Peter Iversen

University of Copenhagen, København, Capital Region, Denmark

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Publications (110)298.98 Total impact

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    ABSTRACT: To investigate the clinical implications of interobserver variation in the assessment of re-biopsies obtained during active surveillance (AS).
    BJU International 06/2014; · 3.05 Impact Factor
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    ABSTRACT: Background Enzalutamide is an oral androgen-receptor inhibitor that prolongs survival in men with metastatic castration-resistant prostate cancer in whom the disease has progressed after chemotherapy. New treatment options are needed for patients with metastatic prostate cancer who have not received chemotherapy, in whom the disease has progressed despite androgen-deprivation therapy. Methods In this double-blind, phase 3 study, we randomly assigned 1717 patients to receive either enzalutamide (at a dose of 160 mg) or placebo once daily. The coprimary end points were radiographic progression-free survival and overall survival. Results The study was stopped after a planned interim analysis, conducted when 540 deaths had been reported, showed a benefit of the active treatment. The rate of radiographic progression-free survival at 12 months was 65% among patients treated with enzalutamide, as compared with 14% among patients receiving placebo (81% risk reduction; hazard ratio in the enzalutamide group, 0.19; 95% confidence interval [CI], 0.15 to 0.23; P<0.001). A total of 626 patients (72%) in the enzalutamide group, as compared with 532 patients (63%) in the placebo group, were alive at the data-cutoff date (29% reduction in the risk of death; hazard ratio, 0.71; 95% CI, 0.60 to 0.84; P<0.001). The benefit of enzalutamide was shown with respect to all secondary end points, including the time until the initiation of cytotoxic chemotherapy (hazard ratio, 0.35), the time until the first skeletal-related event (hazard ratio, 0.72), a complete or partial soft-tissue response (59% vs. 5%), the time until prostate-specific antigen (PSA) progression (hazard ratio, 0.17), and a rate of decline of at least 50% in PSA (78% vs. 3%) (P<0.001 for all comparisons). Fatigue and hypertension were the most common clinically relevant adverse events associated with enzalutamide treatment. Conclusions Enzalutamide significantly decreased the risk of radiographic progression and death and delayed the initiation of chemotherapy in men with metastatic prostate cancer. (Funded by Medivation and Astellas Pharma; PREVAIL ClinicalTrials.gov number, NCT01212991.)
    New England Journal of Medicine 06/2014; · 54.42 Impact Factor
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    ABSTRACT: The androgen receptor inhibitor enzalutamide is approved for the treatment of metastatic castration-resistant prostate cancer that has progressed on docetaxel. Our aim was to assess the activity and safety of enzalutamide monotherapy in men with hormone-naive prostate cancer. This trial is an ongoing open-label, single-arm, phase 2 study, done across 12 European sites. Men aged over 18 years, with hormone-naive prostate cancer for whom hormone therapy was indicated, and who had non-castration levels of testosterone and prostate-specific antigen (PSA) of 2 ng/mL or greater at screening, and an Eastern Cooperative Oncology Group score of 0, received oral enzalutamide 160 mg/day. The primary outcome was the proportion of patients with an 80% or greater decline in PSA at week 25. All analyses included all patients who had received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT01302041. 67 men were enrolled into the study. 62 patients (92·5%, 95% CI 86·2-98·8) had a decline in PSA of 80% or greater at week 25. The most commonly reported treatment-emergent adverse events up to week 25 were gynaecomastia (n=24), fatigue (n=23), nipple pain (n=13), and hot flush (n=12), all of which were of mild to moderate severity. Nine patients had a treatment-emergent adverse event of grade 3 or higher, most of which were reported in one patient each, except for pneumonia (grade 3, two patients) and hypertension (grade 3, four patients). Five patients reported serious adverse events, none of which were deemed to be treatment related. Our findings suggest that enzalutamide monotherapy in men with hormone-naive prostate cancer of varying severity provides a level of disease suppression, and was generally well tolerated. These findings provide a rationale for further investigation of clinical response and outcomes with enzalutamide in non-castrate men with prostate cancer. Astellas Pharma Inc, Medivation Inc.
