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Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer

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Thomsen, Frederik B ; Røder, M Andreas ; Jakobsen, Henrik ; Langkilde, Niels Christian ; Borre, Michael ; Jakobsen, Erik B ; Frey, Anders ; Lund, Lars ; Lunden, Dagmar ; Dahl, Claus ; Brasso, Klaus. / Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer. I: Clinical Genitourinary Cancer. 2019 ; Bind 17, Nr. 4. s. e814-e821.

Bibtex

@article{97ef3c414fc54f8789a02fc06cac1b2a,
title = "Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer",
abstract = "BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.RESULTS: The 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.",
keywords = "Active surveillance, Localised, Prostate cancer, Radical prostatectomy, Survival",
author = "Thomsen, {Frederik B} and R{\o}der, {M Andreas} and Henrik Jakobsen and Langkilde, {Niels Christian} and Michael Borre and Jakobsen, {Erik B} and Anders Frey and Lars Lund and Dagmar Lunden and Claus Dahl and Klaus Brasso",
note = "Copyright {\textcopyright} 2019 Elsevier Inc. All rights reserved.",
year = "2019",
month = aug,
day = "1",
doi = "10.1016/j.clgc.2019.05.005",
language = "English",
volume = "17",
pages = "e814--e821",
journal = "Clinical Genitourinary Cancer (Online)",
issn = "1938-0682",
publisher = "Elsevier",
number = "4",

}

RIS

TY - JOUR

T1 - Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer

AU - Thomsen, Frederik B

AU - Røder, M Andreas

AU - Jakobsen, Henrik

AU - Langkilde, Niels Christian

AU - Borre, Michael

AU - Jakobsen, Erik B

AU - Frey, Anders

AU - Lund, Lars

AU - Lunden, Dagmar

AU - Dahl, Claus

AU - Brasso, Klaus

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.RESULTS: The 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.

AB - BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.RESULTS: The 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.

KW - Active surveillance

KW - Localised

KW - Prostate cancer

KW - Radical prostatectomy

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85066942127&partnerID=8YFLogxK

U2 - 10.1016/j.clgc.2019.05.005

DO - 10.1016/j.clgc.2019.05.005

M3 - Journal article

C2 - 31196798

VL - 17

SP - e814-e821

JO - Clinical Genitourinary Cancer (Online)

JF - Clinical Genitourinary Cancer (Online)

SN - 1938-0682

IS - 4

ER -

ID: 57420011