Research Article| Volume 49, ISSUE 8, P1984-1992, May 2013

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Differences in survival from prostate cancer in Denmark, Iceland and Sweden

Published:March 04, 2013DOI:



      Register-based studies have shown large survival differences among prostate cancer patients in the Nordic countries. The aim of this study was to determine the background of such differences in Denmark, Iceland and Sweden.

      Material and methods

      Patients with prostate cancer were identified through population-based cancer registers in the three countries. Clinical findings at diagnosis were retrieved from hospital records. In Sweden, clinical information was gathered from regional population-based prostate cancer registers. Country-specific incidence and excess mortality rates were compared, with adjustment for prognostic factors.


      The relative survival in the cohorts was comparable to that in previous population-based studies. Significant differences in excess mortality rates were found across countries, which diminished or disappeared after adjustment for patient characteristics, i.e. metastatic status, clinical T stage and prostate-specific antigen level. A difference in the proportion of patients with metastatic disease was the main explanation of the differences in survival among countries, while the incidence rates of metastatic cancer were similar.


      Register-based studies of the relative survival of prostate cancer patients are influenced by national differences in clinical presentation at diagnosis. Differences in the proportion of patients with metastatic spread explained most of the difference in relative survival among patients in Denmark, Iceland and Sweden. Future country comparisons of relative survival should include adjustment for differences in patient characteristics, such as stage, prostate-specific antigen level and screening intensity.


