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

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World Journal of Urology Aims and scope Submit manuscript

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.

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References

  1. Measurement of progress against cancer (1990) Extramural committee to assess measures of progress against cancer. J Natl Cancer Inst 82(10):825–835

    Article  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63(1):11–30

    Article  PubMed  Google Scholar 

  3. Wilt TJ, Brawer MK, Jones KM et al (2012) Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 367(3):203–213

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Bill-Axelson A, Holmberg L, Ruutu M et al (2011) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 364(18):1708–1717

    Article  CAS  PubMed  Google Scholar 

  5. Cooperberg MR, Carroll PR, Klotz L (2011) Active surveillance for prostate cancer: progress and promise. J Clin Oncol 29(27):3669–3676

    Article  PubMed  Google Scholar 

  6. Tosoian JJ, Trock BJ, Landis P et al (2011) Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 29(16):2185–2190

    Article  PubMed  Google Scholar 

  7. van den Bergh RC, Roemeling S, Roobol MJ et al (2009) Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. Eur Urol 55(1):1–8

    Article  PubMed  Google Scholar 

  8. Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A (2010) Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 28(1):126–131

    Article  PubMed  Google Scholar 

  9. Graefen M, Schlomm T (2013) Active surveillance for low-risk prostate cancer: some questions are answered, but many questions remain. Eur Urol 63(4):604–605

    Article  PubMed  Google Scholar 

  10. Bul M, Zhu X, Valdagni R et al (2013) Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol 63(4):597–603

    Article  PubMed  Google Scholar 

  11. Steginga SK, Turner E, Donovan J (2008) The decision-related psychosocial concerns of men with localised prostate cancer: targets for intervention and research. World J Urol 26(5):469–474

    Article  PubMed  Google Scholar 

  12. Cooperberg MR, Broering JM, Kantoff PW, Carroll PR (2007) Contemporary trends in low risk prostate cancer: risk assessment and treatment. J Urol 178(3 Pt 2):S14–S19

    Article  PubMed Central  PubMed  Google Scholar 

  13. van den Bergh RC, Vasarainen H, van der Poel HG et al (2010) Short-term outcomes of the prospective multicentre ‘prostate cancer research international: active surveillance’ study. BJU Int 105(7):956–962

    Article  PubMed  Google Scholar 

  14. Schroder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360(13):1320–1328

    Article  PubMed  Google Scholar 

  15. Chism DB, Hanlon AL, Horwitz EM, Feigenberg SJ, Pollack A (2004) A comparison of the single and double factor high-risk models for risk assignment of prostate cancer treated with 3D conformal radiotherapy. Int J Radiat Oncol Biol Phys 59(2):380–385

    Article  PubMed  Google Scholar 

  16. Epstein JI, Walsh PC, Carmichael M, Brendler CB (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 271(5):368–374

    Article  CAS  PubMed  Google Scholar 

  17. Bul M, van den Bergh RC, Zhu X et al (2012) Outcomes of initially expectantly managed patients with low or intermediate risk screen-detected localized prostate cancer. BJU Int 110(11):1672–1677

    Article  PubMed  Google Scholar 

  18. Whitson JM, Porten SP, Hilton JF et al (2011) The relationship between prostate specific antigen change and biopsy progression in patients on active surveillance for prostate cancer. J Urol 185(5):1656–1660

    Article  PubMed  Google Scholar 

  19. Lu-Yao GL, Albertsen PC, Moore DF et al (2009) Outcomes of localized prostate cancer following conservative management. JAMA 302(11):1202–1209

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Stamey TA, Freiha FS, McNeal JE, Redwine EA, Whittemore AS, Schmid HP (1993) Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 71(3 Suppl):933–938

    Article  CAS  PubMed  Google Scholar 

  21. Bul M, Zhu X, Rannikko A et al (2012) Radical prostatectomy for low-risk prostate cancer following initial active surveillance: results from a prospective observational study. Eur Urol 62(2):195–200

    Article  PubMed  Google Scholar 

  22. Pierorazio PM, Spencer BA, McCann TR, McKiernan JM, Benson MC (2007) Preoperative risk stratification predicts likelihood of concurrent PSA-free survival, continence, and potency (the trifecta analysis) after radical retropubic prostatectomy. Urology 70(4):717–722

    Article  PubMed  Google Scholar 

  23. Gillitzer R, Hampel C, Thomas C et al (2009) Therapy choices of German urologists and radio-oncologists if personally diagnosed with localized prostate cancer. Urologe A 48(4):399–407

    Article  CAS  PubMed  Google Scholar 

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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.

Author information

Authors and Affiliations

  1. Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Andreas Becker, Luis Alex Kluth, Thorsten Schlomm, Margit Fisch & Felix K. H. Chun

  2. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany

    Andreas Becker, Markus Graefen & Thorsten Schlomm

  3. Department of Urology, Kantonsspital Aarau, Aarau, Switzerland

    Daniel Seiler, Maciej Kwiatkowski & Franz Recker

  4. Stiftung Maennergesundheit, Berlin, Germany

    Dietrich Schnell & Lothar Weissbach

  5. Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany

    Maciej Kwiatkowski

Authors
  1. Andreas Becker
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  2. Daniel Seiler
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  3. Maciej Kwiatkowski
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  4. Luis Alex Kluth
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  5. Dietrich Schnell
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  6. Markus Graefen
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  7. Thorsten Schlomm
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  8. Margit Fisch
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  9. Franz Recker
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  10. Lothar Weissbach
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  11. Felix K. H. Chun
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Corresponding author

Correspondence to Andreas Becker.

Additional information

Andreas Becker and Daniel Seiler have contributed equally to the manuscript.

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Becker, A., Seiler, D., Kwiatkowski, M. et al. A comparative assessment of active surveillance for localized prostate cancer in the community versus tertiary care referral center. World J Urol 32, 891–897 (2014). https://doi.org/10.1007/s00345-014-1309-2

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  • DOI: https://doi.org/10.1007/s00345-014-1309-2

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