Study type: Therapy (individual cohort).
Level of evidence: 2b.
Objective: Improving a country's management of cancer patients requires continuous evaluation, and requires the availability of population-based prognostic and therapeutic variables. We aimed to document the national diagnostic and therapeutic tasks in Norwegian patients with prostate cancer diagnosed in 2004, with the 2003 European Association of Urology (EAU) guidelines representing the background.
Patients and methods: The Norwegian Prostate Cancer Registry (NoPCR) was established in 2004, and data collected during this first year were reviewed. The Tumour-Node-Metastasis group, prostate-specific antigen (PSA) level and Gleason score were recorded as basic diagnostic variables, with the initial treatment. Patients with nonmetastatic T1-T3 tumours were separated from those with advanced disease (T4 and/or N+ and/or M+). Patients with T1-T3 tumours, aged < or =75 years, and in good health were candidates for curative local treatment ('CurCands') and were allocated to risk groups.
Results: The compliance rate to the NoPCR was 96%; 2693 (72%) of 3744 eligible patients had T1-T3 tumours and 833 (22%) had advanced disease (not classifiable in 218, 6%). Of 1650 CurCands (low-risk 500; intermediate-risk 453; high-risk 697), 62% had radical prostatectomy or radiotherapy with or without hormone therapy, with the remaining 23% and 10% managed by, respectively, hormone therapy only or observation (other/unknown treatment, 6%).Only 64% of CurCands in the combined intermediate/high-risk group had local treatment. In the low-risk group local treatment was used in 57% of the patients, mainly in men with T2 tumours. In intermediate- and high-risk CurCands, PSA was the strongest factor determining the performance of curative treatment. Adjuvant radiotherapy after radical prostatectomy was used in four of 142 patients with tumour-involved margins.
Conclusion: In 2004 the initial management of prostate cancer in Norway was largely in accordance with the 2003 EAU guidelines, though there was some evidence of 'over-treatment' of low-risk patients and 'under-treatment' of intermediate- and high-risk patients. Some improvement of data collection by the NoPCR is warranted. National prostate cancer registries can contribute to improving the medical care of these patients.