 44 7 of 72 18 of 163 6 of 53 12 of 87 8 of 56 5 of 34 7 of 42 64 of 356 11 of 56 37 of 187 22 of 110 22 of 97 25 of 101 7 of 27 35 of 132 23 of 86 3 of 11 3 of 11 7 of 25 32 of 109 50 of 170 51 of 170 9 of 28 80 of 246 127 of 385 19 of 51 51 of 136 925 of 2434 18 of 47 40 of 102 27 of 65 196 of 457 4410 of 10077 90 of 201 12 of 26 60 of 125 67 of 138 51 of 103 42 of 83 16 of 30 29 of 53 43 of 77 11 of 19 22 of 38 30 of 50 50 of 74 227 of 332 92 of 133 49 of 70 227 of 308 109 of 145 203 of 266 205 of 267 94 of 120 107 of 135 47 of 59 119 of 145 75 of 91 138 of 165 84 of 100 82 of 90 64 of 70

0%

0%

1%

4%

5%

9%

9%

10%

11%

11%

14%

14%

15%

17%

18%

20%

20%

20%

23%

25%

26%

27%

27%

27%

27%

28%

29%

29%

30%

32%

33%

33%

37%

38%

38%

38%

39%

42%

43%

44%

45%

46%

48%

49%

50%

51%

53%

55%

56%

58%

58%

60%

68%

68%

69%

70%

74%

75%

76%

77%

78%

79%

80%

82%

82%

84%

84%

91%

91%

Figure 13. Proportion of men reported to NPCR wit- hin a month from the time point when diagnostic information was given to the patient by hospital, 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 40 80

Percent Örnsköldsviks sjukhus

South Älvsborgs Sjukhus − Skene Sollefteå sjukhus Piteå älvdals sjukhus Länssjukhuset i Kalmar Lycksele lasarett Kalix sjukhus Visby lasarett Gällivare sjukhus Alingsås lasarett Länssjukhuset i Sundsvall Sjukhuset i Bollnäs Länssjukhuset Ryhov Västerviks sjukhus Höglandssjukhuset Capio S:t Görans sjukhus − Urologisektionen Sjukhuset i Gävle Sjukhuset i Hudiksvall Lasarettet i Enköping Värnamo sjukhus Lasarettet Trelleborg Skånes universitetssjukhus − Lund/Malmö Oskarshamns sjukhus Akademiska sjukhuset Södersjukhuset Sunderby sjukhus Others Västmanlands sjukhus Västerås Private practice − Uppsala−Örebro Lasarettet i Ystad Falu lasarett/Ludvika lasarett Kiruna sjukhus Mora lasarett Kärnsjukhuset i Skövde Sjukhuset i Arvika Ljungby lasarett SWEDEN Private practice − Stockholm−Gotland Karolinska universitetssjukhuset − Huddinge Private practice − South east Kullbergska sjukhuset/Mälarsjukhuset Östersunds sjukhus Centralsjukhuset Kristianstad Private practice − South Nyköpings lasarett Centralsjukhuset i Karlstad South Älvsborgs Sjukhus − Borås Universitetssjukhuset Örebro Universitetssjukhuset i Linköping/Vrinnevisjukhuset Private practice − West Danderyds sjukhus Sahlgrenska Universitetssjukhuset Karolinska universitetssjukhuset − Solna Norrlands universitetssjukhus Umeå Ängelholms sjukhus Blekingesjukhuset − Karlskrona Hallands sjukhus Halmstad Centrallasarettet Växjö Norrtälje sjukhus Uddevalla sjukhus Simrishamns sjukhus Karlskoga lasarett Södertälje sjukhus Helsingsborgs lasarett Lindesbergs lasarett Sjukhuset i Lidköping Varbergs sjukhus Skellefteå lasarett Hallands sjukhus Kungsbacka

No. of cases

0 of 71 0 of 23 0 of 12 0 of 14 0 of 111 0 of 26 0 of 21 2 of 45 1 of 18 3 of 42 13 of 158 5 of 58 12 of 122 8 of 81 10 of 95 24 of 194 17 of 135 10 of 75 8 of 42 16 of 82 8 of 39 99 of 381 5 of 18 46 of 151 81 of 251 30 of 92 1 of 3 71 of 201 22 of 62 35 of 95 52 of 135 9 of 20 22 of 47 43 of 91 3 of 6 18 of 35 4297 of 8131 603 of 1120 71 of 131 71 of 127 54 of 95 68 of 117 30 of 50 105 of 172 31 of 49 177 of 270 81 of 121 72 of 107 238 of 324 147 of 198 88 of 116 259 of 338 391 of 494 85 of 107 67 of 79 82 of 95 90 of 104 154 of 176 33 of 36 168 of 180 14 of 15 32 of 34 36 of 38 115 of 121 22 of 23 67 of 70 83 of 83 48 of 48 41 of 41

