title: Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources.
abstract: OBJECTIVE
  Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa.
  
  
  METHODS
  In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost.
  
  
  RESULTS
  The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction).
  
  
  CONCLUSIONS
  AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.
authors.affiliation: Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Frederik B
authors.initials: FB
authors.lastname: Thomsen
authors.forename: Kasper D
authors.initials: KD
authors.lastname: Berg
authors.forename: M Andreas
authors.initials: MA
authors.lastname: Røder
authors.forename: Peter
authors.initials: P
authors.lastname: Iversen
authors.forename: Klaus
authors.initials: K
authors.lastname: Brasso
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003718:Denmark; D019468:Disease Management; D018450:Disease Progression; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy; D020728:Transurethral Resection of Prostate; D057832:Watchful Waiting / Q000191:economics / Q000706:statistics & numerical data*
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Active surveillance; complications; healthcare resources; prostate cancer; treatment