    The Lancet Oncology 04/2014; · 25.12 Impact Factor
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    ABSTRACT: Abstract Objective. The aim of this study was to describe recovery of urinary continence and potency and report oncological and functional outcomes using the survival, continence and potency (SCP) system for patients undergoing robot-assisted radical prostatectomy (RARP). Material and methods. From 2009 to 2012, 232 patients underwent RARP. Self-reported continence, erection sufficient for intercourse (ESI) and scores on the five-item version of the International Index of Erectile Function-5 (IIEF-5) were registered by questionnaire and physician's interview preoperatively and at 3, 6 and 12 month follow-up, and subsequently on a yearly basis. Continence was defined as 0 pads, and potency as ESI or IIEF-5 greater than 17 with or without the aid of phosphodiesterase type 5 inhibitors. Oncological success was defined as absence of biochemical failure (BF) [prostate-specific antigen (PSA) ≥0.2 ng/ml]. The SCP system was used to evaluate combined oncological and functional outcomes. Results. In total, 184 patients were followed for more than 1 year. The 12 month BF-free survival rate was 97.7%. Median time to regain continence was 6.2 months; 12 months postoperatively 79.9% used 0 pads/day. Of patients with preoperative ESI, 77.6% (67.9-86.1) and 34.4% (24.1-47.5) maintained ESI 12 months postoperatively after bilateral and unilateral nerve-sparing surgery (NS), respectively. NS (p < 0.0001), increasing prostate volume (p = 0.014) and lower age (p < 0.0001) were positively associated with recovery of potency. Using the SCP system and defining potency as ESI, functional and oncological success 12 months after surgery was achieved in 69 out of 135 (51.1%) preoperative continent and potent patients who underwent unilateral or bilateral NS, and did not require adjuvant treatment; when defining potency as IIEF greater than 17, this figure was 45 out of 108 (41.7%). As expected, the proportions were significantly higher for bilateral than for unilateral NS (p ≤ 0.0014). Conclusion. RARP provides good early BF-free survival, continence and potency recovery rates for patients eligible for NS.
    Scandinavian journal of urology. 03/2014;
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    ABSTRACT: Active surveillance (AS) has been introduced as an observational strategy to delay or avoid curative treatment without compromising long-term cancer-specific survival. The 10 studies included in this review, published between 2008 and 2013, generally agreed upon patients selection for the AS strategy and how they should be managed within the program. However, uncertainties persists concerning optimal patient selection and reliable progression criteria, as well as the long-term safety of AS. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 03/2014; · 2.64 Impact Factor
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    ABSTRACT: To investigate how location of positive surgical margins (PSM) in pT2 tumors affect the risk of biochemical recurrence (BR). The study includes 1,133 consecutive patients from 1995 until end of 2011, who had organ-confined disease (pT2) following RP. The location of PSM was stratified into apical and non-apical. BR was defined as the first PSA ≥ 0.2 ng/ml after RP. Risk of BR was analyzed with Kaplan-Meier and Cox regression analysis. Median follow-up was 3.6 years (range: 0.5-15.5 years). The overall pT2 PSM rate was 26.3%. Overall, a pT2 with PSM had a 3.1-fold increased risk of BR compared to margin negative patients. Patients with pT2 apical and non-apical PSM had a 5-year biochemical recurrence-free survival of 84.9% (95% CI: 77.6-92.2%) and 78.6% (95% CI: 71.3-85.9%), respectively. In multivariate analysis, pT2 apical and non-apical PSM was individually associated with a 2.2- and 3.8-fold increased risk of BR compared to margin negative patients. In our cohort the location of pT2 PSM was associated with time to BR, that is, patients with non-apical pT2 PSM endured the highest risk of BR compared to apical PSM. This may indicate that not all patients with pT2 PSM should be offered adjuvant therapy. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 02/2014; · 2.64 Impact Factor
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    ABSTRACT: Background Compelling biomarkers identifying prostate cancer patients with a high risk of progression during active surveillance (AS) are needed. Objective To examine the association between ERG expression at diagnosis and the risk of progression during AS. Design, setting, and participants This study included 265 patients followed on AS with prostate-specific antigen (PSA) measurements, clinical examinations, and 10–12 core rebiopsies from 2002 to 2012 in a prospectively maintained database. ERG immunohistochemical staining was performed on diagnostic paraffin-embedded formalin-fixed sections with a ready-to-use kit (anti-ERG, EPR3864). Men were characterised as ERG positive if a minimum of one tumour focus demonstrated ERG expression. Outcome measurements and statistical analysis Overall AS progression was defined as clinical progression: increased clinical tumour category ≥cT2b by digital rectal examination and ultrasound, and/or histopathologic progression: upgrade