0%

0%

0%

0%

0%

0%

0%

4%

6%

7%

8%

9%

10%

10%

11%

12%

13%

13%

19%

20%

21%

26%

28%

30%

32%

33%

33%

35%

35%

37%

39%

45%

47%

47%

50%

51%

53%

54%

54%

56%

57%

58%

60%

61%

63%

66%

67%

67%

73%

74%

76%

77%

79%

79%

85%

86%

87%

88%

92%

93%

93%

94%

95%

95%

96%

96%

100%

100%

100%

Figure 14. Proportion of men assigned a navigator

nurse by hospital, 2014.

0 40 80 Percent Ljungby lasarett

Mora lasarett Sjukhuset i Gävle Örnsköldsviks sjukhus Ängelholms sjukhus Västmanlands sjukhus Västerås Lasarettet i Enköping Others Länssjukhuset i Sundsvall Sjukhuset i Arvika Simrishamns sjukhus Östersunds sjukhus Centralsjukhuset Kristianstad Norrlands universitetssjukhus Umeå Falu lasarett/Ludvika lasarett Kiruna sjukhus Centralsjukhuset i Karlstad Sollefteå sjukhus Sjukhuset i Hudiksvall Sjukhuset i Lidköping Skellefteå lasarett Västerviks sjukhus Lasarettet i Ystad Kärnsjukhuset i Skövde Höglandssjukhuset Sahlgrenska Universitetssjukhuset Gällivare sjukhus Private practice − Stockholm−Gotland Piteå älvdals sjukhus Blekingesjukhuset − Karlskrona Oskarshamns sjukhus South Älvsborgs Sjukhus − Skene Sjukhuset i Bollnäs SWEDEN Centrallasarettet Växjö Uddevalla sjukhus Universitetssjukhuset Örebro Länssjukhuset i Kalmar Sunderby sjukhus Värnamo sjukhus Akademiska sjukhuset Nyköpings lasarett Skånes universitetssjukhus − Lund/Malmö Lindesbergs lasarett Private practice − West Private practice − South Helsingsborgs lasarett Kullbergska sjukhuset/Mälarsjukhuset Visby lasarett Varbergs sjukhus Capio S:t Görans sjukhus − Urologisektionen Lasarettet Trelleborg Alingsås lasarett Hallands sjukhus Halmstad Norrtälje sjukhus Private practice − Uppsala−Örebro Södersjukhuset Karolinska universitetssjukhuset − Solna Danderyds sjukhus Private practice − South east Länssjukhuset Ryhov Södertälje sjukhus Universitetssjukhuset i Linköping/Vrinnevisjukhuset Lycksele lasarett South Älvsborgs Sjukhus − Borås Karolinska universitetssjukhuset − Huddinge Karlskoga lasarett Kalix sjukhus Hallands sjukhus Kungsbacka

No. of cases

15 of 41 21 of 55 58 of 145 29 of 71 30 of 71 89 of 206 21 of 48 4 of 9 61 of 127 4 of 8 12 of 24 57 of 113 11 of 21 67 of 117 84 of 144 9 of 15 162 of 266 27 of 43 49 of 77 51 of 80 46 of 72 47 of 73 46 of 70 38 of 57 69 of 103 131 of 195 17 of 25 594 of 864 11 of 16 73 of 106 14 of 20 29 of 41 38 of 53 4629 of 6396 99 of 135 122 of 166 49 of 66 76 of 102 72 of 94 51 of 66 67 of 82 36 of 44 213 of 258 20 of 24 245 of 292 173 of 200 73 of 84 89 of 102 39 of 44 65 of 73 27 of 30 37 of 41 53 of 58 65 of 71 34 of 37 70 of 76 65 of 70 27 of 29 42 of 45 127 of 136 91 of 96 48 of 50 209 of 216 36 of 37 75 of 76 46 of 46 21 of 21 15 of 15 38 of 38

37%

38%

40%

41%

42%

43%

44%

44%

48%

50%

50%

50%

52%

57%

58%

60%

61%

63%

64%

64%

64%

64%

66%

67%

67%

67%

68%

69%

69%

69%

70%

71%

72%

72%

73%

73%

74%

75%

77%

77%

82%

82%

83%

83%

84%

86%

87%

87%

89%

89%

90%

90%

91%

92%

92%

92%

93%

93%

93%

93%

95%

96%

97%

97%

99%

100%

100%

100%

100%

Figure 15. Proportion of men with time between date of referral and first visit at a specialist cli- nic being 60 days or less by hospital, 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 40 80

