Department of Urology, Faculty of Medicine and University Hospital Cologne, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany,
PAN Clinic, Urological Practice, Cologne, Germany,
Urol Int. 2021;105(5-6):428-435. doi: 10.1159/000512893. Epub 2021 Jan 29.
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.
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.
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.
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.
对于良性前列腺梗阻手术后偶然发现的前列腺癌（IPC）的最佳治疗方法仍存在争议。我们报告了一项德国多中心研究中接受主动监测（AS）治疗的 IPC 患者的长期结果。
HAROW（2008-2013）是一项非干预性、前瞻性的卫生服务研究，旨在治疗局限性前列腺癌（≤cT2）患者，包括 IPC（cT1a/b）患者。对所有接受 AS 治疗的患者进行了随访检查。确定了癌症特异性、无转移生存和停药率。
210 例 IPC 患者中，68 例选择 AS，可进行评估。54 例为 cT1a 期，14 例为 cT1b 期。中位随访时间为 7.7 年（IQR：5.7-9.1）。8 例患者死亡，其中 6 例仍在 AS 或观察等待（WW）中。未观察到前列腺癌特异性死亡。1 例患者发生转移。23 例（33.8%）患者停止 AS 治疗改为侵袭性治疗：12 例选择根治性前列腺切除术，7 例选择放疗，4 例选择激素治疗。另外 19 例患者转为 WW。根据 Kaplan-Meier 估计，10 年总生存率、癌症特异性生存率、无转移生存率和无干预生存率分别为 83.8%（95%CI：72.2-95.3）、100%、98.4%（95%CI：95.3-99.9）和 61.0%（95%CI：47.7-74.3）。多变量分析显示，年龄（RR：0.97；p < 0.001）、PSA 密度≥0.2ng/mL2（RR：13.23；p < 0.001）和手术后 PSA≥1.0ng/mL（RR：5.19；p = 0.016）是接受侵袭性治疗的显著预测因素。
与其他一般低危前列腺癌人群的 AS 系列相比，本研究证实了 IPC 患者有良好的生存结果，而停药率似乎较低。因此，进展风险低的 IPC 患者可能是 AS 的良好候选者。