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        • Bray F.
        • Klint A.
        • Gislum M.
        • et al.
        Trends in survival of patients diagnosed with male genital cancers in the Nordic countries 1964–2003 followed up until the end of 2006.
        Acta Oncol. 2010; 49: 644-654
        • Tretli S.
        • Engeland A.
        • Haldorsen T.
        • et al.
        Prostate cancer – look to Denmark?.
        J Natl Cancer Inst. 1996; 88: 28
        • Engeland A.
        • Haldorsen T.
        • Dickman P.W.
        • et al.
        Relative survival of cancer patients – a comparison between Denmark and the other Nordic countries.
        Acta Oncol. 1998; 37: 49-59
        • Sant M.
        • Allemani C.
        • Santaquilani M.
        • et al.
        EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary.
        Eur J Cancer. 2009; 45: 931-991
        • Storm H.H.
        • Michelsen E.V.
        • Clemmensen I.H.
        • Pihl J.
        The Danish Cancer Registry – history, content, quality and use.
        Dan Med Bull. 1997; 44: 535-539
        • Sigurdardottir L.G.
        • Jonasson J.G.
        • Stefansdottir S.
        • et al.
        Data quality at the Icelandic Cancer Registry: comparability, validity, timeliness, and completeness.
        Acta Oncol. 2012; 51: 880-889
        • Barlow L.
        • Westergren K.
        • Holmberg L.
        • Talback M.
        The completeness of the Swedish Cancer Register: a sample survey for year 1998.
        Acta Oncol. 2009; 48: 27-33
        • Adolfsson J.
        • Garmo H.
        • Varenhorst E.
        • et al.
        Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005.
        Scand J Urol Nephrol. 2007; 41: 456-477
        • Sobin L.H.
        • Wittekind C.H.
        TNM classification of malignant tumors.
        6th ed. Wiley-Liss, New York2002
        • Mostofi F.K.
        Grading of prostatic carcinoma.
        Cancer Chemother Rep. 1975; 59: 111-117
        • Gleason D.F.
        Classification of prostatic carcinomas.
        Cancer Chemother Rep. 1966; 50: 125-128
        • Hakulinen T.
        Cancer survival corrected for heterogeneity in patients withdrawal.
        Biometrics. 1982; 38: 933-942
        • Engholm G.
        • Gislum M.
        • Bray F.
        • Hakulinen T.
        Trends in the survival of patients diagnosed with cancer in the Nordic countries 1964–2003 followed up to the end of 2006. Material and methods.
        Acta Oncol. 2010; 49: 545-560
        • Dickman P.W.
        • Sloggett A.
        • Hills M.
        • Hakulinen T.
        Regression models for relative survival.
        Stat Med. 2004; 23 (Available from: <>): 51-64
        • Brasso K.
        • Iversen P.
        Prostatic cancer screening.
        Ugeskr Laeger. 2002; 164: 155-157
        • Schroder F.H.
        • Hugosson J.
        • Roobol M.J.
        • et al.
        Screening and prostate-cancer mortality in a randomized European study.
        N Engl J Med. 2009; 360: 1320-1328
        • Jonsson E.
        Prostate cancer and screening – to be or not to be.
        Laeknabladid. 2009; 95: 421
        • Bray F.
        • Lortet-Tieulent J.
        • Ferlam J.
        • Forman D.
        • Auvinen A.
        Prostate cancer incidence and mortality in 37 European countries: an overview.
        Eur J Cancer. 2010; 46: 3040-3052
        • Albertsen P.C.
        • Fryback D.G.
        • Storer B.E.
        • Kolon T.F.
        • Fine J.
        Long-term survival among men with conservatively treated localized prostate cancer.
        JAMA. 1995; 274: 626-631
        • Adolfsson J.
        • Rutquist L.-E.
        • Steineck G.
        Prostate carcinoma and long term survival.
        Cancer. 1997; 80: 748-752
        • Draisma G.
        • Boer R.
        • Otto S.J.
        • et al.
        Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer.
        J Natl Cancer Inst. 2003; 95: 868-878
        • Borre M.
        • Erichsen R.
        • Lund L.
        • et al.
        Survival of prostate cancer patients in central and northern Denmark, 1998–2009.
        Clin Epidemiol. 2011; 3: 41-46
        • Lu-Yao G.L.
        • Yao S.L.
        Population-based study of long-term survival in patients with clinically localised prostate cancer.
        Lancet. 1997; 349: 906-910
        • Chodak G.W.
        • Thisted R.A.
        • Gerber G.S.
        • et al.
        Results of conservative management of clinically localized prostate cancer.
        N Engl J Med. 1994; 330: 242-248
        • Albertsen P.C.
        • Hanley J.A.
        • Gleason D.
        • Barry J.M.
        Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer.
        JAMA. 1998; 280: 975-980
        • Bill-Axelson A.
        • Holmberg L.
        • Filen F.
        • et al.
        Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial.
        J Natl Cancer Inst. 2008; 100: 1144-1154
        • Bill-Axelson A.
        • Holmberg L.
        • Ruutu M.
        • et al.
        Radical prostatectomy versus watchful waiting in early prostate cancer.
        N Engl J Med. 2011; 364: 1708-1717
        • Kupelian P.
        • Elshaikh M.
        • Reddy C.
        • Zippe C.
        • Klein E.
        Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy.
        J Clin Oncol. 2002; 20: 3376-3385
        • Iversen P.
        • Johansson J.E.
        • Lodding P.
        • et al.
        Bicalutamide 150 mg in addition to standard care for patients with early non-metastatic prostate cancer: updated results from the Scandinavian Prostate Cancer Period Group-6 Study after a median follow-up period of 7.1 years.
        Scand J Urol Nephrol. 2006; 40: 441-452
        • Albertsen P.C.
        • Hanley J.A.
        • Barrows G.H.
        • et al.
        Prostate cancer and the Will Rogers phenomenon.
        J Natl Cancer Inst. 2005; 97: 1248-1253
        • Storm H.H.
        • Kejs A.M.
        • Engholm G.
        • et al.
        Trends in the overall survival of cancer patients diagnosed 1964–2003 in the Nordic countries followed up to the end of 2006: the importance of case-mix.
        Acta Oncol. 2010; 49: 713-724
        • de Vries E.
        • Soerjomataram I.
        • Houterman S.
        • Louwman M.W.
        • Coebergh J.W.W.
        Decreased risk of prostate cancer after skin cancer diagnosis: a protective role of ultraviolet radiation?.
        Am J Epidemiol. 2007; 165: 966-972