of Gleason score, more than three positive cores or bilateral positive cores, and/or PSA progression: PSA doubling time <3 yr. Risk of progression was analysed using multiple cause-specific Cox regression and stratified cumulative incidences (Aalen-Johansen method). Curatively intended treatment, watchful waiting, and death without progression were treated as competing events. Results and limitations A total of 121 of 142 ERG-negative and 96 of 123 ERG-positive patients had complete diagnostic information. In competing risk models, the ERG-positive group showed significantly higher incidences of overall AS progression (p < 0.0001) and of the subgroups PSA progression (p < 0.0001) and histopathologic progression (p < 0.0001). The 2-yr cumulative incidence of overall AS progression was 21.7% (95% confidence interval [CI], 14.3–29.1) in the ERG-negative group compared with 58.6% (95% CI, 48.7–68.5) in the ERG-positive group. ERG positivity was a significant predictor of overall AS progression in multiple Cox regression (hazard ratio: 2.45; 95% CI, 1.62–3.72; p < 0.0001). The main limitation of this study is its observational nature. Conclusions In our study, ERG positivity at diagnosis can be used to estimate the risk of progression during AS. If confirmed, ERG status can be used to individualise AS programmes. Patient summary The tissue biomarker ERG identifies active surveillance patients with an increased risk of disease progression.
    European Urology 01/2014; · 10.48 Impact Factor
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    ABSTRACT: Abstract Objective.The aim of this study was to record prostate-specific antigen (PSA) response and overall survival (OS) for a group of metastatic castration-resistant prostate cancer (mCRPC) patients treated with enzalutamide following progression after abiraterone treatment in the post-chemotherapy setting. Material and methods. Twenty-four mCRPC patients with progression after abiraterone treatment following primary docetaxel therapy received enzalutamide 160 mg/day. The percentage PSA response was recorded following first line docetaxel, abiraterone and enzalutamide treatment. Fischer's exact test, Mann-Whitney U test and linear regression model were used to test for differences in PSA response. Results.All patients had a follow-up of at least 3 months. The median PSA response following 1 month of enzalutamide was -12% (range -56% to 76%), while the median best PSA response was -22% (-76% to 76%). Forty-six percent had a greater than 30% decrease in PSA. The PSA response to enzalutamide did not correlate with the number of prior cancer treatments (p = 0.57), time from diagnosis to mCRPC (p = 0.11) or prior response to docetaxel (p = 0.67). However, patients treated with second line cabazitaxel had an inferior PSA response to enzalutamide (p = 0.03), and there was a trend for the PSA response to abiraterone to correlate with the PSA response to the succeeding enzalutamide (B = 0.22, p = 0.05). The median OS was 4.8 months. Conclusions.Previous abiraterone therapy is associated with a less marked fall in PSA following enzalutamide therapy in post-chemotherapy mCRPC patients compared with reported results in randomized trials. Larger prospective studies of sequencing are warranted.
    Scandinavian journal of urology. 11/2013;
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    ABSTRACT: To investigate risk factors associated with positive surgical margins (PSM) and biochemical recurrence (BR) in organ confined tumors (pT2) after radical prostatectomy (RP) for localized prostate cancer (PCa). Between 1995 and 2011, 1,649 patients underwent RP at our institution. The study includes the 1,133 consecutive patients with pT2 tumors at final histopathology. Logistic regression analysis was used for risk of PSM. Risk of BR, defined as the first PSA ≥ 0.2 ng/ml, was analyzed with Kaplan-Meier and Cox regression analysis. Median follow-up was 3.6 years (range: 0.5-15.5 years). In logistic regression, NS surgery was independently associated with an increased risk of pT2 PSM (OR = 1.68, 95% CI: 1.3-2.0, P = 0.01) relative to non-NS surgery. NS surgery was not independently associated with BR but the interaction of PSM and NS surgery trended (P = 0.08) to increase the risk of BR compared to PSM and non-NS surgery. Several factors influence the risk of pT2 PSMs in radical prostatectomy. In our cohort pT2 PSM is associated with NS surgery and trend to increase risk of BR compared to non-NS surgery. The optimal selection of candidates for NS surgery is still not clear. J. Surg. Oncol. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 10/2013; · 2.64 Impact Factor
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    ABSTRACT: Prostate cancer that progresses despite castrate levels of serum testosterone is defined as castration-resistant prostate cancer (CRPC). Molecular investigations of the disease have established that progression of CRPC remains driven by androgen receptor signalling and that CRPC continues to respond to hormonal manipulation. Recently, new endocrine treatments including an androgen receptor signalling inhibitor and a testosterone synthesis inhibitor have been approved for treatment of CRPC. We review the pivotal phase 3 trials and discuss their implications for future treatment of CRPC.