Percent Sjukhuset i Arvika

Simrishamns sjukhus Piteå älvdals sjukhus Sjukhuset i Lidköping Karlskoga lasarett Akademiska sjukhuset South Älvsborgs Sjukhus − Borås Kiruna sjukhus Oskarshamns sjukhus Private practice − Stockholm−Gotland South Älvsborgs Sjukhus − Skene Södertälje sjukhus Universitetssjukhuset i Linköping/Vrinnevisjukhuset Sjukhuset i Hudiksvall Visby lasarett Sjukhuset i Bollnäs Danderyds sjukhus Sunderby sjukhus Alingsås lasarett Sjukhuset i Gävle Västerviks sjukhus Länssjukhuset i Sundsvall Centralsjukhuset Kristianstad Höglandssjukhuset Norrtälje sjukhus Ljungby lasarett Kalix sjukhus Kärnsjukhuset i Skövde Private practice − South east Östersunds sjukhus Lasarettet i Enköping Västmanlands sjukhus Västerås Private practice − West Skånes universitetssjukhus − Lund/Malmö Centralsjukhuset i Karlstad SWEDEN Länssjukhuset i Kalmar Gällivare sjukhus Uddevalla sjukhus Kullbergska sjukhuset/Mälarsjukhuset Nyköpings lasarett Varbergs sjukhus Private practice − Uppsala−Örebro Karolinska universitetssjukhuset − Huddinge Sollefteå sjukhus Hallands sjukhus Halmstad Örnsköldsviks sjukhus Lycksele lasarett Private practice − South Mora lasarett Lasarettet Trelleborg Skellefteå lasarett Lasarettet i Ystad Norrlands universitetssjukhus Umeå Capio S:t Görans sjukhus − Urologisektionen Länssjukhuset Ryhov Universitetssjukhuset Örebro Värnamo sjukhus Others Karolinska universitetssjukhuset − Solna Centrallasarettet Växjö Lindesbergs lasarett Falu lasarett/Ludvika lasarett Sahlgrenska Universitetssjukhuset Blekingesjukhuset − Karlskrona Södersjukhuset Ängelholms sjukhus Hallands sjukhus Kungsbacka Helsingsborgs lasarett

No. of cases

0 of 11 0 of 31 0 of 19 2 of 94 1 of 38 4 of 145 3 of 100 1 of 27 1 of 25 99 of 2434 2 of 42 3 of 62 19 of 332 6 of 101 3 of 47 6 of 77 4 of 51 10 of 120 6 of 70 14 of 163 9 of 102 17 of 187 4 of 44 13 of 125 6 of 56 6 of 56 3 of 28 10 of 91 28 of 246 19 of 165 8 of 69 31 of 267 55 of 457 47 of 385 38 of 308 1412 of 10077 20 of 136 4 of 26 31 of 201 23 of 145 8 of 50 16 of 97 22 of 132 12 of 72 9 of 53 15 of 86 18 of 103 7 of 38 70 of 356 15 of 74 12 of 59 17 of 83 24 of 109 30 of 135 12 of 53 30 of 120 28 of 110 23 of 87 3 of 11 10 of 34 50 of 170 9 of 30 54 of 170 91 of 266 56 of 133 29 of 65 43 of 90 46 of 70 97 of 138

0%

0%

0%

2%

3%

3%

3%

4%

4%

4%

5%

5%

6%

6%

6%

8%

8%

8%

9%

9%

9%

9%

9%

10%

11%

11%

11%

11%

11%

12%

12%

12%

12%

12%

12%

14%

15%

15%

15%

16%

16%

16%

17%

17%

17%

17%

17%

18%

20%

20%

20%

20%

22%

22%

23%

25%

25%

26%

27%

29%

29%

30%

32%

34%

42%

45%

48%

66%

70%

Figure 16. Proportion of men with time between di-

agnostic biopsy and information of result

being 18 days or less by hospital, 2014.

