Abstract
Introduction: Optimal treatment for incidental prostate cancer (IPC) after surgical treatment for benign prostate obstruction is still debatable. We report on long-term outcomes of IPC patients managed with active surveillance (AS) in a German multicenter study. Methods: HAROW (2008–2013) was designed as a noninterventional, prospective, health-service research study for patients with localized prostate cancer (≤cT2), including patients with IPC (cT1a/b). A follow-up examination of all patients treated with AS was carried out. Overall, cancer-specific, and metastasis-free survival and discontinuation rates were determined. Results: Of 210 IPC patients, 68 opted for AS and were available for evaluation. Fifty-four patients had cT1a category and 14 cT1b category. Median follow-up was 7.7 years (IQR: 5.7–9.1). Eight patients died of which 6 were still under AS or watchful waiting (WW). No PCa-specific death could be observed. One patient developed metastasis. Twenty-three patients (33.8%) discontinued AS changing to invasive treatment: 12 chose radical prostatectomy, 7 radiotherapy, and 4 hormonal treatment. Another 19 patients switched to WW. The Kaplan-Meier estimated 10-year overall, cancer-specific, metastasis-free, and intervention-free survival was 83.8% (95% CI: 72.2–95.3), 100%, 98.4% (95% CI: 95.3–99.9), and 61.0% (95% CI: 47.7–74.3), respectively. In multivariable analysis, age (RR: 0.97; p < 0.001), PSA density ≥0.2 ng/mL2 (RR: 13.23; p < 0.001), and PSA ≥1.0 ng/mL after surgery (RR: 5.19; p = 0.016) were significantly predictive for receiving an invasive treatment. Conclusion: In comparison with other AS series with a general low-risk prostate cancer population, our study confirmed the promising survival outcomes for IPC patients, whereas discontinuation rates seem to be lower for IPC. Thus, IPC patients at low risk of progression may be good candidates for AS.
References
1.
Brierley
J
, Gospodarowicz
MK
, Wittekind
C
. TNM classification of malignant tumours
. 8th ed. Oxford
: Blackwell
; 2017
.2.
Amin
MB
, Edge
S
, Greene
F
, Byrd
DR
, Brookland
RK
, Washington
MK
, et al. American Joint Committee on Cancer (AJCC) staging manual
. 8th ed. New York, NY
: Springer
; 2017
.3.
Lowe
BA
, Listrom
MB
. Incidental carcinoma of the prostate: an analysis of the predictors of progression
. J Urol
. 1988
;140
(6
):1340
–4
. .4.
Chung
DY
, Goh
HJ
, Koh
DH
, Kim
MS
, Lee
JS
, Jang
WS
, et al. Clinical significance of multiparametric MRI and PSA density as predictors of residual tumor (pT0) following radical prostatectomy for T1a–T1b (incidental) prostate cancer
. PLoS One
. 2018
;13
(12
):e0210037
. .5.
Loeb
S
, Folkvaljon
Y
, Curnyn
C
, Robinson
D
, Bratt
O
, Stattin
P
. Uptake of active surveillance for very-low-risk prostate cancer in Sweden
. JAMA Oncol
. 2017
;3
(10
):1393
–8
. .6.
Shelton
JB
, Buffington
P
, Augspurger
R
, Gaylis
F
, Cohen
T
, Mehlhaff
B
, et al. Contemporary management of incident prostate cancer in large community urology practices in the United States
. Urology
. 2019
;129
:79
–86
. .7.
Mottet
N
, Bellmunt
J
, Bolla
M
, Briers
E
, Cumberbatch
MG
, De Santis
M
, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent
. Eur Urol
. 2017
;71
(4
):618
–29
. .8.
Mohler
JL
, Antonarakis
ES
, Armstrong
AJ
, D’Amico
AV
, Davis
BJ
, Dorff
T
, et al. Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology
. J Natl Compr Canc Netw
. 2019
;17
(5
):479
–505
. .9.
Jones
JS
, Follis
HW
, Johnson
JR
. Probability of finding T1a and T1b (incidental) prostate cancer during TURP has decreased in the PSA era
. Prostate Cancer Prostatic Dis
. 2009
;12
(1
):57
–60
. .10.
Porcaro
AB
, Tafuri
A
, Inverardi
D
, Amigoni
N
, Sebben
M
, Pirozzi
M
, et al. Incidental prostate cancer after transurethral resection of the prostate: analysis of incidence and risk factors in 458 patients
. Minerva Urol Nefrol
. 2020 Jan 29
. Epub ahead of print
.11.
Capogrosso
P
, Capitanio
U
, Vertosick
EA
, Ventimiglia
E
, Chierigo
F
, Oreggia
D
, et al. Temporal trend in incidental prostate cancer detection at surgery for benign prostatic hyperplasia
. Urology
. 2018
;122
:152
–7
. .12.
Rosenhammer
B
, Schönhärl
M
, Mayr
R
, Schnabel
MJ
, Burger
M
, Eichelberg
C
. Introduction of a new score to assess surgical efficiency in holmium laser enucleation of the prostate
. Urol Int
. 2020 Sep 2
;104
(11–12
):914
–22
. .13.
Rosenhammer
B
, Lausenmeyer
EM
, Mayr
R
, Burger
M
, Eichelberg
C
. Holmium laser enucleation of the prostate provides similar incidental prostate cancer detection rates as open prostatectomy: a matched pair analysis
. Urol Int
. 2018
;101
(4
):382
–6
. .14.
