Die Versorgung von Patienten mit lokal begrenztem Prostatakarzinom in Deutschland: Active-Surveillance-Ergebnisse einer nicht-interventionellen Versorgungsstudie

TY - JOUR

T1 - Die Versorgung von Patienten mit lokal begrenztem Prostatakarzinom in Deutschland: Active-Surveillance-Ergebnisse einer nicht-interventionellen Versorgungsstudie

AU - Chun, F K H

AU - Becker, A

AU - Kluth, L A

AU - Seiler, D

AU - Schnell, D

AU - Fisch, M

AU - Graefen, M

AU - Weissbach, L

PY - 2015/1

Y1 - 2015/1

N2 - BACKGROUND: To date, evidence on active surveillance (AS) is restricted to protocol-based studies and the current practice pattern outside medical centers is unknown.OBJECTIVES: 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.MATERIALS AND 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.CONCLUSION: 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.

AB - BACKGROUND: To date, evidence on active surveillance (AS) is restricted to protocol-based studies and the current practice pattern outside medical centers is unknown.OBJECTIVES: 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.MATERIALS AND 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.CONCLUSION: 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.

KW - Aged

KW - Germany

KW - Humans

KW - Male

KW - Population Surveillance

KW - Practice Patterns, Physicians'

KW - Prevalence

KW - Prostatic Neoplasms

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Treatment Outcome

KW - Watchful Waiting

U2 - 10.1007/s00120-014-3647-5

DO - 10.1007/s00120-014-3647-5

M3 - SCORING: Zeitschriftenaufsatz

C2 - 25391440

VL - 54

SP - 6

EP - 13

JO - UROLOGE

JF - UROLOGE

SN - 0340-2592

IS - 1

ER -