0 40 80 Percent Simrishamns sjukhus

Visby lasarett Capio S:t Görans sjukhus − Urologisektionen Piteå älvdals sjukhus Hallands sjukhus Kungsbacka Private practice − West Lycksele lasarett Lasarettet i Enköping Centralsjukhuset Kristianstad Varbergs sjukhus Sahlgrenska Universitetssjukhuset Uddevalla sjukhus Sunderby sjukhus Örnsköldsviks sjukhus Lindesbergs lasarett Private practice − Stockholm−Gotland Private practice − South Ängelholms sjukhus South Älvsborgs Sjukhus − Skene Skellefteå lasarett Nyköpings lasarett Lasarettet i Ystad Sjukhuset i Lidköping Södertälje sjukhus Ljungby lasarett Karolinska universitetssjukhuset − Huddinge Länssjukhuset Ryhov Private practice − Uppsala−Örebro Kärnsjukhuset i Skövde Mora lasarett SWEDEN Akademiska sjukhuset Södersjukhuset Alingsås lasarett Centrallasarettet Växjö Skånes universitetssjukhus − Lund/Malmö Private practice − South east Universitetssjukhuset i Linköping/Vrinnevisjukhuset South Älvsborgs Sjukhus − Borås Sjukhuset i Bollnäs Kalix sjukhus Hallands sjukhus Halmstad Helsingsborgs lasarett Västmanlands sjukhus Västerås Sollefteå sjukhus Falu lasarett/Ludvika lasarett Östersunds sjukhus Kullbergska sjukhuset/Mälarsjukhuset Universitetssjukhuset Örebro Sjukhuset i Hudiksvall Länssjukhuset i Sundsvall Others Norrtälje sjukhus Karolinska universitetssjukhuset − Solna Karlskoga lasarett Länssjukhuset i Kalmar Norrlands universitetssjukhus Umeå Värnamo sjukhus Danderyds sjukhus Centralsjukhuset i Karlstad Blekingesjukhuset − Karlskrona Lasarettet Trelleborg Sjukhuset i Gävle Västerviks sjukhus Oskarshamns sjukhus Höglandssjukhuset

No. of cases

2 of 8 2 of 7 5 of 12 3 of 7 3 of 7 36 of 73 3 of 6 8 of 16 4 of 8 8 of 14 16 of 28 18 of 30 17 of 28 14 of 23 8 of 13 150 of 239 33 of 50 14 of 21 8 of 12 12 of 18 6 of 9 12 of 18 17 of 25 9 of 13 9 of 13 7 of 10 19 of 27 16 of 22 16 of 22 19 of 26 1287 of 1739 29 of 39 6 of 8 9 of 12 23 of 30 60 of 78 31 of 40 42 of 54 14 of 18 7 of 9 7 of 9 13 of 16 23 of 28 53 of 64 5 of 6 41 of 49 26 of 31 23 of 27 30 of 35 18 of 21 20 of 23 7 of 8 7 of 8 7 of 8 7 of 8 37 of 42 24 of 27 9 of 10 14 of 15 72 of 77 18 of 19 20 of 21 44 of 46 25 of 26 5 of 5 17 of 17

25%

29%

42%

43%

43%

49%

50%

50%

50%

57%

57%

60%

61%

61%

62%

63%

66%

67%

67%

67%

67%

67%

68%

69%

69%

70%

70%

73%

73%

73%

74%

74%

75%

75%

77%

77%

78%

78%

78%

78%

78%

81%

82%

83%

83%

84%

84%

85%

86%

86%

87%

88%

88%

88%

88%

88%

89%

90%

93%

94%

95%

95%

96%

96%

100%

100%

Figure 17. Proportion of men with expected survival exceeding 5 years (age at diagnosis ≤ 80 years) with high risk or locally advanced prostate cancer examined with bone scan or other bone investigation by hospital, 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 40 80

Percent Karlskoga lasarett

Capio S:t Görans sjukhus − Urologisektionen Östersunds sjukhus Karolinska universitetssjukhuset − Solna Centralsjukhuset i Karlstad Södersjukhuset Helsingsborgs lasarett Sjukhuset i Gävle Blekingesjukhuset − Karlskrona Private practice − Uppsala−Örebro Hallands sjukhus Halmstad Danderyds sjukhus Alingsås lasarett Skånes universitetssjukhus − Lund/Malmö Kullbergska sjukhuset/Mälarsjukhuset Centrallasarettet Växjö Värnamo sjukhus Hallands sjukhus Kungsbacka Others Uddevalla sjukhus Örnsköldsviks sjukhus Länssjukhuset Ryhov SWEDEN Universitetssjukhuset i Linköping/Vrinnevisjukhuset Private practice − West Länssjukhuset i Sundsvall Västmanlands sjukhus Västerås Sahlgrenska Universitetssjukhuset Private practice − Stockholm−Gotland Ängelholms sjukhus Varbergs sjukhus South Älvsborgs Sjukhus − Borås Skellefteå lasarett Sjukhuset i Lidköping Sjukhuset i Hudiksvall Private practice − South east Private practice − South Norrlands universitetssjukhus Umeå Lasarettet i Ystad Lasarettet i Enköping Höglandssjukhuset Falu lasarett/Ludvika lasarett Akademiska sjukhuset