    Ugeskrift for laeger 09/2013; 175(40):2328-2332.
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    ABSTRACT: We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients. A total of 239 patients were planned to undergo robot-assisted radical prostatectomy performed with a DaVinci robot. Final histopathology and pre- and perioperative parameters were registered. Furthermore, early and late complications were recorded according to the Clavien-Dindo classification. Robot-assisted radical prostatectomy was completed in 232 patients (97.1%). The median duration of surgery decreased significantly from initially 4.6 h in the first quartile to 3.1 h in the last quartile (p < 0.001). Overall, the median perioperative blood loss was 300 ml (range: 25-1,000 ml). The median admission time was one day (range: 1-5 days), and the median duration of bladder catheterization was eight days (range: 6-149 days). In total, 88 post-operative complications were observed in 73 patients (31.5%). A total of 70 complications appeared within 30 days of surgery, whereas 18 occurred later. Among the early complications, the majority (57.1%) were minor (Clavien-Dindo grade ≤ II); however, overall 2.6% suffered an early grade ≥ IIIb complication. Overall, the margin-positive rate was 29.3% decreasing from 43.1% in the first quartile to 24.7% in the last three quartiles (p = 0.008). Robot-assisted laparoscopic radical prostatectomy is a safe procedure with minimal blood loss, short hospitalization and short time catheter post-operatively. not relevant. not relevant.
    Danish Medical Journal 09/2013; 60(9):A4696. · 0.76 Impact Factor
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    ABSTRACT: Background. The Danish attitude for diagnosis and treatment of early localized prostate cancer (PCa) has historically been conservative. Denmark introduced radical prostatectomy (RP) as the last of the Nordic countries in 1995. However, a rapid increment in the Danish incidence of PCa is indicative of a shift in attitude with increasing opportunistic PSA testing. This had led to an increasing number of RPs being performed in Denmark. The objective of this study was to analyze changes in preoperative characteristics over time for the complete cohort of 6489 men who underwent RP between 1995 and 2011. Our hypothesis was that an increasing amount of men undergo RP for lower risk PCa. Material and methods. All patients operated from 1995 to 2011 were identified via patient files and registries. Changes over time in age at surgery, preoperative PSA, clinical T-category, biopsy Gleason score (GS), and D'Amico classification are described. Tests for statistically significant changes were performed. Results. Median age increased from 61.4 to 64.8 years (p < 0.0001) during the 16-year period. Median PSA declined from 11.5 to 7.9 ng/ml (p < 0.0001). Distribution of biopsy GS changed significantly, especially after 2005. Biopsy GS = 7 was found in 20.2% of the patients in 2005 compared to 57.1% in 2011. The proportion of T1 disease increased from 32% to 56%. Significant changes in percentage of patients according to the D'Amico classification were found. After 2005 the proportion of intermediate-risk patients increased significantly. The proportion of patients age 70 or above increased from 2% to 13% in the period studies. Conclusion. Significant preoperative stage- and Gleason grade migration was found in this complete Danish nationwide cohort of patients undergoing RP during the past 16 years. This effect is most likely attributed to an increasing use of PSA as marker for early prostate cancer diagnosis in Denmark and new international guidelines for Gleason grading and scoring.
