Incidence and Survival of urothelial carcinoma of the urinary bladder in Norway 1981-2014.

BACKGROUND: Urothelial carcinoma of the urinary bladder (UCB) is the 4th most common cancer type in men in developed countries, and tumor recurrence or progression occurs in more than half of the patients. Previous studies report contradictory trends in incidence and survival over the past decades. This article describes the trends of UCB incidence and survival from 1981 to 2014, including both invasive and non-invasive UCB using data from the Cancer Registry of Norway. METHODS: In Norway, 33,761 patients were diagnosed with UCB between 1981 and 2014. Incidence and 5-year relative survival were calculated, stratified by sex, morphology, stage, age and diagnostic period. Age-period-cohort models were used to distinguish period- and cohort effects. Temporal trends were summarized by calculating the average absolute annual change in incidence and relative survival allowing for breaks in this trend by incorporating a joinpoint analysis. Excess mortality rate ratios (EMRR) quantify the relative risks by using a proportional excess hazard model. RESULTS: The incidence of UCB in men increased from 18.5 (1981-85) to 21.1 (1991-95) per 100 000 person-years and was rather stable thereafter (1996-2014). The incidence rates of UCB were lower in women increasing linearly from 4.7 to 6.2 over the past 34 years (p = 5.9 · 10-7). These trends could be explained by an increase of the incidence rates of non-invasive tumors. Furthermore, the observed pattern seemed to represent a birth cohort effect. Five-year relative survival increased annually with 0.004 in men (p = 1.3 · 10-6) and 0.003 in women (p = 4.5 · 10-6). There is a significant increase over the past 34 years in survival of UCB in both genders for local tumors but not for advanced stages. CONCLUSIONS: Increasing and stable incidence trends mirror little improvement in primary and secondary prevention of UCB for more than three decades. Survival proportions increased only marginally. Thus, any changes in treatment and follow-up care did not lead to notable improvement with respect to survival of the patients. High estimates of preventable cases together with large recurrence rates of this particular cancer type, demand more research on prevention guidelines, diagnostic tools and treatment for UCB.

Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA).

BACKGROUND: The purpose of the protocol was to reduce the treatment burden in clinical stage I (CSI) seminoma by offering risk-adapted treatment. The protocol aimed to prospectively validate the proposed risk factors for relapse, stromal invasion of the rete testis and tumor diameter >4 cm, and to evaluate the efficacy of one course of adjuvant carboplatin. PATIENTS AND METHODS: From 2007 to 2010, 897 patients were included in a prospective, population-based, risk-adapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n = 469) or surveillance (n = 422). In addition, results from 221 patients receiving carboplatin between 2004 and 2007 are reported. RESULTS: At a median follow-up of 5.6 years, 69 relapses have occurred. Stromal invasion of the rete testis [hazard ratio (HR) 1.9, P = 0.011] and tumor diameter >4 cm (HR 2.7, P < 0.001) were identified as risk factors predicting relapse. In patients without risk factors, the relapse rate (RR) was 4.0% for patients managed by surveillance and 2.2% in patients receiving adjuvant carboplatin. In patients with one or two risk factors, the RR was 15.5% in patients managed by surveillance and 9.3% in patients receiving adjuvant carboplatin. We found no increased RR in patients receiving carboplatin <7 × AUC compared with that in patients receiving ≥7 × AUC. CONCLUSION: Stromal invasion in the rete testis and tumor diameter >4 cm are risk factors for relapse in CSI seminoma. Patients without risk factors have a low RR and adjuvant therapy is not justified in these patients. The efficacy of adjuvant carboplatin is relatively low and there is need to explore more effective adjuvant treatment options in patients with high-risk seminoma. The data do not support the concept of a steep dose response for adjuvant carboplatin.

Regional trends in prostate cancer incidence, treatment with curative intent and mortality in Norway 1980-2007.