No. of cases

2 of 5 4 of 8 4 of 7 12 of 21 10 of 17 12 of 18 4 of 6 5 of 7 6 of 8 8 of 10 4 of 5 4 of 5 4 of 5 33 of 40 5 of 6 15 of 18 6 of 7 6 of 7 37 of 43 13 of 15 10 of 11 10 of 11 933 of 1017 12 of 13 27 of 29 17 of 18 18 of 19 36 of 38 486 of 497 6 of 6 11 of 11 6 of 6 10 of 10 6 of 6 5 of 5 9 of 9 26 of 26 8 of 8 8 of 8 5 of 5 10 of 10 8 of 8 5 of 5

40%

50%

57%

57%

59%

67%

67%

71%

75%

80%

80%

80%

80%

82%

83%

83%

86%

86%

86%

87%

91%

91%

92%

92%

93%

94%

95%

95%

98%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Figure 18. Proportion of men (75 years or younger at

time of diagnosis) with prostate cancer of

very low risk given active surveillance as

primary treatment by hospital, 2014.

0 40 80 Percent Lycksele lasarett

Lindesbergs lasarett Karlskoga lasarett Kalix sjukhus Hallands sjukhus Kungsbacka Capio S:t Görans sjukhus − Urologisektionen Private practice − West Private practice − South east Skellefteå lasarett Private practice − Stockholm−Gotland Karolinska universitetssjukhuset − Solna Centralsjukhuset Kristianstad Piteå älvdals sjukhus Lasarettet i Enköping Alingsås lasarett Universitetssjukhuset i Linköping/Vrinnevisjukhuset Others Varbergs sjukhus Private practice − Uppsala−Örebro Lasarettet Trelleborg Falu lasarett/Ludvika lasarett Skånes universitetssjukhus − Lund/Malmö Karolinska universitetssjukhuset − Huddinge Private practice − South Länssjukhuset Ryhov Sunderby sjukhus Visby lasarett Uddevalla sjukhus Akademiska sjukhuset Helsingsborgs lasarett Ängelholms sjukhus South Älvsborgs Sjukhus − Borås SWEDEN Värnamo sjukhus Sjukhuset i Bollnäs Östersunds sjukhus Mora lasarett Länssjukhuset i Kalmar Västmanlands sjukhus Västerås Länssjukhuset i Sundsvall Norrlands universitetssjukhus Umeå Sahlgrenska Universitetssjukhuset Centralsjukhuset i Karlstad Örnsköldsviks sjukhus Lasarettet i Ystad Danderyds sjukhus Västerviks sjukhus Sjukhuset i Lidköping Höglandssjukhuset Kärnsjukhuset i Skövde Universitetssjukhuset Örebro Nyköpings lasarett Hallands sjukhus Halmstad Sjukhuset i Gävle Blekingesjukhuset − Karlskrona Södersjukhuset Sjukhuset i Hudiksvall Ljungby lasarett Kullbergska sjukhuset/Mälarsjukhuset Centrallasarettet Växjö

No. of cases

0 of 5 0 of 11 0 of 7 0 of 9 0 of 6 0 of 40 1 of 28 1 of 26 1 of 10 12 of 90 11 of 81 1 of 7 1 of 5 1 of 5 1 of 5 12 of 57 4 of 19 3 of 14 2 of 9 4 of 18 9 of 39 18 of 77 5 of 20 6 of 22 7 of 25 7 of 22 2 of 6 12 of 34 17 of 48 7 of 19 6 of 15 9 of 22 638 of 1489 3 of 7 4 of 9 10 of 21 11 of 23 19 of 39 30 of 59 11 of 21 17 of 30 35 of 61 44 of 75 13 of 21 8 of 12 8 of 12 16 of 23 11 of 15 11 of 14 16 of 20 28 of 33 7 of 8 14 of 16 36 of 41 18 of 19 29 of 30 18 of 18 8 of 8 22 of 22 31 of 31

0%

0%

0%

0%

0%

0%

4%

4%

10%

13%

14%

14%

20%

20%

20%

21%

21%

21%

22%

22%

23%

23%

25%

27%

28%

32%

33%

35%

35%

37%

40%

41%

43%

43%

44%

48%

48%

49%

51%

52%

57%

57%

59%

62%

67%

67%

70%

73%

79%

80%

85%

88%

88%

88%

95%

97%

100%

100%

100%

100%

Figure 19. Participation in multidisciplinary team con- ference concerning curative treatment for men (80 years or younger at time of dia- gnosis) with prostate cancer of high risk by hospital, 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 20 60 100