    Acta oncologica (Stockholm, Sweden) 08/2013; · 2.27 Impact Factor
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    ABSTRACT: Abstract Objective. The aim of this study was to analyse whether primary Gleason pattern in biopsy Gleason score (GS) 7 predicted adverse histopathological features and had an impact on the risk of biochemical failure in a consecutive series of patients undergoing radical prostatectomy (RP). Material and methods. Between 2006 and 2010, 441 patients with biopsy GS 7 underwent RP at Rigshospitalet, Copenhagen, Denmark. Favourable histopathological features were defined as pT2 margin-negative cancer, RP specimen GS ≤ 3+4 and no lymph-node metastasis. Adverse histopathological features were defined as advanced pT3/4 cancer or pT2 margin-positive cancer and/or RP specimen GS ≥ 4+3 and/or positive lymph nodes. Biochemical failure was defined as the first prostate-specific antigen (PSA) ≥ 0.2 ng/ml. Results. A total of 344 patients (78.0%) had GS 3+4 in biopsies, while 97 patients (22.0%) had GS 4+3. No difference in age, PSA, percentage of biopsies with cancer, clinical tumour stage or volume on transrectal ultrasonography was found. Primary Gleason pattern 4 was associated with worse pathological stage (p = 0.049). On multivariate analysis, primary Gleason pattern 4 (p < 0.0001), cT stage (p = 0.024), PSA (p < 0.0001) and age (p = 0.009) predicted adverse histopathological features. In univariate analysis, Gleason score 3+4 had a significantly lower biochemical failure rate compared with Gleason score 4+3 (p = 0.0035). PSA (p < 0.0001), primary Gleason pattern 4 (p = 0.001) and percentage of biopsies with cancer (p = 0.02) were independently associated with risk of biochemical failure. Conclusions. In biopsies with GS 7, a primary Gleason pattern 4 was associated with significantly elevated risk of adverse histopathological features and biochemical failure compared to pattern 3 in patients undergoing RP. This study underlines the heterogeneity of biopsy GS 7.
    Scandinavian journal of urology. 07/2013;
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    ABSTRACT: ● To elucidate the role of PSA doubling time (PSAdt) as a progression criterion in patients with low-risk prostate cancer managed on active surveillance (AS). PSAdt was calculated with 95% confidence intervals (95% CI) in order to assess the risk of misclassification. ● Further, the correlation between PSAdt during AS and final histopathology following radical prostatectomy (RP) in patients meeting predefined progression criteria was evaluated. ● 258 consecutive patients followed in an AS program. ● PSAdt was calculated in patients with ≥2 PSA values, 95%CI was calculated in patients with ≥4 PSA values. ● Risk for progression was classified as: High-risk: PSAdt <3 years, re-biopsy Gleason score≥4+3, >3 positive biopsy cores, and/or bilateral tumour, or cT≥2c, intermediate-risk: PSAdt 3≤5 years, Gleason score=3+4 or cT2b, or low-risk: PSAdt >5 years and without histopathological or clinical progression. ● Definitive treatment was recommended high-risk patients and treatment options were discussed with intermediate-risk patients. ● A total of 2.291 PSA determinations obtained during AS were available of which 2.071 were considered valid in the 258 patients. ● PSAdt with 95% CI was calculated in 221 patients based on a median of 8 PSA values. ● The 95% CIs for PSAdt overlapped considerably and up to 91% of the patients' 95% CI crossed between the risk-group definitions. In total 26% (68/258) underwent RP after meeting the progression criteria. ● There was no association between preoperative PSAdt and final histopathology (P = 0.87). ● The uncertainty of calculated PSAdt during AS results in a significant risk of patients being misclassified according to the progression risk definitions which subsequent limits its use in the management of patients on AS.
    BJU International 07/2013; · 3.05 Impact Factor
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    ABSTRACT: Insulin resistance and changes in body composition are side effects of androgen deprivation therapy (ADT) given to prostate cancer patients. The present study investigates if endurance training improves insulin sensitivity and body composition in ADT-treated prostate cancer patients. Nine men undergoing ADT for prostate cancer and 10 healthy men with normal testosterone levels underwent 12 weeks of endurance training. Primary endpoints were insulin sensitivity (euglycemic hyperinsulinemic clamps with concomitant glucose-tracer infusion) and body composition (dual-energy x-ray absorptiometry and magnetic resonance imaging). The secondary endpoint was systemic inflammation. Statistics: Two-way ANOVA. Endurance training increased VO2max (ml(O2)/min/kg) by 11% and 13% in patients and controls, respectively (p<0.0001). The patients and controls demonstrated an increase in peripheral insulin sensitivity of 14% and 11%, respectively (p<0.05), with no effect on hepatic insulin sensitivity (p=0.32). Muscle protein content of GLUT4 and total Akt was also increased in response to the training (p<0.05 and p<0.01, respectively). Body weight (p<0.0001) and whole-body fat mass (p<0.01) were reduced, while lean body mass (p=0.99) was unchanged. Additionally, reductions were noted in abdominal (p<0.01), subcutaneous (p<0.05) and visceral fat mass (p<0.01). Plasma markers of systemic inflammation were unchanged in response to the training. No group×time interactions were found, except for thigh intermuscular adipose tissue (IMAT) (p=0.01), reflecting a significant reduction in IMAT in controls (p<0.05) not observed in patients (p=0.64). In response to endurance training, ADT-treated prostate cancer patients improved insulin sensitivity and body composition to a similar degree as eugonadal men.
