Universität zu Köln

Herden, Jan ORCID: 0000-0002-1667-5200, Schwarte, Andreas, Boedefeld, Edith A. and Weissbach, Lothar (2021). Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study. Urol.Int., 105 (5-6). S. 428 - 436. BASEL: KARGER. ISSN 1423-0399

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Abstract

Introduction: Optimal treatment for incidental prostate cancer (IPC) after surgical treatment for benign prostate obstruction is still debatable. We report on long-term outcomes of IPC patients managed with active surveillance (AS) in a German multicenter study. Methods: HAROW (2008-2013) was designed as a noninterventional, prospective, health-service research study for patients with localized prostate cancer (<= cT2), including patients with IPC (cT1a/b). A follow-up examination of all patients treated with AS was carried out. Overall, cancer-specific, and metastasis-free survival and discontinuation rates were determined. Results: Of 210 IPC patients, 68 opted for AS and were available for evaluation. Fifty-four patients had cT1a category and 14 cT1b category. Median follow-up was 7.7 years (IQR: 5.7-9.1). Eight patients died of which 6 were still under AS or watchful waiting (WW). No PCa-specific death could be observed. One patient developed metastasis. Twenty-three patients (33.8%) discontinued AS changing to invasive treatment: 12 chose radical prostatectomy, 7 radiotherapy, and 4 hormonal treatment. Another 19 patients switched to WW. The Kaplan-Meier estimated 10-year overall, cancer-specific, metastasis-free, and intervention-free survival was 83.8% (95% CI: 72.2-95.3), 100%, 98.4% (95% CI: 95.3-99.9), and 61.0% (95% CI: 47.7-74.3), respectively. In multivariable analysis, age (RR: 0.97; p < 0.001), PSA density >= 0.2 ng/mL(2) (RR: 13.23; p < 0.001), and PSA >= 1.0 ng/mL after surgery (RR: 5.19; p = 0.016) were significantly predictive for receiving an invasive treatment. Conclusion: In comparison with other AS series with a general low-risk prostate cancer population, our study confirmed the promising survival outcomes for IPC patients, whereas discontinuation rates seem to be lower for IPC. Thus, IPC patients at low risk of progression may be good candidates for AS.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Herden, Jan UNSPECIFIED orcid.org/0000-0002-1667-5200 UNSPECIFIED Schwarte, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Boedefeld, Edith A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Weissbach, Lothar UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-581914
DOI:	10.1159/000512893
Journal or Publication Title:	Urol.Int.
Volume:	105
Number:	5-6
Page Range:	S. 428 - 436
Date:	2021
Publisher:	KARGER
Place of Publication:	BASEL
ISSN:	1423-0399
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58191