Percent Private practice − South

Private practice − West Sjukhuset i Hudiksvall Private practice − South east Lasarettet i Ystad Höglandssjukhuset Karolinska universitetssjukhuset − Huddinge Universitetssjukhuset Örebro Sjukhuset i Bollnäs Danderyds sjukhus Uddevalla sjukhus Länssjukhuset i Kalmar Örnsköldsviks sjukhus Private practice − Stockholm−Gotland Kärnsjukhuset i Skövde Akademiska sjukhuset Västmanlands sjukhus Västerås Östersunds sjukhus Sunderby sjukhus Kalix sjukhus Helsingsborgs lasarett Others Centralsjukhuset i Karlstad Centralsjukhuset Kristianstad SWEDEN Varbergs sjukhus Sahlgrenska Universitetssjukhuset Norrlands universitetssjukhus Umeå Länssjukhuset Ryhov Hallands sjukhus Halmstad Universitetssjukhuset i Linköping/Vrinnevisjukhuset Länssjukhuset i Sundsvall Capio S:t Görans sjukhus − Urologisektionen South Älvsborgs Sjukhus − Borås Västerviks sjukhus Södersjukhuset Centrallasarettet Växjö Skånes universitetssjukhus − Lund/Malmö Sjukhuset i Gävle Karolinska universitetssjukhuset − Solna Ängelholms sjukhus Skellefteå lasarett Sjukhuset i Lidköping Mora lasarett Lasarettet Trelleborg Kullbergska sjukhuset/Mälarsjukhuset Falu lasarett/Ludvika lasarett Blekingesjukhuset − Karlskrona

No. of cases

5 of 9 9 of 14 6 of 9 8 of 12 6 of 9 6 of 9 7 of 10 10 of 14 5 of 7 5 of 7 16 of 22 20 of 27 6 of 8 35 of 46 7 of 9 27 of 33 29 of 35 10 of 12 10 of 12 5 of 6 10 of 12 42 of 50 22 of 26 6 of 7 750 of 870 7 of 8 36 of 41 15 of 17 15 of 17 8 of 9 29 of 32 10 of 11 30 of 33 12 of 13 17 of 18 17 of 18 17 of 18 53 of 56 25 of 26 69 of 70 7 of 7 5 of 5 5 of 5 10 of 10 6 of 6 11 of 11 21 of 21 13 of 13

56%

64%

67%

67%

67%

67%

70%

71%

71%

71%

73%

74%

75%

76%

78%

82%

83%

83%

83%

83%

83%

84%

85%

86%

86%

88%

88%

88%

88%

89%

91%

91%

91%

92%

94%

94%

94%

95%

96%

99%

100%

100%

100%

100%

100%

100%

100%

100%

Figure 20. Proportion of men (75 years or younger

at time of diagnosis) with localized high

risk prostate cancer given curative primary

treatment by hospital, 2014.

0 40 80 Percent Universitetssjukhuset Örebro

Sjukhuset i Gävle Sunderby sjukhus Kullbergska sjukhuset/Mälarsjukhuset Länssjukhuset i Sundsvall Västmanlands sjukhus Västerås Karolinska universitetssjukhuset − Huddinge South Älvsborgs Sjukhus − Borås Helsingsborgs lasarett Akademiska sjukhuset Sjukhuset i Hudiksvall Visby lasarett Sahlgrenska Universitetssjukhuset Länssjukhuset i Kalmar Skånes universitetssjukhus − Lund/Malmö Blekingesjukhuset − Karlskrona SWEDEN Östersunds sjukhus Länssjukhuset Ryhov Varbergs sjukhus Carlanderska sjukhuset Sophiahemmet Karolinska universitetssjukhuset − Solna Uddevalla sjukhus Centralsjukhuset i Karlstad Others Norrlands universitetssjukhus Umeå Södersjukhuset Danderyds sjukhus Hallands sjukhus Halmstad Universitetssjukhuset i Linköping/Vrinnevisjukhuset Falu lasarett/Ludvika lasarett Centrallasarettet Växjö Kärnsjukhuset i Skövde Capio S:t Görans sjukhus − UroClinic Västerviks sjukhus Nyköpings lasarett Capio S:t Görans sjukhus − Urologisektionen

No. of cases

0 of 8 4 of 35 2 of 8 17 of 31 13 of 20 27 of 39 28 of 39 27 of 37 25 of 34 54 of 73 9 of 12 7 of 9 155 of 194 45 of 56 222 of 270 47 of 56 2177 of 2502 39 of 44 71 of 80 27 of 30 43 of 47 74 of 80 305 of 329 59 of 63 110 of 117 16 of 17 48 of 51 50 of 53 37 of 39 61 of 64 152 of 159 22 of 23 58 of 60 38 of 39 62 of 63 26 of 26 12 of 12 185 of 185

