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Treatment of intermediate-risk prostate cancer with active surveillance in the routine care-Long-term outcomes of a prospective noninterventional study (HAROW)

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CURRENT UROLOGY 2024年第2期18卷 115-121页

作者： Weissbach, Lothar Schwarte, Andreas Boedefeld, Edith A. Herden, Jan Hlth Res Men GmbH Berlin Germany Urol Practice Borken Borken Germany Univ Cologne Fac Med & Univ Hosp Cologne Dept Urol Urooncol Robot Assisted & Reconstruct Ur Cologne Germany PAN Clin Urol Practice Cologne Germany Univ Hosp Cologne Dept Urol Kerpener Str 62 Cologne Germany

BackgroundWe report here the long-term outcomes of patients with intermediate-risk prostate cancer (PCa) treated with active surveillance (AS) in a daily routine *** and methodsHAROW (2008-2013) was a noninterventional, health service research study investigating the management of localized PCa in a community setting. A substantial proportion of the study centers were office-based urologists. A follow-up examination of all intermediate-risk patients with AS was conducted. Overall, cancer-specific, metastasis-free, and treatment-free survival rates, as well as reasons for discontinuation, were determined and *** the 2957 patients enrolled, 52 with intermediate-risk PCa were managed with AS and were available for evaluation. The median follow-up was 6.8 years (interquartile range, 3.4-8.6 years). Seven patients (13.5%) died of causes unrelated to PCa, of whom 4 were under AS or under watchful waiting. Two patients (3.8%) developed metastasis. The estimated 8-year overall, cancer-specific, metastasis-free, and treatment-free survival rates were 85% (95% confidence interval [CI], 72%-96%), 100%, 93% (95% CI, 82%-100%), and 31% (95% CI, 17%-45%), respectively. On multivariable analysis, prostate-specific antigen density of >= 0.2 ng/mL2 was significantly predictive of receiving invasive treatment (hazard ratio, 3.29; p = 0.006). Reasons for discontinuation were more often due to patient's or physician's concerns (36%) than due to observed clinical *** survival outcome data for intermediate-risk patients managed with AS in real-life health care conditions were promising, rates of discontinuation were high, and discontinuation was often a patient's decision, even when the signs of disease progression were absent. This might be an indication of higher levels of mental burden and anxiety in this specific subgroup of patients, which should be considered when making treatment decisions. From a psychological perspective,

关键词： Active surveillance intermediate-risk prostate cancer HAROW study Conservative management Outcomes research TREATMENT OPTIONS GUIDELINES MANAGEMENT GRADE

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External-beam radiation therapy should be given with androgen deprivation treatment for intermediate-risk prostate cancer： new confirmatory evidence

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Asian Journal of Andrology 2012年第1期14卷 132-133页

作者： Matthew R Cooperberg Department of Urology University of California San Francisco CA 94143-1695 USA

Anewly published study, Radiation Therapy Oncology Group （RTOG） trial 94-08, has demonstrated that a short-course ofneoadjuvant androgen deprivation therapy （ADT） given together with external-beam radiation therapy （EBRT） improves outcomes for men with intermediate-risk prostate cancer compared with EBRT alone） The benefits of neoadjuvant ADT for men receiving EBRT have been recognized for years, but in light of growing concerns regarding potential long-term skeletal, metabolic and cardiovascular toxicities of ADT, the demonstration of benefits with only shortterm treatment is timely.

关键词： External-beam radiation therapy intermediate-risk prostate cancer neoadjuvant ADT RTOG 94-08 brachytherapy

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