World Journal of Urology

, Volume 32, Issue 4, pp 891–897 | Cite as

A comparative assessment of active surveillance for localized prostate cancer in the community versus tertiary care referral center

  • Andreas Becker
  • Daniel Seiler
  • Maciej Kwiatkowski
  • Luis Alex Kluth
  • Dietrich Schnell
  • Markus Graefen
  • Thorsten Schlomm
  • Margit Fisch
  • Franz Recker
  • Lothar Weissbach
  • Felix K. H. Chun
Topic Paper

Abstract

Objectives

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.

Results

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).

Conclusion

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.

Keywords

Prostate cancer Active surveillance Radical prostatectomy Radiotherapy Deferred treatment 

Notes

Conflict of interest

The HAROW study is financially supported by GAZPROM Europe. The authors declare that they have no conflict of interest.

Ethical standards

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.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Andreas Becker
    • 1
    • 2
  • Daniel Seiler
    • 3
  • Maciej Kwiatkowski
    • 3
    • 5
  • Luis Alex Kluth
    • 1
  • Dietrich Schnell
    • 4
  • Markus Graefen
    • 2
  • Thorsten Schlomm
    • 1
    • 2
  • Margit Fisch
    • 1
  • Franz Recker
    • 3
  • Lothar Weissbach
    • 4
  • Felix K. H. Chun
    • 1
  1. 1.Department of UrologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  2. 2.Martini-ClinicProstate Cancer Center Hamburg-EppendorfHamburgGermany
  3. 3.Department of UrologyKantonsspital AarauAarauSwitzerland
  4. 4.Stiftung MaennergesundheitBerlinGermany
  5. 5.Department of UrologyAcademic Hospital BraunschweigBraunschweigGermany

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