Work-up and treatment of prostate cancer before and after publication of the first national guidelines on prostate cancer care in Sweden

Scand J Urol. 2018 Aug;52(4):277-284. doi: 10.1080/21681805.2018.1512650. Epub 2018 Oct 26.


Background and objectives: In 2007, the Swedish National Board of Health and Welfare published the first Swedish guidelines on prostate cancer (PCa) to improve care and decrease geographical and social inequalities. The aim of this analysis was to assess how these guidelines affected PCa care.

Materials and methods: Work-up and treatment for men diagnosed with PCa between 1998 and 2014 were assessed by use of data in the Prostate Cancer data Base Sweden (PCBaSe) with information from the National Prostate Cancer Register (NPCR) and other healthcare registries and demographic databases.

Results: Overall, there were modest improvements in the performance for 14 selected quality indicators, with some notable exceptions. There was a strong increase in the use of active surveillance for very low-risk PCa, up from 56% in 2009 to 92% in 2014, and use of bone imaging for high-risk PCa up from 50% in 2008 to 77% in 2014. There were large differences in work-up and treatment of PCa between healthcare providers with modest decreases over time. The differences between counties were larger than differences according to socioeconomic status with one exception: use of curative treatment for high-risk PCa was more common in men with high income, highest versus lowest tertile, OR 2.74 (95% CI, 1.85-4.06).

Conclusion: The modest improvements in PCa care after the publications of national guidelines indicate that if these are to make an impact on care, feedback to each point of care on their performance as well as local quality improvement programs implementing the guidelines are needed.

Keywords: Prostate cancer; cancer guidelines; cancer registries; quality indicators; socio-economical differences.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Androgen Antagonists / therapeutic use*
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary
  • Delayed Diagnosis
  • Disease Management
  • Guideline Adherence
  • Humans
  • Income
  • Logistic Models
  • Male
  • Middle Aged
  • Mortality / trends
  • Multivariate Analysis
  • Odds Ratio
  • Orchiectomy / trends
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / trends
  • Prostatectomy / trends*
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy*
  • Quality Indicators, Health Care
  • Quality of Health Care*
  • Socioeconomic Factors
  • Sweden
  • Time Factors
  • Watchful Waiting / trends*


  • Androgen Antagonists