Impact of prebiopsy MRI on prostate cancer staging: Results from the Norwegian Prostate Cancer Registry

Abstract Objectives The aim of this study is to evaluate the 2015 introduction of prebiopsy magnetic resonance imaging of the prostate (MRI‐P) as the standard of care for diagnosing prostate cancer (PCa) by the Norwegian public health care authorities. There were three specific objectives of this study: first, to evaluate the consequences of using different TNM manuals for clinical T‐staging (cT‐staging) in a national setting; second, to determine if the data reveals that MRI‐P based cT‐staging is superior to digital rectal examination (DRE)‐based cT‐staging compared with pathological T‐stage (pT‐stage) post radical prostatectomy; and third, to assess whether treatment allocations have changed over time. Materials and Methods All patients registered in the Norwegian Prostate Cancer Registry between 2004 and 2021 were retrieved and 5538 were eligible for inclusion. Concordance between clinical T‐stage (cT‐stage) and pT‐stage was assessed by percentage agreement, Cohen's kappa and Gwet's agreement. Results MR visualisation of lesions influences reporting of tumour extension beyond DRE findings. Agreement between cT‐stage and pT‐stage declined from 2004 to 2009, which coincided with an increase in the percentage being pT3. From 2010, agreement increased, which aligned with changes in cT‐staging and the introduction of MRI‐P. From 2017, regarding the reporting of cT‐DRE and cT‐Total (overall cT‐stage), agreement diminished for cT‐DRE but remained relatively stable (>60%) for cT‐Total. Regarding treatment allocation, the study suggests that staging with MRI‐P has shifted treatment towards radiotherapy in locally advanced high‐risk disease. Conclusion Introduction of MRI‐P has affected cT‐stage reporting. Agreement between cT‐stage and pT‐stage appears to have improved. This study suggests that use of MRI‐P influences treatment decisions in certain patient subgroups

Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe:data from the ERA-EDTA Registry

Patients starting renal replacement therapy (RRT) for end-stage renal disease often present with one or more co-morbidities. This study explored the prevalence of co-morbidities in patients who started RRT in Europe during the period from 2005 to 2014. Using data from patients aged 20 years or older from all 11 national or regional registries providing co-morbidity data to the European Renal Association - European Dialysis and Transplant Association Registry, we examined the prevalence of the following co-morbidities: diabetes mellitus (DM) (primary renal disease and/or co-morbidity), ischaemic heart disease (IHD), congestive heart failure (CHF), peripheral vascular disease (PVD), cerebrovascular disease (CVD) and malignancy. Overall, 70% of 7578 patients who initiated RRT in 2014 presented with at least one co-morbidity: 39.0% presented with DM, 25.0% with IHD, 22.3% with CHF, 17.7% with PVD, 16.4% with malignancy and 15.5% with CVD. These percentages differed substantially between countries. Co-morbidities were more common in men than in women, in older patients than in younger patients, and in patients on haemodialysis at Day 91 when compared with patients on peritoneal dialysis. Between 2005 and 2014 the prevalence of DM and malignancy increased over time, whereas the prevalence of IHD and PVD declined. More than two-thirds of patients initiating RRT in Europe have at least one co-morbidity. With the rising age at the start of RRT over the last decade, there have been changes in the co-morbidity pattern: the prevalence of cardiovascular co-morbidities decreased, while the prevalence of DM and malignancy increase

International comparison and time trends of first kidney transplant recipient characteristics across Europe:an ERA Registry study

peer reviewedBACKGROUND: The aim of this study was to provide an overview of age, sex and primary renal disease (PRD) distribution among first kidney transplant recipients across Europe. METHOD: The European Renal Association (ERA) Registry database was used to obtain data on patients aged 20 years or older receiving their first kidney transplant between 2010 and 2019 from 12 European countries. The numbers and percentages of recipients in each age, sex and PRD group were calculated by country, donor type and year. RESULTS: In total, 99 543 adults received a first kidney transplant. Overall, 23% of the recipients were 65 years or older, 36% were female and 21% had glomerulonephritis and 15% diabetes mellitus as PRD. Compared with deceased donor kidney transplant recipients, living donor kidney transplant recipients were less often 65 years or older (13% versus 26%), more often had glomerulonephritis (25% versus 20%) and less often diabetes mellitus (8% versus 17%) as PRD. We found large international differences, which were most prominent for age and PRD and less prominent for sex. Over time, the largest change in recipient characteristics was observed for the percentage of recipients aged 65 years or older, increasing from 18% in 2010 to 28% in 2019 for all countries combined with a similar trend in most countries. CONCLUSION: We observed large differences for age and PRD distribution between recipients of living and deceased donor kidneys and between European countries. Over time, the percentage of older first kidney transplant recipients increased