The proposed survival benefit of Neoadjuvant Chemotherapy in advanced bladder carcinoma warrants further analysis in search of subgroups having the highest benefit. Downstaging analysis and the concept of Organ Confined disease (OC) and Nonorgan Confined (NOC) disease may serve for the first step in such an investigation.

Aim. To evaluate tolerability and technical feasibility of colorectal cancer screening with flexible sigmoidoscopy.Methods. One thousand men and women aged 59-61 years, randomly selected from the population register of Uppsala, Sweden, were invited by mail. After random allocation, half of them were called up by a nurse (group 1), white the other half were asked to call themselves (group 2) to book a sigmoidoscopy. After the examination, the participants anonymously answered a questionnaire about their subjective experiences. Endoscopists and their assisting nurse filled out structured forms documenting various technical aspects including an estimation of the subjects' discomfort.Results. Four hundred and sixty-nine subjects participated. Mean intubation depth was 59 cm (range 28-60) and mean duration 5.8 min (range 2-23). On average, participants reported low degrees of discomfort and feeling of exposure, but 19 and 27% rated pain and distension, respectively, on the upper half of a visual analogue scale (VAS). Most subjects found the duration acceptable. Patient discomfort, as appraised by the endoscopists, was lower in men than in women, positively linked to duration of the procedure, but inversely associated with intubation distance. However, the overall differences between strata of participants were small. Among self-reported variables, group 1 and 2 differed significantly only with regard to 'other discomfort'. All but six subjects would accept a repeat examination. Failures, resulting in incomplete examinations, occurred in 14 subjects.Conclusions. Flexible sigmoidoscopy is generally well tolerated and technically feasible in screening for colorectal cancer. A more personalised invitation did not have any important effects on the subjective experience. (C) 2004 Elsevier Ltd. All rights reserved.

You have accessJournal of UrologyDiscussed Poster, Sunday, May 9, 2004, 8:00 am - 12:00 pm1 Apr 2004327: Downstaging Analysis Following Neoadjuvant Cisplatinum Based Combination Chemotherapy for Invasive Bladder Carcinoma.Evaluation of Two Combined Prospective Nordic Trials Amir Sherif, Erkki Rintala, Oddvar Mestad, Lars Holmberg, Jonas Nilsson, Sten Nilsson, and Per-Uno Malmstrom Amir SherifAmir Sherif More articles by this author , Erkki RintalaErkki Rintala More articles by this author , Oddvar MestadOddvar Mestad More articles by this author , Lars HolmbergLars Holmberg More articles by this author , Jonas NilssonJonas Nilsson More articles by this author , Sten NilssonSten Nilsson More articles by this author , and Per-Uno MalmstromPer-Uno Malmstrom More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37589-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "327: Downstaging Analysis Following Neoadjuvant Cisplatinum Based Combination Chemotherapy for Invasive Bladder Carcinoma.Evaluation of Two Combined Prospective Nordic Trials." The Journal of Urology, 171(4S), p. 86 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 86 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Amir Sherif More articles by this author Erkki Rintala More articles by this author Oddvar Mestad More articles by this author Lars Holmberg More articles by this author Jonas Nilsson More articles by this author Sten Nilsson More articles by this author Per-Uno Malmstrom More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVES:A Nordic collaborative group assessed the effectiveness of cisplatinum based combination chemotherapy prior to cystectomy in two consecutive trials. We analyzed overall survival in all patients and in prespecified subgroups defined by preoperative T-stage, gender and age. METHODS:The studies included in 1985-1997 620 patients with clinically T1G3, T2-T4aNXM0 urothelial bladder cancer and WHO performance </=2. Platinum was combined with adriamycin in the first and with methotrexate in the second trial. In the first of the studies, preoperative radiotherapy was used in both arms. Individual patient data were used. No patients were lost to follow-up. The median follow-up was 4.7 years. A fixed effect model was used to combine the results of the two trials. Subgroup analyses were performed for T-stages, gender and age groups. All analyses were done according to intention to treat. RESULTS:The combined study results showed a hazard ratio of 0.80 (95% confidence interval 0.64-0.99) for overall survival in favor of neoadjuvant treatment. Survival was 56% at five years in the experimental group versus 48% in the control group, thus corresponding to an eight percent absolute risk reduction after neoadjuvant chemotherapy. We could not substantiate any differences in effect by subgroup. CONCLUSIONS:In a combined analysis of two trials within the same study organization and the same clinical and biological domain, neoadjuvant platinum based combination chemotherapy was associated with a 20% reduction in the relative hazard in probability of death.

