Treatment of Incidental Prostate Cancer by Active Surveillance: Results of the HAROW Study

Herden, Jan; Eminaga, Okyaz; Wille, Sebastian; Weißbach, L.

doi:10.1159/000431024

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…The results are similar: invasive treatment was reported in 19% of T1a tumours in a study by Descazeaud et al [10] and in 30% of T1a and T1b tumours in a study by Lee et al [11]. Recently, we reported on a cohort of patients with IPCa who were treated by AS in a prospective setting: 11.1% of the patients switched to invasive treatment after a mean follow-up of 26.5 months [12].…”

Section: Introductionsupporting

confidence: 78%

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

Herden

Wille

Weißbach³

2015

BJU International

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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.

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Section: Introductionsupporting

confidence: 78%

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

Herden

Wille

Weißbach³

2015

BJU International

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“…Discontinuation of AS was recommended in case of histological evidence of progressive disease, increasing PSA levels with PSA-DT <3 years, or clinical signs of progression on DRE, alternatively on patient’s request. Data of recruitment, diagnostics, and course of disease in the total cohort and the IPC cohort with a median observation period of 26.5 months have been published elsewhere [18, 19].…”

Section: Methodsmentioning

confidence: 99%

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Herden

Schwarte

Boedefeld³

et al. 2021

Urol Int

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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/mL2 (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.

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“…This study was nested within the prospective, multicenter, observational HAROW study, which included 3,169 patients newly diagnosed with localized PCa between July 2008 and July 2013. The study has been described in detail elsewhere . In the present study, of the 1,787 men, who had chosen RP as the primary treatment option, 378 were matched according to length of therapy to the 378 men whose primary treatment option was AS.…”

Section: Methodsmentioning

confidence: 99%

“…The study has been described in detail elsewhere. 12 In the present study, of the 1,787 men, who had chosen RP as the primary treatment option, 378 were matched according to length of therapy to the 378 men whose primary treatment option was AS. The time interval between treatment decision and time of the interview ranged from 19 to 78 months (mean 47.9 6 SD 15.4).…”

Section: Methodsmentioning

confidence: 99%

Patients' perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy

Kendel

Helbig

Neumann

et al. 2016

Intl Journal of Cancer

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Treatment choice for localized prostate cancer (PCa) is a controversial issue, and mortality risk is probably the most decisive factor in this regard. The study aimed to compare prostate-cancer-specific mortality risk estimates for different treatment options assigned by patients managed with active surveillance (AS), radical prostatectomy (RP) and patients who had discontinued AS (DAS). Patients initially managed with AS or RP (N 5 370) were matched according to length of therapy. All patients completed mailed questionnaires assessing their mortality risk estimates (in %) and prostate-cancer-specific anxiety. Differences in risk estimates among the three treatment groups were analyzed using ANOVA, relationships of clinical and psychosocial variables with risk estimates using standard multiple regression. In all treatment groups, the prostate-cancer-specific mortality risk was overestimated. This applied whether it was the patient's own treatment or the alternative treatment option. RP patients assigned a mortality risk to AS that was almost three times higher than that assigned to RP (50.9 6 25.0 vs. 17.8 6 19.7, d 5 1.48; p < 0.001). Anxiety was significantly associated with risk estimates for AS (p 5 0.008) and RP (p 5 0.001). Compared with clinical data that suggest that the prostate-cancer-specific mortality risk for AS is low and does not significantly differ from that for RP, patients strongly overestimated the mortality risk. This was most markedly so in RP patients, who drastically overestimated the benefits of RP compared to the risk of AS. This overestimation could increase overtreatment and should therefore be corrected by better patient education.

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Treatment of Incidental Prostate Cancer by Active Surveillance: Results of the HAROW Study

Cited by 8 publications

References 23 publications

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

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

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Patients' perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy

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