Long-term Outcomes of Active Surveillance in Localized Prostate Cancer in Community Practice

Overview

This prospective non-interventional study of 329 patients with localized prostate cancer managed by active surveillance (AS) in a community setting demonstrated a 10-year overall survival of 86% and metastasis-free survival of 97%. Over half of the patients discontinued AS for invasive treatment primarily due to biopsy upgrades and PSA elevation, with no prostate cancer-specific deaths observed.

Background

Active surveillance (AS) is a curative-intent management strategy for well-differentiated, localized prostate cancer, involving regular PSA testing, digital rectal exams, and repeat biopsies to detect progression. Previous long-term studies from academic centers have shown excellent cancer-specific survival exceeding 98% at 10 years. However, data on AS outcomes in routine community urology practice are limited. The HAROW study prospectively evaluated AS in a real-world German community setting, where AS was relatively novel at the time of recruitment.

Data Highlights

Key Findings

• Median follow-up was 7.7 years with a range up to 11 years.
• No prostate cancer-specific deaths occurred despite 28 deaths from other causes.
• Metastasis developed in 2.1% of patients after a median of 5.4 years.
• 56.8% of patients discontinued AS for invasive treatment, mainly radical prostatectomy or radiotherapy.
• Main reasons for discontinuation were biopsy upgrading and PSA elevation.
• 50 patients transitioned from AS to watchful waiting, maintaining a non-invasive approach.

Clinical Implications

Active surveillance in a community urology setting yields excellent long-term cancer control with minimal prostate cancer-specific mortality, supporting its use outside academic centers. Regular monitoring with PSA and biopsy remains critical to identify progression warranting intervention. Patient selection and adherence to follow-up protocols are essential to optimize outcomes.

Conclusion

This study confirms that active surveillance is a safe and effective management strategy for localized prostate cancer in routine community practice, with low rates of metastasis and no prostate cancer-specific deaths over up to 11 years of follow-up.

References

1. HAROW Study Group 2024 -- Long-term Effects of Active Surveillance on Clinically Localized Prostate Cancer