[Patterns of care of patients with localized prostate cancer in Germany: a health care study with focus on active surveillance].
BACKGROUND
To date, evidence on active surveillance (AS) is restricted to protocol-based studies and the current practice pattern outside medical centers is unknown.


OBJECTIVE
The goal of this work was to capture the current treatment pattern of AS for localized prostate cancer (PCa) in patients managed by office-based urologists in Germany.


METHODS
Our cohort consisted of 361 patients included in the AS arm of the HAROW (Hormonal Treatment, Active Surveillance, Radiation Therapy, OP, Watchful Waiting) study, an observational health service study in Germany. Descriptive characteristics and active-treatment-free survival (ATFS), surgical outcomes, and triggers for active treatment were assessed.


RESULTS
Currently, only 15% of all patients with localized PCa were treated with AS. At baseline, 83% and 58% of all AS patients met the Chism and PRIAS low-risk criteria, respectively. After a median follow-up of 24 months, no systemic progression was observed, 5 patients died of non-disease-specific causes and active treatment was delivered in 20.5% of all patients. Triggers for active therapy were progression at biopsy (42%), rise in prostate-specific antigen level (27%), medical advice (16%) and patient's preference (10%), respectively.


CONCLUSIONS
Our short-term results indicate that - in the hands of office-based urologists - active surveillance might represent a feasible treatment option for patients with localized PCa. The majority of patients were free of active treatment 2 years after AS initiation. Generally accepted inclusion and progression criteria are lacking and should be developed in order to facilitate and standardize AS in patients with low-risk PCa.
Klinik und Poliklinik für Urologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
F K H
FK
Chun
A
A
Becker
L A
LA
Kluth
D
D
Seiler
D
D
Schnell
M
M
Fisch
M
M
Graefen
L
L
Weissbach
D000368:Aged; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000706:statistics & numerical data*