Risk stratification: a tool to predict the course of active surveillance for localized prostate cancer?

Herden, Jan; Heidenreich, Axel; Weißbach, L.

doi:10.1111/bju.13715

Cited by 9 publications

(7 citation statements)

References 29 publications

(47 reference statements)

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“…2c). In this context, we were able to demonstrate in a previous investigation of our cohort, that the main reason for intervention in the intermediate-/high-risk group was patient preference without sings of progression [22].…”

Section: Discussionsupporting

confidence: 53%

Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study

et al. 2020

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Purpose To report on long-term outcomes of patients treated with active surveillance (AS) for localized prostate cancer (PCa) in the daily routine setting. Methods HAROW (2008–2013) was a non-interventional, health service research study about the management of localized PCa in the community setting, with 86% of the study centers being office-based urologists. A follow-up examination of all patients who opted for AS as primary treatment was carried out. Overall, cancer-specific, and metastasis-free survival, as well as discontinuation rates, were determined. Results Of 329 patients, 62.9% had very-low- and 21.3% low-risk tumours. The median follow-up was 7.7 years (IQR 4.7–9.1). Twenty-eight patients (8.5%) died unrelated to PCa, of whom 19 were under AS or watchful waiting (WW). Additionally, seven patients (2.1%) developed metastasis. The estimated 10-year overall and metastasis-free survival was 86% (95% CI 81.7–90.3) and 97% (95% CI 94.6–99.3), respectively. One hundred eighty-seven patients (56.8%) discontinued AS changing to invasive treatment: 104 radical prostatectomies (RP), 55 radiotherapies (RT), and 28 hormonal treatments (HT). Another 50 patients switched to WW. Finally, 37.4% remained alive without invasive therapy (22.2% AS and 15.2% WW). Intervention-free survival differed between the risk groups: 47.8% in the very-low-, 33.8% in the low- and 34.6% in the intermediate-/high-risk-group (p = 0.008). On multivariable analysis, PSA-density ≥ 0.2 ng/ml2 was significantly predictive for receiving invasive treatment (HR 2.55; p = 0.001). Conclusion Even in routine care, AS can be considered a safe treatment option. Our results might encourage office-based urologists regarding the implementation of AS and to counteract possible concerns against this treatment option.

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Section: Discussionsupporting

confidence: 53%

Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study

et al. 2020

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“…Carlsson et al [18] found that nearly 30% of definitive treatment was related to patients' preference. Similarly, whereas in the LR group, most patients received deferred treatment due to tumor progression, patients with IR mainly discontinued AS at their own convenience in the study by Herden et al [23]. On the one hand, these results indicate that patients/physicians may have a greater fear of tumor progression.…”

Section: Discussionmentioning

confidence: 96%

Active Surveillance for Intermediate-risk Prostate Cancer: A Systematic Review, Meta-analysis, and Metaregression

Baboudjian

Breda²,

Rajwa³

et al. 2022

European Urology Oncology

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“…Many cohorts have included men with intermediate-risk under AS [ 14 , 24 , 25 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 ]. Table 2 shows a summary of studies including intermediate-risk patients undergoing AS and compares oncological outcomes between low-risk and intermediate-risk.…”

Section: Criteria For Inclusion Monitoring and Trigger For Interventionmentioning

confidence: 99%

Active Surveillance in Intermediate-Risk Prostate Cancer: A Review of the Current Data

Blas

Shiota

Eto

2022

Cancers

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Active surveillance (AS) is a monitoring strategy to avoid or defer curative treatment, minimizing the side effects of radiotherapy and prostatectomy without compromising survival. AS in intermediate-risk prostate cancer (PC) has increasingly become used. There is heterogeneity in intermediate-risk PC patients. Some of them have an aggressive clinical course and require active treatment, while others have indolent disease and may benefit from AS. However, intermediate-risk patients have an increased risk of metastasis, and the proper way to select the best candidates for AS is unknown. In addition, there are several differences between AS protocols in inclusion criteria, monitoring follow-up, and triggers for active treatment. A few large series and randomized trials are under investigation. Therefore, more research is needed to establish an optimal therapeutic strategy for patients with intermediate-risk disease. This study summarizes the current data on patients with intermediate-risk PC under AS, recent findings, and discusses future directions.

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Risk stratification: a tool to predict the course of active surveillance for localized prostate cancer?

Abstract: Our results show no differences in the outcome of risk-stratified patients in the specified risk groups managed with AS, while switching to an invasive treatment on the patient's request was more frequent in the intermediate-/high-risk group.

Cited by 9 publications

References 29 publications

Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study

Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study

Active Surveillance for Intermediate-risk Prostate Cancer: A Systematic Review, Meta-analysis, and Metaregression

Active Surveillance in Intermediate-Risk Prostate Cancer: A Review of the Current Data

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