Neoadjuvant Cisplatinum Based Combination Chemotherapy Improves Overall Survival in Patients with Invasive Bladder Cancer : A Combined Analysis of Two Nordic Collaborative Studies

Objective: Previous studies have shown a relationship between serum prostate-specific antigen (PSA) level and prostate tumour volume. Reports based on selected case series have also indicated that serum PSA may be used for staging, although a varying prevalence of metastasizing tumours complicates the interpretation of these studies. In order to determine the accuracy of the serum level of PSA in predicting the presence of metastases we performed a prospective cohort study of a geographically defined population of men with prostate cancer.Methods: Serum level of PSA and the results of investigations for regional lymph node and distant metastases were recorded for all 8328 men with prostate cancer registered in the Swedish National Prostate Cancer Register 1996-1997.Results: The prevalence of lymph node metastases among men who had undergone lymph node exploration was 4%. 16% and 33% for well, moderately and poorly differentiated tumours. The corresponding prevalence of distant metastases was 12%. 30% and 48%. With serum PSA <20 ng/ml as a cut-off point the negative likelihood ratios for well and moderately differentiated tumours were found to be 0.47 and 0.45 for lymph node metastases and 0.24 and 0.18 for distant metastases. resulting in post-test probabilities >92% for the exclusion of metastases. In men with poorly differentiated tumours. the negative likelihood ratio would need to be even lower to safely exclude disseminated disease.Conclusion: For well to moderately differentiated tumours, further investigations to assess the presence of metastases may be omitted with no great risk for understaging if serum PSA <20 ng/ml.

Objective: To evaluate how serum, prostate-specific antigen (PSA) levels in a population-based cohort of men with prostate cancer vary with age and intensity in the diagnostic activity, and to describe the treatment selection processes associated with PSA level.Material and Methods: All men in the Swedish National Prostate Cancer Register diagnosed during 1996-1997 were included. In 1996 the register included 19 counties. covering 61% of the S, Swedish male population, and in 1997 21 Counties with 79% of the Swedish mate population,Results: A total of 8328 men were registered. PSA levels were missing in 341 cases. With increasing PSA there was a shift towards more advanced and poorly differentiated tumours. PSA at diagnosis increased with aged with the exception of patients younger than 50 years who had higher PSA values. The mean logarithm of PSA correlated negatively with the percentage of localized tumours (p<0.005)and the age-adjusted incidence (p<0.05) in each respective county in 1997. PSA was higher in men receiving radiotherapy compared with those treated with radical prostatectomy as well its in the group treated with bilateral orchiectomy compared with those receiving GnRH-analogues.Conclusions: If PSA is used as a surrogate measure of extent of tumour volume in a population of prostate cancer patients, our findings indicate that age distribution and differences in incidence (possibly due to variation in diagnostic activity) should be taken Into account. In Our cohort there was it selection process. probably in part guided by PSA level. when choosing type of curative or palliative treatment.

INTRODUCTIONIn 1996 registration of prostate cancer in four of the six Swedish regions was started to facilitate evaluation of geographical variations in incidence and treatment.MATERIAL AND METHODSFor all cases of prostate cancer, personal identification number, tumour stage, tumour grade and primary treatment were registered.RESULTSIn the four regions covered by the register, 3541 cases of prostate cancer were registered. Altogether there were 5795 cases of prostate cancer diagnosed in Sweden the same year. The age-standardized incidence varied from 89/100000 to 169/100000 among counties. The proportion of localized tumours correlated positively to the incidence (p < 0.05) and negatively to mean age at diagnosis (p < 0.01). There was also a significant positive correlation between the proportion of localized tumours and the percentage of patients given curative treatment. All registered variables showed large geographical variations, especially concerning percentage of T1c tumours, treatment of localized tumours and choice of palliative treatment.CONCLUSIONDiagnostic activity varied considerably among counties, resulting in large variation in age-standardized incidence. High incidence is associated with a larger proportion of localized tumours, which, in turn, is associated with early age at diagnosis. In counties where a policy of detecting tumours early is practised, curative treatment is also given more often. Treatment of localized tumours and preference for palliative treatment seem to depend on local traditions. The lack of cytological and histopathological standards makes geographical comparisons based on tumour grade impossible.