Background and ObjectivesSurgery for prostate cancer is associated with adverse effects. We studied long‐term risk of adverse effects after retropubic (RRP) and robot‐assisted radical prostatectomy (RARP).MethodsIn the National Prostate Cancer Register of Sweden, men who had undergone radical prostatectomy (RP) between 2004 and 2014 were identified. Diagnoses and procedures indicating adverse postoperative effects were retrieved from the National Patient Register. Relative risk (RR) of adverse effects after RARP versus RRP was calculated in multivariable analyses adjusting for year of surgery, hospital surgical volume, T stage, Gleason grade, PSA level at diagnosis, patient age, comorbidity, and educational level.ResultsA total of 11 212 men underwent RRP and 8500 RARP. Risk of anastomotic stricture was lower after RARP than RRP, RR for diagnoses 0.51 (95%CI = 0.42‐0.63) and RR for procedures 0.46 (95%CI = 0.38‐0.55). Risk of inguinal hernia was similar after RARP and RRP but risk of incisional hernia was higher after RARP, RR for diagnoses 1.48 (95%CI = 1.01‐2.16), and RR for procedures 1.52 (95%CI = 1.02‐2.26).ConclusionsThe postoperative risk profile for RARP and RRP was quite similar. However, risk of anastomotic stricture was lower and risk of incisional hernia higher after RARP.

Readmission rates after different radical prostatectomy methods were similar, ranging from 9% to 11%, with wide variation among hospitals. Readmission rates can be used as an indicator of perioperative care quality but potential confounders must be adjusted to avoid bias.

Objective: The aim of this study was to assess the risk of serious adverse effects after radiotherapy (RT) with curative intention and radical prostatectomy (RP). Materials and methods: Men who were diagnosed with prostate cancer between 1997 and 2012 and underwent curative treatment were selected from the Prostate Cancer data Base Sweden. For each included man, five prostate cancer-free controls, matched for birth year and county of residency, were randomly selected. In total, 12,534 men underwent RT, 24,886 underwent RP and 186,624 were controls. Adverse effects were defined according to surgical and diagnostic codes in the National Patient Registry. The relative risk (RR) of adverse effects up to 12 years after treatment was compared to controls and the risk was subsequently compared between RT and RP in multivariable analyses. Results: Men with intermediate- and localized high-risk cancer who underwent curative treatment had an increased risk of adverse effects during the full study period compared to controls: the RR of undergoing a procedures after RT was 2.64 [95% confidence interval (CI) 2.56–2.73] and after RP 2.05 (95% CI 2.00–2.10). The risk remained elevated 10–12 years after treatment. For all risk categories of prostate cancer, the risk of surgical procedures for urinary incontinence was higher after RP (RR 23.64, 95% CI 11.71–47.74), whereas risk of other procedures on the lower urinary tract and gastrointestinal tract or abdominal wall was higher after RT (RR 1.67, 95% CI 1.44–1.94, and RR 1.86, 95% CI 1.70–2.02, respectively). Conclusion: The risk of serious adverse effects after curative treatment for prostate cancer remained significantly elevated up to 12 years after treatment.

Objective. Recent guidelines on serum testing of prostate-specific antigen (PSA) levels in asymptomatic men emphasize the importance of an informed decision. This study assessed the proportion of men who had received written or oral information on the possible consequences of testing of serum levels of PSA before blood draw. Material and methods. From the National Prostate Cancer Register (NPCR) in Sweden, 600 men per year were randomly selected out of all men with T1c prostate cancer who were diagnosed in the work-up of a PSA test as a part of health examination in 2006–2008. In a mailed questionnaire these men were asked whether and how they had been informed about the pros and cons of a PSA test prior to blood draw. Results. In total, 1621 out of 1800 men (90.1%) responded to the questionnaire; 39/1563 (2.5%) reported that they had received only written information before testing, 179/1563 (11.5%) had received both oral and written information, 763/1563 (48.8%) had received oral information only, 423/1563 (27.1%) had not received any information and 159/1563 (10.2%) were not aware of that a PSA test had been performed. Conclusions. The proportion of men who had received written information on the pros and cons of a PSA test before blood draw in the setting of a health examination was low. Improved routines for giving information to the patient before a PSA test are warranted.

The cruise industry is the fastest growing component of mass tourism and is a key contributor to overtourism. The cruise industry is having a very significant impact on the country of Iceland, as cruises take people to some of the country’s most remote areas. In Iceland, the increase has been even more dramatic, with cruise ship arrivals increasing by over 91% (between 2015 and 2019) in Iceland’s small northern town of Akureyri and its surrounding ports. This paper is critical of the expansion of cruise tourism in Iceland despite the potential economic impacts of cruise ship tourism. Scholars argue the need to consider economic gains alongside environmental costs and social consequences that disrupt communities. This in perspective paper considers current economic, environmental and social impacts of cruise ship arrivals in Iceland before outlining some recommendations that align with environmentally friendly practices for policy makers to consider going forward. The triple bottom line framework is widely considered in tourism planning, and this paper seeks to connect the economic, social and environmental dimensions of tourism in a sustainable way to look at the present situation in Iceland and address policy considerations going forward.

49 Background: Men who are curatively treated with radiotherapy (RT) or radical prostatectomy (RP) for localized prostate cancer have long life expectancy but data on long term complications to treatment are scarce. Methods: In the nationwide, population-based Prostate Cancer data Base Sweden (PCBaSe), we identified men who underwent RT or RP between 1997 and 2012. Date of radiotherapy and dose of radiation were reassessed in an audit. For each case five controls from the background population, matched for age and county of residence, had been identified. The National Patient Register was used to identify diagnoses and surgical procedures indicating a complication to treatment, such as urinary incontinence, lower urinary tract symptoms and gastrointestinal symptoms, up to twelve years after treatment. The incidence rate ratio of complications for men who received RT and RP relative to their matched controls was calculated and relative risks (RR) were calculated for RT vs RP adjusted for treatment year, age, Charlson comorbidity index, educational level, PSA-level, clinical T stage and biopsy Gleason score. Results: In total, 37,420 men met the study criteria, of whom 12,534 had undergone RT and 24,886 had undergone RP. There were 186,624 matched controls. The risk of receiving any of the analyzed diagnoses or surgeries at 12 years after treatment was higher after RT; RT vs RP RR 1.20 (95%CI 1.08-1.34) and RT vs RP RR 1.49, (95% CI 1.36-1.64) for the diagnoses and surgical procedures respectively. At 3 years the risk of receiving any of the analyzed diagnoses was comparable between the treatments; RT vs RP RR 1.02 (95% CI 0.91-1.16) but the risk of undergoing any of the analyzed surgical procedures remained higher after RT during the entire study period. Men who underwent RP had a higher risk of being diagnosed or treated for urinary incontinence; RT vs RP RR 0.09 (95% CI 0.04-0.19) and RR 0.04 (95% CI 0.01-0.11) for the selected diagnoses and surgical procedures respectively. Conclusions: Complications after RP mostly occurred within the first 3 years after surgery whereas complications after RT were more frequent at a later date after treatment.

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