0%

11%

25%

55%

65%

69%

72%

73%

74%

74%

75%

78%

80%

80%

82%

84%

87%

89%

89%

90%

91%

92%

93%

94%

94%

94%

94%

94%

95%

95%

96%

96%

97%

97%

98%

100%

100%

100%

Figure 21. Proportion of men with prostate cancer planned for a prostatectomy with uni- or bilateral nerve sparing intent by hospital 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 40 80

Percent Länssjukhuset i Kalmar

Sjukhuset i Hudiksvall Centrallasarettet Växjö Karolinska universitetssjukhuset − Huddinge Akademiska sjukhuset Centralsjukhuset i Karlstad Others Länssjukhuset i Sundsvall Universitetssjukhuset i Linköping/Vrinnevisjukhuset Karolinska universitetssjukhuset − Solna Skånes universitetssjukhus − Lund/Malmö Sunderby sjukhus Sophiahemmet South Älvsborgs Sjukhus − Borås Västerviks sjukhus SWEDEN Västmanlands sjukhus Västerås Blekingesjukhuset − Karlskrona Södersjukhuset Hallands sjukhus Halmstad Nyköpings lasarett Sjukhuset i Gävle Sahlgrenska Universitetssjukhuset Falu lasarett/Ludvika lasarett Norrlands universitetssjukhus Umeå Östersunds sjukhus Capio S:t Görans sjukhus − Urologisektionen Kullbergska sjukhuset/Mälarsjukhuset Danderyds sjukhus Varbergs sjukhus Länssjukhuset Ryhov Kärnsjukhuset i Skövde Carlanderska sjukhuset Uddevalla sjukhus Capio S:t Görans sjukhus − UroClinic Visby lasarett Helsingsborgs lasarett

No. of cases

8 of 17 5 of 8 27 of 39 15 of 20 28 of 37 39 of 51 10 of 13 10 of 13 74 of 96 159 of 206 90 of 116 4 of 5 42 of 52 14 of 17 5 of 6 1165 of 1390 21 of 25 25 of 29 26 of 30 34 of 39 7 of 8 15 of 17 85 of 96 8 of 9 27 of 30 28 of 31 112 of 122 23 of 25 26 of 28 18 of 19 36 of 38 18 of 19 24 of 25 33 of 34 45 of 46 8 of 8 16 of 16

47%

62%

69%

75%

76%

76%

77%

77%

77%

77%

78%

80%

81%

82%

83%

84%

84%

86%

87%

87%

88%

88%

89%

89%

90%

90%

92%

92%

93%

95%

95%

95%

96%

97%

98%

100%

100%

Figure 22. Proportion of men with pathologic pT2-

tumour after radical prostatectomy having

negative surgical margins by hospital, 2014.

3.2 Diagnostics .

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, 1998-2014.

Stockholm- Gotland

Uppsala-

Orebro ¨ South east South West North Total

Year of dx

1998 748 (69) 1370 (98) 716 (100) 1153 (100) 1381 (98) 772 (100) 6140 (94)

1999 1140 (92) 1580 (99) 791 (100) 1334 (99) 1487 (99) 835 (100) 7167 (98)

2000 1193 (84) 1520 (100) 775 (100) 1411 (100) 1587 (98) 756 (100) 7242 (96)

2001 1285 (90) 1589 (100) 776 (100) 1517 (100) 1581 (98) 712 (100) 7460 (98)

2002 1344 (86) 1659 (100) 849 (100) 1480 (99) 1473 (99) 828 (100) 7633 (97)

2003 1702 (95) 1911 (100) 903 (100) 1653 (100) 1778 (99) 927 (100) 8874 (99)

2004 1927 (95) 2022 (99) 1030 (100) 1807 (100) 1939 (99) 1056 (100) 9781 (99)

2005 1974 (95) 1981 (99) 1143 (100) 1794 (99) 1907 (100) 957 (100) 9756 (99)

2006 1686 (86) 1923 (99) 1122 (100) 1717 (99) 1907 (100) 827 (100) 9182 (97)

2007 1676 (98) 1828 (99) 1102 (100) 1629 (98) 1803 (100) 869 (100) 8907 (99)

2008 1611 (93) 1829 (100) 1051 (100) 1730 (98) 1704 (100) 930 (100) 8855 (98)

2009 2016 (96) 2256 (100) 1398 (100) 1879 (99) 1946 (100) 1028 (100) 10523 (99) 2010 1886 (98) 1930 (100) 1236 (100) 1681 (98) 1951 (100) 1078 (100) 9762 (99)