OBJECTIVES: To compare the trends in prostate cancer incidence, treatment with curative intent and mortality across regions and counties in Norway, and to consider changes in incidence (an indicator for early diagnosis) and treatment with curative intent as explanatory factors for the decreasing prostate cancer mortality rates. PATIENTS AND METHODS: Prostate cancer incidence and mortality data (1980-2007) alongside treatment data (1987-2005) were obtained from the national, population-based Cancer Registry of Norway. Joinpoint regression models were fitted to age-adjusted incidence, treatment and mortality rates to identify linear changes in the trends. RESULTS: Both age-adjusted incidence rates and rates of curative treatment of prostate cancer increased significantly in all five regions of Norway since the early 1990s. There was a strong positive correlation between increasing incidence and increasing use of curative treatment. The frequency of curative treatment in Western Norway was almost threefold that in the Northern and Central regions around year 2000. Subsequently, the regional trends converged and only minor differences in prostate cancer incidence and use of curative treatment were observed by 2005. The declines in mortality were observed earliest in the regions with the highest incidence and the most frequent use of curative treatment, while the largest decreases in mortality were found in counties where the largest increases in curative treatment were observed. CONCLUSIONS: The elucidation of the prostate cancer mortality trends is hindered by an inability to tease out the potential effects of early treatment from the more general impact of improved and more active treatment. However, it is likely that both sets of intervention have contributed to the decline in prostate cancer mortality in Norway since 1996.

Detection of urinary bladder cancer with flow cytometry and hexaminolevulinate in urine samples.

OBJECTIVES: Urinary bladder urothelial carcinoma is diagnosed by a combination of cystoscopy and biopsy, with cytology as a valuable additional technique. The accuracy of cytological diagnosis depends on the experience of the cytologist and can inevitably vary from one cytologist to another. There is a need for an easy, reliable and objective diagnostic method. In the present study a new method was designed for the detection of bladder cancer cells in urine. METHODS: Flow cytometry was utilized to detect protoporphyrin IX in an artificial model consisting of normal urinary bladder transitional epithelial cells (NBECs) from healthy volunteers' urine and an established human urinary bladder carcinoma cell line, TCCSUP, after incubation with hexaminolevulinate (HAL). In addition, urine samples from 19 patients with histopathologically confirmed superficial bladder cancer were examined. RESULTS: Incubation of NBECs or TCCSUP cells with HAL for 1 hour resulted in production of protoporphyrin IX only in the TCCSUP cells. Incubation of a mixture of NBECs and TCCSUP cells with HAL gave rise to a separated subpopulation of cells with protoporphyrin IX fluorescence. After cell sorting by flow cytometry the protoporphyrin IX-containing subpopulation of cells was confirmed as TCCSUP cells on cytological examination. It was possible to detect 5% TCCSUP cells in the mixture of NBECs/TCCSUP cells. To test the feasibility of the method in clinica diagnosis, urine samples from patients with bladder cancer were also measured with comparable, although preliminary and limited, results to those of cytological examination. CONCLUSIONS: The preliminary results show that the technique may be feasible for the detection of bladder cancer cells in urine with possible advantages of simplicity, reliability and objectivity.

[Laser treatment of benign prostatic hyperplasia]. / Laserbehandling av benign prostata hyperplasi.

Transurethral resection of the prostate (TURP) has been the gold standard for BPH for over 50 years. For the last five years laser treatment of BPH has been developed as a new modality. The principles of laser surgery and the options available in clinical practice today are outlined. A survey of indications, patient selection, results and complications are given based on the authors' own experience and reports from the international literature.

[Diagnosis and treatment of benign prostatic hyperplasia in general practice. Norwegian Medical Society]. / Utredning og behandling av benign prostatahyperplasi i allmennpraksis.

The prevalence of benign prostatic hyperplasia increases with increasing age. The growing number of elderly men in the population will cause a marked increase in the number of men suffering from this condition. The magnitude of the problem necessitates close cooperation between urologists and general practitioners in future in order to take care of patients with benign prostatic hyperplasia. The purpose of the present survey is to present guidelines for general practitioners to enable them to diagnose this condition and to present the various alternative treatments currently available. Patients with mild and modest symptoms do not need to be referred to an urologist and can be taken care of by the general practitioners themselves.

