Kirsti Aas

• Fosså, Sophie Dorothea; Storås, Anne Marie Holck; Aas, Kirsti; Johannessen, Tom Børge; Gjelsvik, Ylva Maria & Myklebust, Tor Åge (2024). Pretreatment Patient-reported Overall Health: A Prognostic Factor for Early Overall Mortality After Primary Curative Treatment of Prostate Cancer. European Urology Open Science. ISSN 2666-1691. 63, p. 62–70. doi: 10.1016/j.euros.2024.03.005.
• Löffeler, Sven; Bertilsson, Helena Maria; Müller, Christoph Rainer; Aas, Kirsti; Haugnes, Hege Sagstuen & Aksnessæther, Bjørg Yksnøy [Show all 22 contributors for this article] (2024). Protocol of a randomised, controlled trial comparing immediate curative therapy with conservative treatment in men aged ≥75 years with non-metastatic high-risk prostate cancer (SPCG 19/GRand-P). BJU International. ISSN 1464-4096. doi: 10.1111/bju.16314. Full text in Research Archive Show summary

  Background: Older men (aged ≥75 years) with high risk, non-metastatic prostate cancer (PCa) are increasingly treated with curative therapy (surgery or radiotherapy). However, it is unclear if curative therapy prolongs life and improves health-related quality of life (HRQoL) in this age group compared to conservative therapy, which has evolved considerably during the last decade. Study design: The Scandinavian Prostate Cancer Group (SPCG) 19/Norwegian Get-Randomized Research Group-Prostate (GRand-P) is a randomised, two-armed, controlled, multicentre, phase III trial carried out at study centres in Norway, Denmark, Finland, and Sweden. Endpoints: The primary endpoints are overall survival and HRQoL (burden of disease scale, European Organisation for the Research and Treatment of Cancer [EORTC] Elderly Cancer patients). Secondary endpoints are PCa-specific survival, metastasis-free survival, role-functioning scale (EORTC quality of life questionnaire 30-item core), urinary irritative/obstructive scale (26-item Expanded Prostate Cancer Index Composite [EPIC-26]), bowel scale (EPIC-26), intervention-free survival, PCa morbidity, use of secondary and tertiary systemic therapies, mean quality-adjusted life-years (QALYs), and mean total healthcare costs. Patients and methods: A total of 980 men (aged ≥75 years) with non-metastatic, high-risk PCa will initially be screened with Geriatric 8 (G8) health status screening tool and Mini-COG© brief cognitive test. Participants identified by G8 as 'fit' or 'frail' will be randomised (ratio 1:1) to either immediate curative therapy (radiotherapy or prostatectomy) or conservative therapy (endocrine therapy or observation). Participants who are unable or unwilling to participate in randomisation will be enrolled in a separate observation group. Randomised patients will be followed for 10 years. Trial registration: Ethics approval has been granted in Norway (457593), Denmark (H-22051998), Finland (R23043) and Sweden (Dnr 2023-05296-01). The trial is registered on Clinicaltrials.org (NCT05448547).

• Nilsson, Mona Otrebski; Aas, Kirsti; Myklebust, Tor Åge; Gjelsvik, Ylva Maria; Haug, Erik Skaaheim & Fosså, Sophie Dorothea [Show all 7 contributors for this article] (2023). Do all prostate cancer patients want, and experience shared decision making prior to curative treatment? Scandinavian Journal of Urology. ISSN 2168-1805. 58, p. 133–140. doi: 10.2340/sju.v58.14730. Full text in Research Archive
• Bjerner, Lars; Bratt, Ola; Aas, Kirsti; Albertsen, Peter C.; Fosså, Sophie D. & Kvåle, Rune [Show all 16 contributors for this article] (2023). Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death—Results from the Norwegian Prostate Cancer Consortium. European Urology. ISSN 0302-2838. p. 1–7. doi: 10.1016/j.eururo.2023.04.028.
• Haug, Erik Skaaheim; Myklebust, Tor Åge; Jones, Charles Patrick W.; Reisæter, Lars Anders Rokne; Aas, Kirsti & Berg, Arne Stenrud [Show all 12 contributors for this article] (2023). Impact of prebiopsy MRI on prostate cancer staging: Results from the Norwegian Prostate Cancer Registry. BJUI Compass. ISSN 2688-4526. 4(3), p. 331–338. doi: 10.1002/bco2.214. Full text in Research Archive
• Sacco, Matteo; Gandaglia, Giorgio; Aas, Kirsti; Ceci, Francesco; Chiu, Peter K. & Fankhauser, Christian D. [Show all 28 contributors for this article] (2022). The Changing Face of cN0M0 Prostate Cancer Being Found With pN+ After Surgery in the Contemporary Era: Results of an International European Survey on Disease Management. Clinical Genitourinary Cancer. ISSN 1558-7673. 21(3). doi: 10.1016/j.clgc.2022.11.012.
• Aas, Kirsti; Berge, Viktor; Myklebust, Tor Åge & Fosså, Sophie Dorothea (2021). Comparative survival outcomes of high-risk prostate cancer ttreated with radical prostatectomy or definitive radiotherapy regimens. European Urology Open Science. ISSN 2666-1691. 26, p. 55–63. doi: 10.1016/j.euros.2021.01.011. Full text in Research Archive Show summary

