Department of Urology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Health Research for Men GmbH, Berlin, Germany.
World J Urol. 2018 Mar;36(3):383-391. doi: 10.1007/s00345-018-2175-0. Epub 2018 Jan 12.
To analyze the utilization of Active Surveillance (AS) and Watchful Waiting (WW) in the daily routine setting, since both are non-invasive treatment options for localized prostate cancer (PCa), which are used in a curative (AS) or palliative (WW) setting. Since differentiation of both strategies is not always clear, patients were compared with respect to the inclusion criteria, frequency of follow-up examinations (Prostate Specific Antigen = PSA tests, rebiopsies), and initiation of a deferred treatment.
HAROW is a non-interventional, health-service research study on the management of localized PCa in the community setting. Of 3169 patients, prospectively enrolled from 2008 to 2013 with a mean follow-up of 28.2 months, 468 chose AS and 126 WW. Treating urologists reported clinical variables, information on therapy and clinical course of disease.
AS patients were significantly younger and had more low-risk tumors. No differences were seen in the number of PSA tests during follow-up: mean number of PSA tests was 6.08 for AS- and 5.18 for WW patients, more than four PSA tests were reported in 63.9% AS- and 59.5% WW patients (p = 0.136). At least one re-biopsy was performed in 39.7% AS- and 9.5% WW patients (p < 0.001). Discontinuation rates were 23.9% (n = 112) for AS and 11.9% (n = 15) for WW. Most of the AS patients opted for a curative treatment (prostatectomy = 65, radiotherapy = 30), whereas 12 WW patients received a palliative hormone therapy and three patients received radiotherapy.
Physicians seem to distinguish clearly between AS and WW in terms of inclusion criteria and deferred therapy, whereas this differentiation tends to become indistinct in terms of follow-up examinations.
分析主动监测（AS）和观察等待（WW）在日常实践中的应用，因为这两种方法都是局限性前列腺癌（PCa）的非侵入性治疗选择，可用于治愈（AS）或姑息（WW）治疗。由于这两种策略的区分并不总是明确的，因此比较了这两种策略的纳入标准、随访检查的频率（前列腺特异性抗原[PSA]检查、再次活检）以及开始推迟治疗的情况。
HAROW 是一项关于社区环境中局限性 PCa 管理的非干预性、卫生服务研究。在 2008 年至 2013 年期间，前瞻性纳入了 3169 例患者，平均随访 28.2 个月，其中 468 例选择 AS，126 例选择 WW。治疗泌尿科医生报告了临床变量、治疗信息和疾病临床过程。
AS 患者明显更年轻，且肿瘤低危比例更高。在随访期间的 PSA 检查次数方面无差异：AS 患者的平均 PSA 检查次数为 6.08 次，WW 患者为 5.18 次，63.9%的 AS 患者和 59.5%的 WW 患者进行了 4 次以上的 PSA 检查（p=0.136）。39.7%的 AS 患者和 9.5%的 WW 患者至少进行了一次再次活检（p<0.001）。AS 的停药率为 23.9%（n=112），WW 的停药率为 11.9%（n=15）。大多数 AS 患者选择了治愈性治疗（前列腺切除术=65 例，放疗=30 例），而 12 例 WW 患者接受了姑息性激素治疗，3 例 WW 患者接受了放疗。
医生在纳入标准和推迟治疗方面似乎可以明确区分 AS 和 WW，但在随访检查方面，这种区分趋于模糊。
