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

Frederik B Thomsen1, M Andreas Røder2, Henrik Jakobsen3

  • 1Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen, Denmark.

Clinical Genitourinary Cancer
|June 15, 2019
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Summary

Active surveillance and radical prostatectomy show similar prostate cancer (PCa) mortality at 10 years for favorable-risk localized PCa. These treatments also had comparable rates of subsequent therapies, supporting active surveillance as a viable option.

Keywords:
Active surveillanceLocalisedProstate cancerRadical prostatectomySurvival

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Area of Science:

  • Oncology
  • Urology
  • Clinical Medicine

Background:

  • Active surveillance (AS) and radical prostatectomy (RP) are established treatments for favorable-risk localized prostate cancer (PCa).
  • Comparative studies on oncologic outcomes and survival between AS and RP are needed.
  • This study aimed to compare PCa treatments and mortality in men managed with AS versus immediate RP.

Purpose of the Study:

  • To compare the 10-year oncologic outcomes between active surveillance and radical prostatectomy in men with favorable-risk localized prostate cancer.
  • To evaluate differences in the incidence of salvage radiotherapy, hormonal therapy, and castration-resistant prostate cancer between the two treatment groups.
  • To assess the cumulative prostate cancer mortality rates at 10 years for both management strategies.

Main Methods:

  • An observational study involving 647 men on AS and 647 men treated with RP, utilizing propensity score matching.
  • Examination of 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.
  • Analysis of treatment-free survival at 10 years for men managed with AS.

Main Results:

  • The 10-year curative treatment-free survival for AS was 61%.
  • No significant differences were observed in the use of salvage radiotherapy, hormonal therapy, or development of castration-resistant PCa between AS and RP groups.
  • Cumulative prostate cancer mortality at 10 years was similar between AS (0.4%) and RP (0.5%).

Conclusions:

  • Active surveillance and immediate radical prostatectomy demonstrate similar prostate cancer mortality at 10 years for men with favorable-risk localized PCa.
  • There were no significant differences in the utilization of subsequent PCa therapies between the AS and RP groups.
  • The findings support active surveillance as a suitable treatment strategy for select men with favorable-risk localized prostate cancer.