Five-year followup of a prospective trial of radical cystectomy and neoadjuvant chemotherapy: Nordic Cystectomy Trial I. The Nordic Cooperative Bladder Cancer Study Group.

PURPOSE: Chemotherapy is widely used in patients with locally advanced bladder cancer but until now there has been no conclusive evidence that this therapy improves survival. The Nordic Cooperative Bladder Cancer Study Group conducted a randomized phase III study to assess the possible benefit of neoadjuvant chemotherapy in patients with bladder cancer undergoing radical cystectomy after short-term radiotherapy. MATERIALS AND METHODS: Our trial included 325 patients with locally advanced stage T1 grade 3 or stages T2 to T4aNXM0 bladder cancer allocated randomly into a chemotherapy or no chemotherapy group (control). The chemotherapy schedule consisted of 2 cycles of 70 mg./m.2 cisplatin and 30 mg./m.2 doxorubicin with a 3-week interval between the cycles. RESULTS: After 5 years the overall survival rate was 59% in the chemotherapy group and 51% in the control group (p = 0.1). The corresponding cancer specific survival rate was 64 and 54%, respectively. In regard to treatment, no difference was observed for stages T1 and T2 disease, while there was a 15% difference in overall survival for patients with stages T3 to T4a disease (p = 0.03). In a multivariate analysis only chemotherapy and T category emerged as independent prognostic factors. The relative death risk for patients who received chemotherapy was 0.69 (95% confidence interval 0.49 to 0.98) compared to the control group after adjustment for the other tested factors. CONCLUSIONS: Neoadjuvant chemotherapy seems to improve long-term survival after cystectomy in patients with stages T3 to T4a bladder carcinoma, while no survival benefit was found for stages T1 to T2 disease.

Scanning electron microscopy of the accessory sex glands of the adult male rat.

This study describes the morphology of the accessory sex glands of the adult male rat as observed by scanning electron microscopy (SEM). The purpose was to obtain a systematic and comparative SEM description of these glands and to evaluate different preparation techniques. A common morphological feature is polyhedral delineation of the cells, which exhibited a variable convexity of their apical surface. The cell apices were more or less studded with microvilli. Nevertheless, it was possible to distinguish the glands by their surface morphology. In the ventral prostate, there was a considerable heterogeneity in cell surface appearance. The lateral lobe had a characteristic brush border, and in the dorsal lobe, surface blebbing and intracellular cisternae were observed. The cells of the seminal vesicle were covered by long microvilli, while particularly distinct, elevated cell borders and intracellular cisternae were typical for the coagulating gland. The secretory mechanism was merocrine in the ventral and lateral prostate and the seminal vesicle, and was mainly apocrine in the dorsal prostate. Surprisingly, only merocrine secretion was obvious in the coagulating gland. The most controversial observation, which needs further investigation, was the discovery of large orifices in the apical surface of individual seminal vesicle cells. These orifices may be indicative of an additional apocrine secretion in this gland. In studying this organ system, SEM provides information that adds to previous transmission electron microscopical investigations.

Effects of castration upon the morphology of the accessory sex organs of the male rat--a scanning electron microscopy study.

A systematic, comparative study of the accessory sex glands of the adult male rat after androgen withdrawal was carried out. The changes were investigated by using scanning electron microscopy at different intervals after surgical castration. The main common signs of epithelial cell involution were flattening of the cell surface, reduction of the size and number of microvilli, some blurring of the cell borders, cessation of secretory activity and diminution of the luminal volume of the glands. Overall, confident signs of atrophy were evident after one week, and complete epithelial involution was reached by the third week. The epithelial cell atrophy was accompanied by a relative stromal hyperplasia. The new observation seems to be that the process of stroma consolidation is progressing for a considerable time subsequent to the completion of the epithelial involution. This phenomenon is particularly evident in the dorsal prostate, the seminal vesicle and the coagulating gland.