    Endocrine Related Cancer 06/2013; · 5.26 Impact Factor
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    ABSTRACT: AIM: Although prostate-specific antigen (PSA) screening reduces mortality from prostate cancer, substantial over-diagnosis and subsequent overtreatment are concerns. Early screening of men for PSA may serve to stratify the male population by risk of future clinical prostate cancer. METHODS AND MATERIAL: Case-control study nested within the Danish 'Diet, Cancer and Health' cohort of 27,179 men aged 50-64 at enrolment. PSA measured in serum collected at cohort entry in 1993-1997 was used to evaluate prostate cancer risk diagnosed up to 14years after. We identified 911 prostate cancer cases in the Danish Cancer Registry through 31st December 2007 1:1 age-matched with cancer-free controls. Aggressive cancer was defined as ⩾T3 or Gleason score ⩾7 or N1 or M1. Statistical analyses were based on conditional logistic regression with age as underlying time axis. RESULTS: Total PSA and free-to-total PSA ratio at baseline were strongly associated with prostate cancer risk up to 14years later. PSA was grouped in quintiles and free-to-total PSA ratio divided in three risk groups. The incidence rate ratio for prostate cancer was 150 (95% confidence interval, 72-310) among men with a total PSA in the highest quintile (>5.1ng/ml) compared to the lowest (<0.80ng/ml). The risk of aggressive cancer was highly elevated in men with a PSA level in the highest quintile. The results indicate that one-time measurement of PSA could be used in an individualised screening strategy, sparing a large proportion of men from further PSA-based screening.
    European journal of cancer (Oxford, England: 1990) 05/2013; · 4.12 Impact Factor
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    ABSTRACT: The objective of this study was to investigate standardised relative survival and mortality ratio for patients undergoing radical prostatectomy for localized prostate cancer at our institution. Between 1995 and 2010, a total of 1,350 consecutive patients underwent radical prostatectomy. Patients were followed prospectively per protocol. No patients were lost to follow-up. Overall and cause-specific survival were described using Kaplan-Meier plots. Standardized relative survival and mortality ratio were calculated based on expected survival in the age-matched Danish population using the methods and macros described by Dickmann. The country-specific population mortality rates used for calculation of the expected survival were based on data from The Human Mortality Database. The median follow-up was 3.4 years (range: 0-14.3 years). A total of 59 (4.4%) patients died during follow-up. In all, 17 (1.3%) patients died of prostate cancer. The estimated ten-year overall survival was 89.3%. The cancer-specific survival was estimated to 96.6% after ten years. Relative survival was 1.04 after five years and 1.14 after ten years. The standardized mortality ratio, i.e. observed mortality/expected mortality, was 0.61 and 0.39 at five and ten years, respectively. The overall and cancer-specific ten-year survival in a consecutive series of patients in a non-screened Danish population is ≥ 89%. The survival and mortality ratio is significantly better than expected in the age-matched background population. This finding is likely explained by selection bias. Although the results indicate an excellent outcome in terms of cancer control, the efficacy of prostatectomy for localized prostate cancer remains at debate. not relevant. not relevant.
