Utilization of Active Surveillance and Watchful Waiting for localized prostate cancer in the daily practice.

Abstract

To analyze the utilization of Active Surveillance (AS) and Watchful Waiting (WW) in the daily routine setting, since both are non-invasive treatment options for localized prostate cancer (PCa), which are used in a curative (AS) or palliative (WW) setting. Since differentiation of both strategies is not always clear, patients were compared with respect to the inclusion criteria, frequency of follow-up examinations (Prostate Specific Antigen=PSA tests, rebiopsies), and initiation of a deferred treatment. HAROW is a non-interventional, health-service research study on the management of localized PCa in the community setting. Of 3169 patients, prospectively enrolled from 2008 to 2013 with a mean follow-up of 28.2months, 468 chose AS and 126 WW. Treating urologists reported clinical variables, information on therapy and clinical course of disease. AS patients were significantly younger and had more low-risk tumors. No differences were seen in the number of PSA tests during follow-up: mean number of PSA tests was 6.08 for AS- and 5.18 for WW patients, more than four PSA tests were reported in 63.9% AS- and 59.5% WW patients (p=0.136). At least one re-biopsy was performed in 39.7% AS- and 9.5% WW patients (p<0.001). Discontinuation rates were 23.9% (n=112) for AS and 11.9% (n=15) for WW. Most of the AS patients opted for a curative treatment (prostatectomy=65, radiotherapy=30), whereas 12 WW patients received a palliative hormone therapy and three patients received radiotherapy. Physicians seem to distinguish clearly between AS and WW in terms of inclusion criteria and deferred therapy, whereas this differentiation tends to become indistinct in terms of follow-up examinations.