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

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

110 Downloads (Pure)

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.

Original languageEnglish
JournalClinical Genitourinary Cancer
Volume17
Issue number4
Pages (from-to)e814-e821
ISSN1558-7673
DOIs
Publication statusPublished - 1. Aug 2019

Keywords

  • Active surveillance
  • Localised
  • Prostate cancer
  • Radical prostatectomy
  • Survival

Fingerprint

Dive into the research topics of 'Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer'. Together they form a unique fingerprint.

Cite this