  Background: Observational data has indicated improved survival after radical prostatectomy (RP) compared with definitive radiotherapy (RT) in men with high-risk prostate cancer (PCa). Objective: To compare PCa-specific mortality (PCSM) and overall mortality (OM) in men with high-risk PCa treated with RP or RT, providing information on target doses and fractionations. Design, setting, and participants: This is an observational study from the Cancer Registry of Norway. Patients were diagnosed with high-risk PCa during 2006–2015, treated with RP 12 mo or RT 15 mo after diagnosis, and stratified according to RP or RT modality; external beam radiotherapy (EBRT; 70–<74, 74–<78, or 78 Gy), hypofractionated RT or EBRT combined with brachytherapy (BT-RT). Outcome measurements and statistical analysis: Competing risk and Kaplan- Meier methods estimated PCSM and OM, respectively. Multivariable Cox regression models evaluated hazard ratios (HRs) for PCSM and OM. Results and limitations: In total, 9254 patients were included (RP 47%, RT 53%). RT patients were older, had poorer performance status and more unfavorable disease characteristics. With a median follow-up time of seven and eight yrs, the overall 10- yr PCSM was 7.2% (95% confidence interval [CI] 6.4–8.0) and OM was 22.9% (95% CI 21.8–24.1). Compared with RP, EBRT 70–<74 Gy was associated with increased (HR 1.88, 95% CI 1.33–2.65, p < 0.001) and BT-RT with decreased (HR 0.49, 95% CI 0.24– 0.96, p = 0.039) 10-yr PCSM. Patients treated with EBRT 70–78 Gy had higher adjusted 10-yr OM than those treated with RP. Conclusions: In men with high-risk PCa, treatment with EBRT <74 Gy was associated with increased adjusted 10-yr PCSM and OM, and BT-RT with decreased 10-yr PCSM, compared with RP. Patient summary: In this study, we compared mortality after radical prostatectomy (RP) and radiotherapy (RT) in men with high-risk prostate cancer (PCa); the results suggest that men receiving lower-dose RT have higher, and patients receiving brachytherapy may have lower, risk of death from PCa than patients treated with prostatectomy.

• Fosså, Sophie Dorothea; Aas, Kirsti; Muller, Christoph Rainer; Jerm, Marianne Brenn; Tandstad, Torgrim & Lilleby, Wolfgang [Show all 10 contributors for this article] (2020). Definitive radiotherapy for prostate cancer in Norway 2006-2015: Temporal trends, performance and survival. Radiotherapy and Oncology. ISSN 0167-8140. 155, p. 33–41. doi: 10.1016/j.radonc.2020.10.022. Full text in Research Archive Show summary

  Background More studies are needed to document nation-wide use and effectiveness of curative definitive radiotherapy (Def-RT) in the treatment of prostate cancer (PCa). Patients and methods For 38,960 men diagnosed with PCa without distant metastases from 2006 to 2015 data from the Norwegian Prostate Cancer Registry and a national radiotherapy database (NoRadBase) was analyzed. Overall survival and PCa-specific mortality were described comparing EQD-2 < 74 Gy (“low-dose”) with EQD-2 ≥ 74 Gy (“escalated dose”). Results Use of Def-RT decreased (27–24%) whereas the proportion of radical prostatectomies (RPs) increased (31–38%). In high-risk patients the use of RP doubled (18–36%), while the proportion of Def-RT remained stable (about 35%). Before 2010, almost a quarter of patients received low-dose Def-RT with gradual increase of escalated Def-RT thereafter. Escalated Def-RT was associated with significantly more favorable 10-year PCa-specific mortality (4.4% [95% CI: 2.7–10.7%]) than observed after low-dose Def- RT (8.8% [95% CI: 6.2–9.8%), with the most beneficial effects in high-risk patients. Our analyses indicated the need to expand the NoRadBase by consensus-based quality measures. Conclusion In this nationwide cohort, the overall use of Def-RT decreased slightly. In high-risk patients the provision of Def-RT remained stable and was accompanied by doubling of patients with RP and reduction of a “no curative treatment” strategy. Escalated dose Def-RT significantly reduced 10-year PCa-specific mortality compared to low-dose Def-RT. Aiming for cancer care equity national radiotherapy registries for PCa should regularly monitor data based on consensus-based quality measures enabling feedback to the responsible hospitals.

