Predictors of upgrading from low-grade cancer at prostatectomy in men with biparametric magnetic resonance imaging.

Introduction: Prostate-specific antigen (PSA) density has previously been identified as a predictor of histological upgrading at radical prostatectomy, but how information from pre-treatment biparametric magnetic resonance imaging (bpMRI) contributes needs further clarification. The objective of this register-based study was to identify predictors of upgrading at prostatectomy in men with Grade group (GG) 1 and pre-treatment bpMRI. Material and methods: This single-center study included men with GG 1 cancer on prediagnostic biopsy, who underwent bpMRI and robotic-assisted radical prostatectomy (RARP) between March 2014 and September 2019. We estimated logistic regression models to explore predictors for upgrading. The explored potential predictors were age, PSA density, tumor stage and Prostate Imaging Reporting and Data System (PI-RADS) score (dichotomised 1-3 versus 4-5). Results: Upgrading was observed in 56% (73/130) of the men. PSA density was the only significant predictor for upgrading (unadjusted OR = 1.7, 95% CI 1.2; 2.4 adjusted OR = 1.7, 95% CI 1.2; 2.5). The probability of upgrading was lower for men with a PIRADS 1-3 than for PIRADS 4-5, but the difference was not statistically significant (adjusted OR 0.4, 95% CI 0.2; 1.1, p = 0.082). Among men with PI-RADS 1-3, the probability increased with increasing PSA density (p = 0.036). With PI-RADS 4-5 the probability of upgrading was high over the entire PSA density range. Conclusions: PSA density is a clinically important factor to predict upgrading from GG1 when bpMRI shows PI-RADS 1-3. In men with PI-RADS 4-5 on bpMRI, the probability of an undetected GG 2-5 cancer is high regardless of the PSA density.

TECLA-an innovative technical approach for prostate cancer registries.

Objective: To present a code-driven, electronic database for patients TrEated with robotic-assisted radiCaL prostAtectomy (TECLA), developed at Innlandet Hospital (IH), Trust, Norway, for research, local quality control and to deliver data to the National Cancer Registry of Norway (CRN). Clinical data are directly extracted from the structured documentation in the electronic medical record (EMR).Materials and methods: The urological department at IH treats about 200 patients with robotic-assisted radical prostatectomy (RARP) annually. All consenting patients registered with the procedure code for RARP are included in TECLA. Clinical data are obtained automatically from the EMR, by structured forms. Patient-reported outcome and experience measures (PROMs and PREMs) are filled in by the patients on an iPad or a smartphone.Results: The basic construct of TECLA is presented. From August 2017 to June 2018, 200 men were treated with RARP, of which 182 (91%) provided consent for inclusion in the register. Of these, 97% completed the PROM survey before treatment and 91% at 3 months follow-up. PREMs were completed by 78%. All clinical variables for the hospital stay and for the 6-week follow-up were more than 95% complete.Conclusion: This entirely electronic surgical quality register is easy to use, both for patients and clinicians, and has a high capture rate. The data collection is linked to the clinicians' workflow, without double data entry, so entering data does not add any extra work. The register design can be used by other hospitals for various surgical procedures.

Cumulative incidence of asthma and allergy in north-Norwegian schoolchildren in 1985 and 1995.

The prevalence of asthma and allergy in children is increasing. In order to investigate time trends, follow-up studies conducted several years apart and with identical study designs are essential. We compared two identical, cross-sectional and questionnaire-based studies of asthma and allergy in north-Norwegian schoolchildren (7-13 years of age). The first study was conducted in 1985 (n = 10,093) and the second in 1995 (n = 8,676). The cumulative incidence was as follows: diagnosed asthma, 8.6% in 1995 vs. 5.1% in 1985, relative risk (RR) = 1.71 (95% CI: 1.53-1.90); allergic rhinoconjunctivitis, 22.1% in 1995 vs. 16.4% in 1985, RR = 1.39 (95% CI: 1.31-1.47); and atopic dermatitis, 19.7% in 1995 vs. 13.2% in 1985, RR = 1.48 (95% CI: 1.39-1.58). The cumulative incidence of allergic rhinoconjunctivitis and atopic dermatitis was higher in children of Sami ethnicity than Norse ethnicity in the 1985 study. Furthermore, although not statistically significant, there was a trend towards a greater increase in the cumulative incidence of diagnosed asthma, symptoms of asthma, allergic rhinoconjunctivitis, and atopic dermatitis from 1985 to 1995 in children of Sami ethnicity than Norse ethnicity. We conclude that there has been a marked increase in the cumulative incidence of asthma and allergy prevalence among schoolchildren in northern Norway from 1985 to 1995.