Urology – Olof Akre's research group

Administrator

Ongoing projects

SPCG-15 – Surgery versus radiotherapy for locally advanced prostate cancer (Olof Akre)

SPCG-15 is a prospective, multi-centre, open-label, randomized phase III trial including 1,200 patients at more than 20 hospitals in the Nordic countries. Patients are randomized to either standard (radiotherapy) or experimental (surgical) treatment for prostate cancer that grows outside the prostate capsule but has not yet spread to other organs. The primary endpoint is cause-specific survival. Secondary endpoints include metastasis-free and overall survival, quality-of-life, functional outcomes, and health-services requirements. Each subject will be followed up for a minimum of 20 years. 

A Program for prediction of Mortality in prostate cancer - ProMort (Olof Akre)

The ProMort research program is a multi-disciplinary, international research project aiming to develop new, high-performing prognostic tools for prostate cancer that can be implemented in clinical practice and help tailoring the right treatment to the right patient. The program is run in collaboration between KI, Harvard (USA), CRS4 (Italy), University of Turin (Italy), Örebro University Hospital, and the Swedish Prostate Cancer Register (NPCR). Specifically, ProMort aims to 1) identify molecular factors associated with prostate cancer death, using tumor tissue from diagnostic biopsies; 2) identify novel histopathological features associated with prostate cancer death using standard pathological review and artificial intelligence (AI); 3) improve prognostication in prostate cancer by combining clinical variables with the outcomes of aims 1-2 in a new prognostic tool.

Nerve-sparing in high-risk patients undergoing robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer (Peter Wiklund)

We are investigating the oncological effect of nerve sparing for men with high-risk prostate cancer undergoing RALP. Functional outcomes after non-nerve sparing (non-NS) RALP are poor, and strongly correlated to worse QoL. Therefore, it is important to understand if there are patients with high-risk PC that can undergo NS without increasing the risk for affecting the oncological outcomes. We are using data from a Karolinska database of 780 men who underwent RALP between 2002-2016 for high-risk PCa and evaluate the frequencies of biochemical recurrences and cancer-specific deaths.

Prostate Cancer IRE Study – PRIS (Anna Lantz)

The aim of the PRIS study is to evaluate the feasibility to treat localized prostate cancer with Irreversible Electroporation (IRE) - a novel image-guided tissue ablation technology that induces cell death through short pulsed electric fields - in comparison with conventional radical treatments (surgery or radiation) through a randomized controlled trial with the primary objective to locally control the tumour with a minimum of side effects. 

Image recognition using AI on Prostate Cancer MRI (Fredrik Jäderling) 

In collaboration with Gothenburg University, Sahlgrenska University hospital, and Chalmers, the project aims to develop AI algorithms based on prostate MRI to detect and grade prostatic lesions.

Lifelong health and well-being in bladder exstrophy (Lotta Renström)

Together with pediatric urologists at Karolinska University Hospital, a clinical follow-up of individuals born with bladder exstrophy is conducted to increase knowledge about the condition and thereby provide better information to families and children/adolescents about the prognosis. We want to correlate outcomes with treatment during childhood and find out how sexuality, fertility, and quality of life are affected.

Correlation between LUTS and psychiatric conditions in children and adolescents (Lotta Renström, Olof Akre)

Lower urinary tract symptoms (LUTS) often co-occur with psychiatric disorders in adolescents, including anxiety, attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). With a better understanding of the correlation between these disorders, new strategies could be developed for more accurate diagnosis and optimal treatment for patients with LUTS and concurrent psychiatric conditions. This registry study is conducted in collaboration with the child psychiatry department at Mount Sinai, New York.

Side effects after radiation therapy for prostate cancer

Approximately 25-40% of men undergoing radical prostatectomy for localized prostate cancer will show a rising PSA after surgery and thus become eligible for salvage radiation therapy. However, the risk of overtreatment is high as not all with PSA recurrence will die from their disease, even if left untreated. Knowledge of the prevalence and severity of long-term side effects is low, and we are conducting several ongoing studies to investigate this further.
We are also studying the risk of serious side effects after curative primary radiation therapy for prostate cancer

Early radiotherapy for men with measurable prostate specific antigen after prostate cancer surgery

Some patients still have a measurable prostate specific antigen (PSA) above 0.1 ng/mL at first follow up after radical prostatectomy (PSA persistence). Little is known about this patient population, especially with regards to long-term survival and the effect of adjuvant radiotherapy (aRT). Our aim was to study outcomes in a population-based setting. All men in Stockholm, Sweden who underwent a prostatectomy between the year 2004-2018 were included. Patients were identified from the Stockholm PSA and Biopsy register. We identified almost 500 men with PSA persistence from a cohort of 9000 men who underwent surgery for prostate cancer. Almost 100 men received early radiotherapy.

Positive surgical margin (PSM) and oncological outcomes after RALP in different CAPRA-risk groups with a minimum follow up of 10 years

We evaluate the impact of PSM after more than 10 years after RALP stratifying on preoperative CAPRArisk groups. Using data from 1039 men who underwent RALP between 2002-2007 at Karolinska for localized PCa we analysed if PSM is a predictor for BCR, salvage radiation treatment (RT), ADT and cancer specific death
depending on preoperative risk groups. We use CAPRA risk group score dividing patients into low, intermediate and high risk. We found that an extensive PSM seems to have an impact on cancer recurrence and the need for additional oncological treatment in all risk groups. In high risk prostate cancer patients focal PSM also had an impact on the need of additional treatment.

A randomized trial comparing conventional "salvage" radiotherapy and individualized PSAMA-PET targeted treatment in patients with biochemical recurrence after prostate cancer surgery (Stefan Carlsson)

In this randomized study of patients who have undergone prostate cancer surgery, we compare conventional salvage radiation therapy (SRT) with an individualized treatment guided by findings from a new type of imaging technology called PSMA-PET. We follow all patients to determine which method contributes to curing the most patients. Patients also complete quality-of-life questionnaires to identify any side effects in both treatment arms.