• Aas, Kirsti; Fosså, Sophie Dorothea; Myklebust, Tor Åge; Møller, Bjørn; Kvåle, Rune & Vlatkovic, Ljiljana [Show all 7 contributors for this article] (2020). Increased curative treatment is associated with decreased prostate cancer-specific and overall mortality in senior adults with high-risk prostate cancer; results from a national registry-based cohort study. Cancer Medicine. ISSN 2045-7634. 9(18), p. 6646–6657. doi: 10.1002/cam4.3297. Full text in Research Archive
• Fosså, Sophie Dorothea; Beyer, Bud; Dahl, Alv A; Aas, Kirsti; Eri, Lars Magne & Kvan, Espen [Show all 10 contributors for this article] (2019). Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique. Scandinavian Journal of Urology. ISSN 2168-1805. p. 1–7. doi: 10.1080/21681805.2019.1693625. Full text in Research Archive
• Kvåle, Rune; Myklebust, Tor Åge; Fosså, Sophie Dorothea; Aas, Kirsti; Ekanger, Christian & Helle, Svein Inge [Show all 8 contributors for this article] (2019). Impact of positive surgical margins on secondary treatment, palliative radiotherapy and prostate cancer‐specific mortality. A population‐based study of 13 198 patients. The Prostate. ISSN 0270-4137. 79(16), p. 1852–1860. doi: 10.1002/pros.23911. Full text in Research Archive Show summary

  Background: The results of studies evaluating the impact of positive surgical margins on prostate cancer‐specific mortality have been inconsistent. We, therefore, evaluated the impact of surgical margin status on subsequent secondary treatment, palliative radiotherapy, and prostate cancer‐specific mortality. Methods A total of 14 837 men treated with radical prostatectomy (RP) during the period 2001 to 2015 were identified from the Cancer Registry of Norway. Of those, 13 198 (89%) patients had complete data on the preoperative prostate‐specific antigen level, pathological T‐category, Gleason score in the prostatectomy specimen, and margin status. Multivariable Cox proportional hazards models were used to evaluate the risk, and flexible parametric models for the cumulative incidence were fitted to predict the probabilities of secondary treatment (salvage radiotherapy or prophylactic breast radiation), palliative radiotherapy, and prostate cancer‐specific mortality. Results After a median follow‐up time of 5.2 years (3591 patients with ≥8 years of follow‐up), positive surgical margins (PSMs) were independently predictive of secondary treatment (hazard ratio [HR] = 2.43, 95% confidence interval [CI] = 2.21‐2.66) and palliative radiotherapy (HR = 1.45, 95% CI = 1.03‐2.05). After 10 years, the absolute increased risk for palliative radiotherapy in patients with PSMs after RP varied between 0.1% in pT2 tumors with a Gleason score of 6, to 12% for pT3b tumors with a Gleason score of 9 to 10. PSMs were not independently associated with prostate cancer‐specific mortality (HR = 1.14, 95% CI = 0.82‐1.59). Conclusion PSMs were associated with increased application of secondary treatment and palliative radiotherapy but were not predictive of prostate cancer‐specific mortality. As the use of palliative radiotherapy was only marginally increased in patients with PSMs and the lowest‐risk disease characteristics, avoiding PSMs may be of greatest prognostic relevance in patients with higher‐risk disease characteristics.

• Aas, Kirsti; Fosså, Sophie Dorothea; Kvåle, Rune; Møller, Bjørn; Myklebust, Tor Åge & Vlatkovic, Ljiljana [Show all 8 contributors for this article] (2018). Is time from diagnosis to radical prostatectomy associated with oncological outcomes? . World Journal of Urology. ISSN 0724-4983. 37(8), p. 1571–1580. doi: 10.1007/s00345-018-2570-6.
• Aas, Kirsti; Axcrona, Karol; Kvåle, Rune; Møller, Bjørn; Myklebust, Tor Åge & Axcrona, Ulrika [Show all 8 contributors for this article] (2017). Ten-year Mortality in Men With Nonmetastatic Prostate Cancer in Norway. Urology. ISSN 0090-4295. 110, p. 140–147. doi: 10.1016/j.urology.2017.07.048.

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• Aas, Kirsti; Fosså, Sophie Dorothea; Kvåle, Rune; Møller, Bjørn; Myklebust, Tor Åge & Vlatkovic, Ljiljana [Show all 8 contributors for this article] (2018). Increasing Time from Diagnosis to Radical Prostatectomy (RP-interval) is Not Associated with Adverse Oncological Outcomes: Implications for cancer patient pathways (CPPs). European Urology. Supplement. ISSN 1569-9056. 17(14), p. e2825–e2827. doi: 10.1016/S1569-9056(18)33709-6.

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