title: A comparative assessment of active surveillance for localized prostate cancer in the community versus tertiary care referral center.
abstract: OBJECTIVE
  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
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany, a.becker@uke.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Daniel
authors.initials: D
authors.lastname: Seiler
authors.forename: Maciej
authors.initials: M
authors.lastname: Kwiatkowski
authors.forename: Luis Alex
authors.initials: LA
authors.lastname: Kluth
authors.forename: Dietrich
authors.initials: D
authors.lastname: Schnell
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Franz
authors.initials: F
authors.lastname: Recker
authors.forename: Lothar
authors.initials: L
authors.lastname: Weissbach
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003153:Community Health Services; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D011878:Radiotherapy; D013557:Switzerland / Q000453:epidemiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D057832:Watchful Waiting