Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results
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ORIGINAL ARTICLE
Long‑term outcomes of active surveillance for clinically localized prostate cancer in a community‑based setting: results from a prospective non‑interventional study Jan Herden1,2 · Andreas Schwarte3,4 · Thorsten Werner5 · Uwe Behrendt6 · Axel Heidenreich1 · Lothar Weissbach7 Received: 23 June 2020 / Accepted: 21 September 2020 © The Author(s) 2020
Abstract Purpose To report on long-term outcomes of patients treated with active surveillance (AS) for localized prostate cancer (PCa) in the daily routine setting. Methods HAROW (2008–2013) was a non-interventional, health service research study about the management of localized PCa in the community setting, with 86% of the study centers being office-based urologists. A follow-up examination of all patients who opted for AS as primary treatment was carried out. Overall, cancer-specific, and metastasis-free survival, as well as discontinuation rates, were determined. Results Of 329 patients, 62.9% had very-low- and 21.3% low-risk tumours. The median follow-up was 7.7 years (IQR 4.7–9.1). Twenty-eight patients (8.5%) died unrelated to PCa, of whom 19 were under AS or watchful waiting (WW). Additionally, seven patients (2.1%) developed metastasis. The estimated 10-year overall and metastasis-free survival was 86% (95% CI 81.7–90.3) and 97% (95% CI 94.6–99.3), respectively. One hundred eighty-seven patients (56.8%) discontinued AS changing to invasive treatment: 104 radical prostatectomies (RP), 55 radiotherapies (RT), and 28 hormonal treatments (HT). Another 50 patients switched to WW. Finally, 37.4% remained alive without invasive therapy (22.2% AS and 15.2% WW). Intervention-free survival differed between the risk groups: 47.8% in the very-low-, 33.8% in the low- and 34.6% in the intermediate-/high-risk-group (p = 0.008). On multivariable analysis, PSA-density ≥ 0.2 ng/ml2 was significantly predictive for receiving invasive treatment (HR 2.55; p = 0.001). Conclusion Even in routine care, AS can be considered a safe treatment option. Our results might encourage office-based urologists regarding the implementation of AS and to counteract possible concerns against this treatment option. Keywords HAROW study · Active surveillance · Conservative management · Health service research · Outcomes research · Routine care
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03471-x) contains supplementary material, which is available to authorized users. * Jan Herden jan.herden@uk‑koeln.de 1
2
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, Cologne, Germany PAN Clinic, Urological Practice, Cologne, Germany
Active surveillance (AS) is a non-invasive treatment strategy for patients with well-differentiated, localized prostate cancer (PCa). In contrast to watchful waiting (WW) being a palliative option for patients with reduced life expectancy, 3
Urological Practice Borke
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