Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study

Abstract

ObjectiveTo conduct a comparative prospective analysis of patients with incidental T1a/T1b prostate cancer (IPCa) and those with prostate cancer (PCa) diagnosed by core needle biopsy, treated by active surveillance (AS), with regard to inclusion criteria, progression and switch to deferred treatment. Patients and MethodsThe HAROW study is an observational outcomes research study on the management of localized PCa. Treating urologists reported clinical variables and information on therapy and clinical course of disease at 6-month intervals. With respect to therapy, only recommendations were made; the final decision on the therapeutic method rested with the treating physician. ResultsOut of 2 957 patients included in the HAROW study, 447 chose AS. The median follow-up was 28.3 months. T1a, T1b, T1c and T2a disease were diagnosed in 81, 18, 292 and 56 patients, respectively. Patients in the IPCa group had lower prostate-specific antigen (PSA) levels (4.2 vs 6.1 ng/mL) and more comorbidities than those diagnosed by core needle biospy. The IPCa group also had fewer re-biopsies (25.3 vs 43.2%) and fewer changes to invasive treatment (12.1 vs 25.9%). No significant differences were found with respect to the criteria for discontinuation, subsequent therapies and histological findings after radical prostatectomy. ConclusionUrologists are highly inclined to use AS as a therapeutic option in IPCa. More patients with IPCa than those diagnosed after core needle biopsy continued on AS, which was also associated with the indication for a re-biopsy being less stringently observed.

Acknowledging unreported problems with active surveillance for prostate cancer: a prospective single-centre observational study

“…This is also comparable to other large trials. 15 Hence, our findings support the implementation of incidental tumours in AS, as it is recommended in the recently published S3-Guidelines of the German Society of Urology. 16 Dropout and compliance Only few reports have looked at compliance problems in AS.…”

Two Decades of Active Surveillance for Prostate Cancer in a Single-Center Cohort: Favorable Outcomes after Transurethral Resection of the Prostate

“…Our results reiterate findings from other studies that were conducted over shorter durations and at least five years after our study had begun, including PRIAS (2006), HAROW (2008–2013), and The Movember Foundation’s GAP3 cohort (2014–2016; a database to which we have also contributed) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

“…Here, we prospectively assessed our T1a/b and T1c subgroups with respect to their reclassification rates, which occurred approximately thrice as quickly in the T1c group (reclassification per 3.6 years) versus the T1a/b group (reclassification per 11.2 years). One other study has reported similarly, noting a doubled reclassification rate after biopsy in T1c patients, though its mean FU time was only 2.4 years [ 15 ]. Moreover, the delayed reclassification rate in our T1a/b cohort indicates that such patients (a) live longer prior to developing a definitive treatment requirement, and (b) may be better candidates for WW than definitive active treatment.…”

Clinical experience with active surveillance protocol using regular magnetic resonance imaging instead of regular repeat biopsy for monitoring: A study at a high-volume center in Korea

“…Compared to the termination rate on AS in 14–41% of patients by prostate biopsy, those in incidental prostate cancer patients of 11–19% are likely lower. 28 , 29 In the present study, no significant differences were observed in the termination rates on AS (48.7% vs. 61.4%; P > 0.99) according to diagnostic methods. However, patients with incidental prostate cancer had longer AS adherence duration and follow-up duration.…”