    Danish Medical Journal 04/2013; 60(4):A4612. · 0.76 Impact Factor
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    ABSTRACT: OBJECTIVES: To describe survival and cause of death in a nationwide cohort of Danish patients with prostate cancer undergoing radical prostatectomy (RP). To describe risk factors associated with prostate cancer mortality. PATIENTS AND METHODS: Observational study of 6489 men with localised prostate cancer treated with RP at six different hospitals in Denmark between 1995 and 2011. Survival was described using Kaplan-Meier estimates. Causes of death were obtained from the national registry and cross-checked with patient files. Cumulative incidence of death, any cause and prostate cancer-specific, was described using Nelson-Aalen estimates. Risk for prostate cancer death was analysed in a Cox multivariate regression model using the covariates: age, cT-category, PSA level and biopsy Gleason score. RESULTS: The median follow-up was 4 years. During follow-up, 328 patients died, 109 (33.2%) from prostate cancer and 219 (66.8%) from other causes. Six patients (0.09%) died ≤30 days of RP. In multivariate analysis, cT-category was a predictor of prostate cancer death (P < 0.001). Compared with T1 disease, both cT2c (hazard ratio [HR] 2.2) and cT3 (HR 7.2) significantly increased the risk of prostate cancer death. For every doubling of PSA level the risk of prostate cancer death was increased by 34.8% (P < 0.001). Biopsy Gleason score 4 + 3 and ≥8 were associated with an increased risk of prostate cancer death compared with biopsy Gleason score ≤ 6 of 2.3 and 2.7 (P = 0.003), respectively. The cumulative hazard of all-cause and prostate cancer-specific mortality after 10 years was 15.4% (95% confide3nce interval [CI] 13.2-17.7) and 6.6% (95% CI 4.9-8.2) respectively. CONCLUSIONS: We present the first survival analysis of a complete, nationwide cohort of men undergoing RP for localised prostate cancer. The main limitation of the study was the relatively short follow-up. Interestingly, our national results are comparable to high-volume, single institution, single surgeon series.
    BJU International 03/2013; · 3.05 Impact Factor
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    ABSTRACT: The incidence of prostate cancer in Denmark rose approximately 50% from 2000 to 2009 in parallel with the introduction of prostate-specific antigen (PSA)-testing. Available evidence indicates a significant overtreatment of patients with low-risk prostate cancer. Active surveillance has been proposed as an observation strategy to reduce overtreatment and limit curatively intended therapy to those patients who need it. We reported the first Danish results from an active surveillance cohort. A total of 167 patients were prospectively followed in an active surveillance programme. The median follow-up was 3.4 years (1.1-9.5). At entry the median age was 65 years (51-73), 94% had a Gleason score ≤ 6, 87.4% had a PSA ≤ 10 ng/ml and 99% ≤ cT2a. Ten patients progressed on digital rectal examination, 40 patients progressed due to a short PSA doubling time, and 34 patients progressed on re-biopsy. A total of 59 patients discontinued active surveillance. The estimated five-year probability of remaining on active surveillance was 60.0% (95% confidence interval 50.9-69.1%). Active surveillance as a management strategy for patients with clinically localized, low-risk prostate cancer is accepted by patients, seems feasible and can reduce overtreatment. However, long-term follow-up data are lacking and considerable uncertainties about optimal selection and progression criteria remain. The authors received financial support from the IMK Almene Fond. not relevant.
    Danish Medical Journal 02/2013; 60(2):A4575. · 0.76 Impact Factor
  • Martin Andreas Røder, Peter Iversen
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    ABSTRACT: There is no evidence for the use of radical prostatectomy in patients with disseminated prostate cancer. However, development of new and effective treatment strategies has changed the therapeutic scenario for advanced disease. Multimodal therapy, also including local therapy of the primary tumour, has received increased attention, and clinical studies in lymph node positive disease are under way. We report three patients in whom radical prostatectomy was performed despite the presence of metastases.
    Ugeskrift for laeger 12/2012; 174(50):3160-3161.

Publication Stats

2k Citations
298.98 Total Impact Points

Institutions

  • 2000–2014
    • University of Copenhagen
      • Faculty of Health and Medical Sciences
      København, Capital Region, Denmark
  • 2013
    • Copenhagen University Hospital
      København, Capital Region, Denmark
  • 2010
    • Region Hovedstaden
      • Department of Urology
      Hillerød, Capital Region, Denmark
  • 2000–2010
    • Walter Reed National Military Medical Center
      • Division of Urology
      Washington, Washington, D.C., United States
  • 2004
    • Technische Universität Dresden
      Dresden, Saxony, Germany
  • 2003
    • Medical College of Wisconsin
      • Department of Urology
      Milwaukee, WI, United States
  • 1998–2003
    • Rigshospitalet
      • Department of Urology
      København, Capital Region, Denmark