World Journal of Urology

, Volume 36, Issue 3, pp 383–391 | Cite as

Utilization of Active Surveillance and Watchful Waiting for localized prostate cancer in the daily practice

  • Jan HerdenEmail author
  • Lothar Weissbach
Original Article



To analyze the utilization of Active Surveillance (AS) and Watchful Waiting (WW) in the daily routine setting, since both are non-invasive treatment options for localized prostate cancer (PCa), which are used in a curative (AS) or palliative (WW) setting. Since differentiation of both strategies is not always clear, patients were compared with respect to the inclusion criteria, frequency of follow-up examinations (Prostate Specific Antigen = PSA tests, rebiopsies), and initiation of a deferred treatment.


HAROW is a non-interventional, health-service research study on the management of localized PCa in the community setting. Of 3169 patients, prospectively enrolled from 2008 to 2013 with a mean follow-up of 28.2 months, 468 chose AS and 126 WW. Treating urologists reported clinical variables, information on therapy and clinical course of disease.


AS patients were significantly younger and had more low-risk tumors. No differences were seen in the number of PSA tests during follow-up: mean number of PSA tests was 6.08 for AS- and 5.18 for WW patients, more than four PSA tests were reported in 63.9% AS- and 59.5% WW patients (p = 0.136). At least one re-biopsy was performed in 39.7% AS- and 9.5% WW patients (p < 0.001). Discontinuation rates were 23.9% (n = 112) for AS and 11.9% (n = 15) for WW. Most of the AS patients opted for a curative treatment (prostatectomy = 65, radiotherapy = 30), whereas 12 WW patients received a palliative hormone therapy and three patients received radiotherapy.


Physicians seem to distinguish clearly between AS and WW in terms of inclusion criteria and deferred therapy, whereas this differentiation tends to become indistinct in terms of follow-up examinations.


Localized prostate cancer Active Surveillance Watchful Waiting HAROW study Health-service research 


Authors’ contribution

JH Project development, Data analysis, Manuscript writing. LW Project development, Data collection, Data analysis, Manuscript editing


The HAROW study was initiated and conducted by the Foundation of Men’s Health (Berlin, Germany). Gazprom Germany sponsored the Foundation of Men’s Health by providing an unconditional Grant for data collection and data management.

Compliance with ethical standards

Conflict of interest

Jan Herden and Lothar Weissbach declare that they have no conflicts of interest.

Ethical approval

The HAROW study was approved by the ethics committee of the Bavarian State Board of Physicians. The study was registered under study ID 479 at the DKSR (German Cancer Study Registry; February 2008). All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the State Chamber of Medicine in Bavaria and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyUniversity Hospital CologneCologneGermany
  2. 2.Health Research for Men GmbHBerlinGermany

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