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dc.contributor.authorCarlsson, Sigrid
dc.date.accessioned2010-11-19T14:00:44Z
dc.date.available2010-11-19T14:00:44Z
dc.date.issued2010-11-19
dc.identifier.isbn978-91-628-8023-1
dc.identifier.urihttp://hdl.handle.net/2077/21922
dc.description.abstractAims: The Göteborg randomized population-based prostate cancer screening trial is a prospective study evaluating the efficacy of prostate-specific antigen (PSA)-based screening and its effect on prostate cancer mortality. The potential negative consequences in relation to benefits for men undergoing this screening are explored in this thesis. Methods: As of December 31, 1994, there were 32,298 men born between Jan 1, 1930 and Dec 31, 1944 (ages 50-64, median 56 years) living in the city of Göteborg. Of these, 20,000 men were randomly allocated in a 1:1 ratio to either a screening group or to a control group. This population constitutes the basis for this thesis. The cumulative incidence of prostate cancer and prostate cancer mortality were calculated and analyses made by intention-to-screen. Anxiety levels were assessed in screen-positive men. Short-term overall mortality after prostate biopsy was studied. Perioperative mortality after radical prostatectomy was evaluated from registry linkage with the follow-up study of the National Prostate Cancer Register (NPCR) 1997-2002. Side-effects from radical prostatectomy were evaluated for men in the screening study who underwent radical prostatectomy at Sahlgrenska University Hospital between 2001-2008. Results: A PSA-based screening program reduced the relative risk of prostate cancer mortality by 44% over 14 years. Overall, 293 men needed to be invited for screening and 12 to be diagnosed to prevent one prostate cancer death. Attending a screening program for prostate cancer is seldom associated with severe negative psychological distress, even for men with persistently elevated PSA levels. The risk of excess fatal complications after biopsy of the prostate is low. Radical prostatectomy is a procedure with very low perioperative mortality throughout the whole of Sweden. With 14 years of screening, for each prostate cancer death averted, the surgically induced morbidity due to screen-detected prostate cancer will render four men impotent or sexually inactive, and less than one man incontinent. Conclusions: PSA screening significantly, and substantially, reduces prostate cancer mortality. This benefit compares favorably to other cancer screening programs. The potential negative consequences of such screening may be acceptable in the light of a disease-specific mortality reduction. The risks of severe consequences from the screening procedures and radical prostatectomy seem minor, but the risk of negatively influencing the sexual performance may be substantial. The outcome on a population level may differ from the benefit for the individual.sv
dc.language.isoengsv
dc.relation.haspartI. Hugosson J, Carlsson S, Aus G, Bergdahl S, Khatami A, Lodding P, Pihl CG, Stranne J, Holmberg E, Lilja H. Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Lancet Oncol. 2010 Aug;11(8):725-32.::PMID:: 20598634sv
dc.relation.haspartII. Carlsson S, Aus G, Wessman C, Hugosson J. Anxiety associated with prostate cancer screening with special reference to men with a positive screening test (elevated PSA) - Results from a prospective, population-based, randomised study. Eur J Cancer. 2007 Sep;43(14):2109-16.::PMID:: 17643983sv
dc.relation.haspartIII. Carlsson S, Holmberg E, Moss S, Roobol M, Schröder F, Tammela T, Aus G, Auvinen A, Hugosson J. No excess mortality after prostate biopsy - Results from the European Randomized Study of Screening for Prostate Cancer. BJU Int. 2010. In press.::PMID:: 20950305sv
dc.relation.haspartIV. Carlsson S, Adolfsson J, Bratt O, Johansson JE, Ahlstrand C, Holmberg E, Stattin P, Hugosson J. Nationwide population-based study on 30-day mortality after radical prostatectomy in Sweden. Scand J Urol Nephrol. 2009;43(5):350-6.::PMID:: 19921978sv
dc.relation.haspartV. Carlsson S, Aus G, Bergdahl S, Khatami A, Lodding P, Stranne J, Hugosson J. The excess burden of side-effects from treatment in men allocated to screening for prostate cancer. The Göteborg randomised population-based prostate cancer screening trial. Accepted for publication in Eur J Cancer. 2010.sv
dc.subjectprostate cancersv
dc.subjectscreeningsv
dc.subjectmortalitysv
dc.subjectearly detectionsv
dc.subjectanxietysv
dc.subjectprostatectomysv
dc.subjectProstate-Specific Antigensv
dc.subjectprostate biopsysv
dc.subjectimpotencesv
dc.subjecturinary incontinencesv
dc.titleProstate cancer screening with PSA - A study of potential negative consequencessv
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailsigrid.carlsson@gmail.comsv
dc.type.degreeDoctor of Philosophy (Medicine)sv
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academysv
dc.gup.departmentInstitute of Clincial Sciences. Department of Urologysv
dc.gup.defenceplaceTorsdagen den 9 december, kl. 13.00, Stora aulan, Sahlgrenska Universitetssjukhusetsv
dc.gup.defencedate2010-12-09
dc.gup.dissdb-fakultetSA


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