Norwegian Prostate Cancer Registry
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A total of 5,215 people were diagnosed with prostate cancer in 2024. Results from this year's report show that Norwegian men generally receive equal and good diagnostics and treatment for their cancer.
Summary from the annual report 2024
Prostate cancer is the most common form of cancer among men in Norway, with 5215 new cases in 2024, of which 48 % were under the age of 70. At the time of diagnosis, 52 % had localized cancer, 31 % had regional spread, and 9 % had spread to other organs. In 2023, 866 men died from prostate cancer, of whom 60 % were over 80 years old. Mortality rates have significantly declined over the past ten years and 2023 recorded the lowest number of deaths since 1996.
The median PSA level at diagnosis has remained stable in recent years for men under 85 years. PSA values at diagnosis suggest targeted testing to detect prostate cancer at an early stage. Regional variations reflect differences in PSA testing practices.
There have been small annual changes in the distribution of ISUP grades at the time of diagnosis. Variations in ISUP grading practices in biopsy assessments among laboratories has been a challenge in establishing uniform registration.
There are significant local variations in the distribution of clinical tumor extent (cT-DRE) at diagnosis, which may partly be situational. Compared to cT-DRE, MRI tends to upgrade the local tumor extent (radT), which can influence risk classification and clinical decisions.
At hospital level, there are variations in the distribution of risk groups at diagnosis. This may reflect differences in early diagnostics as well as varying practices in reporting the parameters included in risk grouping.
Primary treatment is largely selected according to the National Clinical Guidelines for Prostate Cancer. There have been relatively few changes in treatment choices over the past five years, but a slowly increasing proportion of men over 80 years receive curative treatment. Among those with low-risk profiles, only 5 % received radical treatment -well within the quality target of 15 %. In the intermediate-risk group, 39 % were not radically treated at the time of diagnosis. Within two years, 28,9 % of these men transitioned from observation to radical treatment. In the highrisk group, 81,5 % of men received radical treatment - a high target achievement compared to the quality target (≥70 %). High adherence to quality targets for men under 75 years is reported across all health regions.
It remains unclear whether men over 75 years should be treated as aggressively as younger men; this is currently being investigated in the SPCG19 study. Whether surgery or radiotherapy is chosen varies somewhat depending on where the patient lives, with more radiotherapy being used in the Western and Central Norway health regions. In total, in Norway in 2024, 1,601 men underwent surgery, and 759 men received radiotherapy.
Amongst men who underwent prostatectomy, the distribution of risk groups remains stable and consistent across health regions. There are also no significant regional differences in the distribution of pT stage, the concordance between cT and pT, or between pre- and post-operative ISUP grading. Nationally, there is still a high target achievement for negative surgical margins in both pT2 and pT3 tumors.
Radical radiotherapy is used for a large proportion of men with high-risk prostate cancer and rarely for low-risk cases. There is high adherence to the recommendation for combined castration with abiraterone (dual hormone therapy) for men with the highest risk of recurrence.
The proportion of men receiving radiotherapy after prostatectomy has increased annually over a ten-year period. Regardless of margin status, one in seven men with localized tumors and two in five with locally advanced tumors undergo radiotherapy. If the surgical margin is not clear, the risk of requiring radiotherapy doubles.
Life-prolonging treatment for metastatic prostate cancer generally follows clinical recommendations without abnormal variation between national health authorities. However, there is some variation between hospitals in the use of new antihormonal drugs and high-dose prostate radiotherapy in primary metastatic settings, warranting further professional evaluation.
Late effects can occur after prostate cancer treatment. This report shows that men who underwent surgery or radiotherapy reported worse sexual function one and three years after diagnosis than men who did not receive such treatment.Those who had surgery reported worse urinary continence, while bowel function was, on average, slightly poorer in some who had received radiotherapy. Men with prostate cancer did generally not report high levels of fatigue compared to a control group, although slightly more was noted among those who had received radiotherapy. Most survey participants stated they were satisfied with the information they had received about possible side effects and with the treatments offered at their hospital.
The vast majority of men diagnosed with prostate cancer can expect to live many years after diagnosis, depending on age and stage of the disease. Survival estimates in advanced disease are uncertain, partly because treatments are evolving rapidly. Variations between health authorities are considered to be random and uncertain. There is no basis to conclude that prostate cancer-specific mortality in Norway depends on place of residence.