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Introduction: Radical prostatectomy has not been performed in Denmark until recently. In this paper, we report the results of the first patients undergoing a radical retropubic prostatectomy at Rigshospitalet., Material and Methods: Fifty consecutive patients, aged 47-68, median 59 years underwent radical prostatectomy. Ninety percent of the patients received three months of neoadjuvant endocrine therapy., Results: Histopathology showed that 78% had organ-confined disease. During a median follow-up of 370 days, 11 patients (22%) developed biochemical failure, defined as a PSA value above 0.1 ng/ml. Although the number of patients is small and the follow-up limited, we confirmed correlations between preoperative characteristics and the risk of extraprostatic extension at tumour and biochemical progression. Surgery was performed without major complications. Erectile dysfunction was reported by 88%, whereas complete urinary continence was achieved in 90% of the patients.

This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

Radical retropubic prostatectomy (RRP) as intended curative therapy for patients with clinically localized prostate cancer (PC) was initiated in 1995 in Denmark. This paper reports single-institution results fromthe first 1200 consecutive patients operated during a 15-year period. Median age at surgery was 63 years. Median PSA was 9 ng/mL. Palpable tumors (≤cT2) were present in 48% of patients. Gleason score at biopsy was ≤7 for 85% of patients. In sixty-five percent of patients, histopathology revealed localized PCa after RRP. Positive surgical margins were found in 39.2% of the cases. Biochemical recurrence (BR) occurred for 214 (18%) of patients. The estimated biochemical recurrence free survival (BRFS) was 71.7% and 63.2% after 5 and 10 years, respectively. When patients were stratified according to the D'Amico criteria, BRFS after 10 years was 75.3%, 59.7%, and 39.3% for low-, mediumand high-risk patients, respectively. In univariate analysis, clinical stage, PSA at diagnosis and type of surgery were significant predictors of BR. In multivariate analysis, Gleason score > 7, PSA > 10, and higher clinical stage were significant predictors of BR. Early Danish results in a population not subjected to screening demonstrate BRFS rates comparable with earlier reports from the prescreening era. [ABSTRACT FROM AUTHOR]

To investigate the risk of recurrence and long-term mortality after radical cystectomy (RC) for bladder cancer (BC) at a high-volume tertiary referral center in Denmark over 19 years. Patients undergoing RC between the 1st of January 2000 to 31st of December 2018 were included. Patient data were manually retrieved from electronic patient files. Follow-up ended 18th of May 2020. Cumulative incidences were used to assess risk of recurrence and mortality using competing risk modelling. Cause-specific Cox regression models were used for multivariable analysis. A total of 1267 patients underwent RC of which 1042 were eligible for analysis. Overall mortality was 40% and 56% after 5 and 10 years, respectively. The cumulative incidence of recurrence and BC specific mortality was high within the first 2 years. Only 3.2% of the patients with recurrence were alive at the end of follow-up. The cumulative incidence of BC mortality after 5 years was 6.7% (95% CI 3.6–9.9) and 10% (95% CI 6.8–14) for patients with ≤ pT1bN0 and pT2N0, respectively. For patients with lymph node positive disease the cumulative incidence of BC mortality after 5 years was 65% (95% CI 58–71). We found a significant risk of recurrence and disease-specific mortality following RC for BC, especially within the first 2 years following surgery. Our data seem comparable to other large cohorts. The chance of long-term survival following recurrence is low and there is a continuous need to improve adjuvant or salvage strategies following RC. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The dramatic increase in prostate cancer incidence causes higher demands for public health care. To meet these demands, fast track pathways have been introduced in radical prostatectomy. However, the short length of hospital admission leaves less time for patient education. The aim of this study was to investigate whether nurse-led telephone consultations (TCs) could optimize resources and secure rehabilitation and patient satisfaction in the post-operative period. This study is a prospective randomized controlled trial. A random sample of 95 consecutively enrolled patients was randomized to either intervention or standard follow-up. The intervention was an additional TC 3 days post-operatively. The care and patient education offered during hospitalization was similar for all patients. Randomization took place at discharge and was controlled externally. Data were collected from medical records and questionnaires 2 weeks post-operatively. We found no difference in the overall efficacy regarding patient satisfaction, sense of security and post-operative discomfort. Some patients had unmet needs and TCs provided better rehabilitation regarding management of bowel function, pain, catheter and wound care. There was no difference in the need of post-operative contact to other health care affiliates. In general, patients were sufficiently educated in managing early rehabilitation and they expressed high satisfaction and sense of security in the post-operative period after discharge regardless of TC. Therefore, TCs will not be the standard procedure, but the results have increased awareness in daily clinical practice and optimized the clinical pathway in general. The results indicate commitment and high adherence to clinical guidelines among the nursing staff. [ABSTRACT FROM AUTHOR]