2011 1788 (91) 1957 (100) 1209 (100) 1793 (97) 1854 (100) 973 (100) 9574 (98)

2012 1881 (96) 1731 (100) 1123 (100) 1638 (92) 1540 (100) 1022 (100) 8935 (98)

2013 2310 (94) 1919 (99) 1140 (100) 1642 (93) 1533 (100) 983 (100) 9527 (97)

2014 2917 (83) 2041 (99) 1175 (100) 1703 (96) 1579 (100) 1037 (100) 10452 (94) Total 29084 (91) 31046 (99) 17539 (100) 27561 (98) 28950 (99) 15590 (100) 149770 (98)

Table 2. Number of cases and capture ratio (%) in NPCR by county, for year of diagnosis 2014.

Cancer

register NPCR Capture

ratio (%) Landsting

J¨ amtland 168 168 (100)

J¨ onk¨ oping 346 346 (100)

Kalmar 267 267 (100)

Others/private - West 457 457 (100)

V¨ asterbotten 273 273 (100)

V¨ astmanland 273 273 (100)

Orebro ¨ 191 191 (100)

Osterg¨ ¨ otland 339 339 (100)

West G¨ otaland 917 916 (100)

Sk˚ ane 886 884 (100)

Halland 260 259 (100)

Norrbotten 223 222 (100)

S¨ odermanland 198 197 (99)

V¨ asternorrland 348 346 (99)

Others/private - Uppsala- ¨ Orebro 141 140 (99)

Blekinge 138 137 (99)

Dalarna 244 242 (99)

V¨ armland 355 352 (99)

Others/private - South east 253 250 (99)

Kronoberg 230 227 (99)

Uppsala 244 240 (98)

G¨ avleborg 352 344 (98)

Gotland 52 48 (92)

Stockholm 506 458 (91)

Others/private - South 465 405 (87)

Others/private - Stockholm-Gotland 2881 2350 (82)

Since year of diagnosis is taken from the Swedish Cancer Register, the numbers may differ slightly from the previous table.

0 3 6 9 12

Months since diagnosis 0

20 40 60 80 100

Cumulative proportion (%) reported to NPCR ^66.3%

88.0%

97.0%

Figure 23. Time (months) between date of diagno- sis and reporting to the NPCR for cases diagnosed 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 3 6 9 12

Months since diagnosis 0

20 40 60 80 100

Cumulative proportion (%) reported to NPCR

Stockholm−Gotland

64.6%

79.5%

90.5%

0 3 6 9 12

Months since diagnosis 0

20 40 60 80 100

Cumulative proportion (%) reported to NPCR

Uppsala−Örebro

64.2%

91.8%

99.8%

0 3 6 9 12

Months since diagnosis 0

20 40 60 80 100

Cumulative proportion (%) reported to NPCR

South east

67.7%

93.0%

99.9%

0 3 6 9 12

Months since diagnosis 0

20 40 60 80 100

Cumulative proportion (%) reported to NPCR

South

65.0%

90.0%

99.5%

0 3 6 9 12

Months since diagnosis 0

20 40 60 80 100

Cumulative proportion (%) reported to NPCR

West

68.4%

88.1%

98.7%

0 3 6 9 12

Months since diagnosis 0

20 40 60 80 100

Cumulative proportion (%) reported to NPCR

North

72.9%

95.3% 99.8%

Figure 24. Time (months) between date of diagno-

sis and reporting to the NPCR for cases

diagnosed 2014 by health care region.

Table 3. Main reason for the initiation of the medical investigation that led to the prostate cancer diagnosis by year of diagnosis, 2004-2014.

Health

control LUTS Other

symptoms Missing Total

Year of dx

2004 2800 (29) 3473 (36) 3107 (32) 401 (4) 9781

2005 2744 (28) 4124 (42) 2381 (24) 507 (5) 9756

2006 2610 (28) 3965 (43) 2121 (23) 486 (5) 9182

2007 2909 (33) 3685 (41) 1907 (21) 406 (5) 8907

2008 3079 (35) 3654 (41) 1789 (20) 333 (4) 8855

2009 4461 (42) 3820 (36) 1915 (18) 327 (3) 10523

2010 4124 (42) 3471 (36) 1914 (20) 253 (3) 9762

2011 4181 (44) 3297 (34) 1868 (20) 228 (2) 9574

2012 4143 (46) 2840 (32) 1690 (19) 262 (3) 8935

2013 4702 (49) 2863 (30) 1738 (18) 224 (2) 9527

2014 5512 (53) 3089 (30) 1597 (15) 254 (2) 10452