Related Experiment Video
Updated: Aug 19, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
[Active surveillance-much safety, little recruitment : Is it possible to extend the indication for
Lothar Weißbach1, Edith A Boedefeld2, Jan Herden3,4
1Gesundheitsforschung für Männer gGmbH, Muthesiusstr. 7, 12163, Berlin, Deutschland. weissbach@gesundheitsforschung-fuer-maenner.de.
Background:
In contrast to North America or Sweden, active surveillance (AS) has not yet become established in our country for suitable prostate carcinomas (PCa). The strict entry criteria specified by the guideline are not likely to improve the acceptance in the near future. In early detection, prostate-specific antigen (PSA) testing leads to high numbers of overtreatment. There are various reasons for the continued preference for radical surgery.
Objectives:
The goal is to examine whether the heterogeneous group with intermediate-risk PCa contains tumors that may be eligible for AS.
Materials And Methods:
In the HAROW trial, 52 AS patients with differently defined intermediate-risk PCa were followed for a median of 85.6 months. Oncologic outcomes are reported.
Results:
Sixteen (30%) patients had a tumor of cT2b category, 21 (40%) had a Gleason score 3 + 4, 7 (14%) had ≥3 positive biopsy cores, 21 (40%) had a PSA >10 ng/ml, and 22 (42%) had a PSA density >0.2 ng/ml2. Carcinoma-specific and metastasis-free survival were 100% and 96%, respectively. Thirty four patients discontinued AS in favor of invasive treatment, and an additional eight men maintained a noninvasive approach by switching to watchful waiting.
Conclusions:
Efforts are under way to specify the criteria for patients with intermediate-risk PCa who may be eligible for AS. Tumors of cT2 category could be grouped together. The Gleason 4 fraction needs to be quantified because it determines the prognosis.
