Clinical and Translational Oncology

, Volume 21, Issue 12, pp 1673–1679 | Cite as

Outcomes of clinically localized prostate cancer patients managed with initial monitoring approach versus upfront local treatment: a North American population-based study

  • O. Abdel-RahmanEmail author
Research Article



To assess the outcomes of active monitoring (active surveillance or watchful waiting) as an initial management approach compared to upfront definitive local treatments (prostatectomy or radiation therapy) in a cohort of clinically localized prostate cancer patients.


Patients with clinically localized prostate cancer registered within the Surveillance, Epidemiology and End Results (SEER) watchful waiting database from 2010–2015 were reviewed. Kaplan–Meier analysis was used to compare overall survival outcomes between patients treated with different initial therapeutic approaches. Multivariate Cox regression analysis (stratified by the risk group) was used to assess potential factors affecting prostate cancer-specific survival.


Using Kaplan–Meier analysis, prostatectomy was associated with better overall survival compared to radiation therapy and active monitoring (P < 0.001). Multivariate Cox regression analysis was then employed to evaluate different factors affecting prostate cancer-specific survival. Among patients with low-risk disease, the following factors were predictive of better prostate cancer-specific survival: younger age (hazard ratio for patients ≥ 70 years versus patients 40–69 years: 2.081; 95% CI 1.277–3.390; P = 0.003), white race (hazard ratio for black race versus white race: 2.575; 95% CI 1.538–4.311; P < 0.001), non-Hispanic ethnicity (hazard ratio versus Hispanic ethnicity: 0.472; 95% CI 0.244–0.910; P = 0.025), and initial treatment with prostatectomy (hazard ratio for prostatectomy versus active monitoring: 0.551; 95% CI 0.371–0.818; P = 0.003).


Active monitoring seems to be at least as effective as upfront radiation therapy in the management of low-risk disease. Radical prostatectomy is associated with better overall and prostate cancer-specific survival compared to either radiation therapy or active monitoring.


Prostate cancer Watchful waiting Active surveillance Surgery Radiation therapy Outcomes 



This study is based on the SEER watchful waiting database.



Compliance with ethical standards

Conflict of Interest

All author declares that they have no conflict of interest.

Ethical approval

All analyses in the current study are aligned with established health ethics guidelines.

Informed consent

The current study is based on a publicly available dataset. Thus, Informed consent was not needed.

Supplementary material

12094_2019_2098_MOESM1_ESM.png (67 kb)
Supplementary figure-1: Kaplan-Meier curve for overall survival comparison according to treatment approach among patients with low-risk disease (in the post-matching cohort). (PNG 68 kb)
12094_2019_2098_MOESM2_ESM.docx (13 kb)
Supplementary file1 (DOCX 13 kb)


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Clinical Oncology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Department of OncologyUniversity of Calgary, Tom Baker Cancer CentreCalgaryCanada

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