Herden
J
, Ansmann
L
, Ernstmann
N
, Schnell
D
, Weißbac
L
. The treatment of localized prostate cancer in everyday practice in Germany
. Dtsch Arztebl Int
. 2016
;113
(19
):329
–36
. .15.
Heidenreich
A
, Aus
G
, Bolla
M
, Joniau
S
, Matveev
VB
, Schmid
HP
, et al. EAU guidelines on prostate cancer
. Eur Urol
. 2008
;53
:68
–80
.16.
Parker
C
. Active surveillance: towards a new paradigm in the management of early prostate cancer
. Lancet Oncol
. 2004
;5
(2
):101
–6
. .17.
van den Bergh
RC
, Roemeling
S
, Roobol
MJ
, Roobol
W
, Schröder
FH
, Bangma
CH
. Prospective validation of active surveillance in prostate cancer: the PRIAS study
. Eur Urol
. 2007
;52
(6
):1560
–3
. .18.
Weissbach
L
, Stuerzebecher
S
, Mumperow
E
, Klotz
T
, Schnell
D
. HAROW: the first comprehensive prospective observational study comparing treatment options in localized prostate cancer
. World J Urol
. 2016
;34
(5
):641
–7
. .19.
Herden
J
, Eminaga
O
, Wille
S
, Weissbach
L
. Treatment of incidental prostate cancer by active surveillance: results of the HAROW study
. Urol Int
. 2015
;95
(2
):209
–15
. .20.
Saar
M
, Linxweiler
J
, Borkowetz
A
, Fussek
S
, Urbanova
K
, Bellut
L
, et al. German Prostate Cancer Consortium (DPKK). Current role of multiparametric MRI and MRI targeted biopsies for prostate cancer diagnosis in Germany: a nationwide survey
. Urol Int
. 2020
;104
:731
–40
.21.
Schulze
A
, Christoph
F
, Sachs
M
, Schroeder
J
, Stephan
C
, Schostak
M
, et al. Use of the prostate health index and density in 3 outpatient centers to avoid unnecessary prostate biopsies
. Urol Int
. 2020
;104
(3–4
):181
–6
. .22.
Descazeaud
A
, Peyromaure
M
, Salin
A
, Amsellem-Ouazana
D
, Flam
T
, Viellefond
A
, et al. Predictive factors for progression in patients with clinical stage T1a prostate cancer in the PSA era
. Eur Urol
. 2008
;53
(2
):355
–61
. .23.
Lee
DH
, Chung
DY
, Lee
KS
, Kim
IK
, Rha
KH
, Choi
YD
, et al. Clinical experiences of incidental prostate cancer after transurethral resection of prostate (TURP) according to initial treatment: a study of a Korean high volume center
. Yonsei Med J
. 2014
;55
(1
):78
–83
. .24.
Tosoian
JJ
, Mamawala
M
, Epstein
JI
, Landis
P
, Macura
KJ
, Simopoulos
DN
, et al. Active surveillance of grade group 1 prostate cancer: long-term outcomes from a large prospective cohort
. Eur Urol
. 2020
;77
(6
):675
–82
.25.
Soloway
MS
, Soloway
CT
, Eldefrawy
A
, Acosta
K
, Kava
B
, Manoharan
M
. Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment
. Eur Urol
. 2010
;58
(6
):831
–5
. .26.
Hamdy
FC
, Donovan
JL
, Lane
JA
, Mason
M
, Metcalfe
C
, Holding
P
, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer
. N Engl J Med
. 2016
;375
(15
):1415
–24
. .27.
Klotz
L
, Vesprini
D
, Sethukavalan
P
, Jethava
V
, Zhang
L
, Jain
S
, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer
. J Clin Oncol
. 2015
;33
(3
):272
. .28.
Bokhorst
LP
, Valdagni
R
, Rannikko
A
, Kakehi
Y
, Pickles
T
, Bangma
CH
, et al. A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment
. Eur Urol
. 2016
;70
(6
):954
–60
. .29.
Loeb
S
, Walter
D
, Curnyn
C
, Gold
HT
, Lepor
H
, Makarov
DV
. How active is active surveillance? Intensity of follow-up during active surveillance for prostate cancer in the United States
. J Urol
. 2016
;196
:721
–6
.30.
Park
J
, Yoo
S
, Cho
MC
, Jeong
CW
, Ku
JH
, Kwak
C
, et al. Patients with biopsy Gleason score 3 + 4 are not appropriate candidates for active surveillance
. Urol Int
. 2020
;104
(3–4
):199
–204
. .31.
Cantrell
BB
, DeKlerk
DP
, Eggleston
JC
, Boitnott
JK
, Walsh
PC
. Pathological factors that influence prognosis in stage A prostatic cancer: the influence of extent versus grade
. J Urol
. 1981
;125
(4
):516
–20
. .32.
Capitanio
U
, Scattoni
V
, Freschi
M
, Briganti
A
, Salonia
A
, Gallina
A
, et al. Radical prostatectomy for incidental (stage T1a–T1b) prostate cancer: analysis of predictors for residual disease and biochemical recurrence
. Eur Urol
. 2008
;54
(1
):118
–25
. .33.
Magheli
A
, Rais-Bahrami
S
, Carter
HB
, Peck
HJ
, Epstein
JI
, Gonzalgo
ML
. Subclassification of clinical stage T1 prostate cancer: impact on biochemical recurrence following radical prostatectomy
. J Urol
. 2007
;178
(4 Pt 1
):1277
–1
. .34.
Klotz
L
. Active surveillance for low-risk prostate cancer
. Curr Opin Urol
. 2017
;27
(3
):225
–30
. .© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
