A comparative assessment of active surveillance for localized prostate cancer in the community versus tertiary care referral center
To date, evidence on active surveillance (AS) is restricted to protocol-based studies. Conversely, practice patterns outside of such protocols are unknown. The aim of this study was to capture the current AS treatment patterns for localized prostate cancer in patients managed by office-based urologists compared to patients treated at a tertiary care center.
Methods and materials
Two prospective cohorts were investigated: 361 AS arm patients of the German Hormonal treatment, Active surveillance, Radiation therapy, OP, Watchful waiting (HAROW) study, an observational health service study and 387 protocol-based AS patients treated at the Department of Urology of the Kantonsspital Aarau, Switzerland were included. Observational non-protocol HAROW versus on-protocol Kantonsspital Aarau (KSA) was compared, and active-treatment-free survival represented the primary outcome.
Study population of the observational HAROW versus tertiary care protocol-based KSA cohorts differed statistically significantly regarding age (p < 0.001) and proportion of patients meeting the Chism criteria (p < 0.001). In stratified analyses, AFTS at 1 and 2 years was, respectively, 87.7 % (95 % CI 84.0–91.7) and 75.0 % (95 % CI 69.7–80.8) in HAROW patients compared to 90.8 % (95 % CI 87.8–93.9) and 75.3 % (95 % CI 70.7–80.1) for patients in the KSA cohort (p = 0.97).
We demonstrate significant differences in terms of AS inclusion, surveillance and discontinuation criteria between patients managed by office-based urologists compared to their tertiary care counterparts. Interestingly, the risk of deferred active therapy was equally moderate for both groups in the short-term follow-up.
KeywordsProstate cancer Active surveillance Radical prostatectomy Radiotherapy Deferred treatment
Conflict of interest
The HAROW study is financially supported by GAZPROM Europe. The authors declare that they have no conflict of interest.
The authors confirm that the study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.