Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer

Frederik B. Thomsen*, M. Andreas Røder, Henrik Jakobsen, Niels Christian Langkilde, Michael Borre, Erik B. Jakobsen, Anders Frey, Lars Lund, Dagmar Lunden, Claus Dahl, Klaus Brasso

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.

PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.

RESULTS: The 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.

CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.

OriginalsprogEngelsk
TidsskriftClinical Genitourinary Cancer
Vol/bind17
Udgave nummer4
Sider (fra-til)e814-e821
ISSN1558-7673
DOI
StatusUdgivet - 1. aug. 2019

Fingeraftryk

Prostatic Neoplasms
Confidence Intervals
Propensity Score
Prostate-Specific Antigen
Incidence

Citer dette

Thomsen, F. B., Røder, M. A., Jakobsen, H., Langkilde, N. C., Borre, M., Jakobsen, E. B., ... Brasso, K. (2019). Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer. Clinical Genitourinary Cancer, 17(4), e814-e821. https://doi.org/10.1016/j.clgc.2019.05.005
Thomsen, Frederik B. ; Røder, M. Andreas ; Jakobsen, Henrik ; Langkilde, Niels Christian ; Borre, Michael ; Jakobsen, Erik B. ; Frey, Anders ; Lund, Lars ; Lunden, Dagmar ; Dahl, Claus ; Brasso, Klaus. / Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer. I: Clinical Genitourinary Cancer. 2019 ; Bind 17, Nr. 4. s. e814-e821.
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title = "Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer",
abstract = "BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.RESULTS: The 10-year curative treatment-free survival for men on AS was 61{\%} (95{\%} confidence interval [CI], 57{\%}-65{\%}). No differences in use of salvage radiotherapy (AS, 2.7{\%}; 95{\%} CI, 1.4{\%}-4.1{\%} vs. RP 5.4{\%}; 95{\%} CI, 3.4{\%}-7.3{\%}), hormonal therapy (AS, 6.9{\%}; 95{\%} CI, 4.4{\%}-9.4{\%} vs. RP, 4.1{\%}; 95{\%} CI, 2.5{\%}-5.6{\%}), developing castration-resistant PCa (AS, 1.7{\%}; 95{\%} CI, 0.5{\%}-2.9{\%} vs. RP, 2.0{\%}; 95{\%} CI, 0.7{\%}-3.4{\%}), or cumulative PCa mortality (AS, 0.4{\%}; 95{\%} CI, 0{\%}-1.0{\%} vs. RP, 0.5{\%}; 95{\%} CI, 0{\%}-1.5{\%}) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.",
keywords = "Active surveillance, Localised, Prostate cancer, Radical prostatectomy, Survival",
author = "Thomsen, {Frederik B.} and R{\o}der, {M. Andreas} and Henrik Jakobsen and Langkilde, {Niels Christian} and Michael Borre and Jakobsen, {Erik B.} and Anders Frey and Lars Lund and Dagmar Lunden and Claus Dahl and Klaus Brasso",
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pages = "e814--e821",
journal = "Clinical Genitourinary Cancer",
issn = "1558-7673",
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Thomsen, FB, Røder, MA, Jakobsen, H, Langkilde, NC, Borre, M, Jakobsen, EB, Frey, A, Lund, L, Lunden, D, Dahl, C & Brasso, K 2019, 'Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer', Clinical Genitourinary Cancer, bind 17, nr. 4, s. e814-e821. https://doi.org/10.1016/j.clgc.2019.05.005

Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer. / Thomsen, Frederik B.; Røder, M. Andreas; Jakobsen, Henrik; Langkilde, Niels Christian; Borre, Michael; Jakobsen, Erik B.; Frey, Anders; Lund, Lars; Lunden, Dagmar; Dahl, Claus; Brasso, Klaus.

I: Clinical Genitourinary Cancer, Bind 17, Nr. 4, 01.08.2019, s. e814-e821.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer

AU - Thomsen, Frederik B.

AU - Røder, M. Andreas

AU - Jakobsen, Henrik

AU - Langkilde, Niels Christian

AU - Borre, Michael

AU - Jakobsen, Erik B.

AU - Frey, Anders

AU - Lund, Lars

AU - Lunden, Dagmar

AU - Dahl, Claus

AU - Brasso, Klaus

PY - 2019/8/1

Y1 - 2019/8/1

N2 - BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.RESULTS: The 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.

AB - BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.RESULTS: The 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.

KW - Active surveillance

KW - Localised

KW - Prostate cancer

KW - Radical prostatectomy

KW - Survival

U2 - 10.1016/j.clgc.2019.05.005

DO - 10.1016/j.clgc.2019.05.005

M3 - Journal article

VL - 17

SP - e814-e821

JO - Clinical Genitourinary Cancer

JF - Clinical Genitourinary Cancer

SN - 1558-7673

IS - 4

ER -

Thomsen FB, Røder MA, Jakobsen H, Langkilde NC, Borre M, Jakobsen EB et al. Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer. Clinical Genitourinary Cancer. 2019 aug 1;17(4):e814-e821. https://doi.org/10.1016/j.clgc.2019.05.005