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The Probability of Remaining Under Active Surveillance for Localized Prostate Cancer: An Analysis of Young Patients
Kevin Claassen1, Christina Justenhoven, Silke Hermann
1Cancer Registry North-Rhine Westphalia, Bochum, Germany; Department of Human Medicine, Medical School Hamburg, Germany; Cancer Registry of Rhineland-Palatinate in the Institute for Digital Health Data, Mainz, Germany; German Cancer Research Center (DKFZ), Epidemiological Cancer Registry Baden-Württemberg, Heidelberg, Germany; Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany; Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.
Background:
After a diagnosis of prostate cancer, the 15-year cancer-specific survival probability is high; in suitable patients, active surveillance lessens the side effects of curative treatment. Limited evidence is available on the continuation of active surveillance in young prostate cancer patients in Germany.
Methods:
Using data that were reported, as required by law, to the population-based cancer registries of the German federal states of North Rhine-Westphalia, Baden-Württemberg, and Rhineland- - Palatinate, we studied the course of 732 patients under 60 years of age who were under active surveillance after receiving a diagnosis of low-risk localized prostate cancer (ISUP grade 1 or 2) in the years 2016-2021.
Results:
The median duration of follow-up was 28 months. 64% [61%; 68%] of the patients were still under active surveillance at two years; this was true for 66% [62%; 70%] of those with ISUP grade 1 disease, 46% [37%; 58%] of those with ISUP grade 2 disease, and 72% [63%; 83%] of those for whom no Gleason grading was available. 62% of discontinuations occurred without any documented progression and without a documented patient-initiated decision.
Conclusion:
The two-year probability of young prostate cancer patients remaining under active surveillance was lower in Germany than in other countries. The cancer registries mostly received no information concerning the clinical rationale for the discontin uations. The potentially incomplete reporting of reasons for discontinuing active surveillance suggests that clinical reporting practices should be improved.
