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.

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.

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.

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.

Clinical genitourinary cancer. 2019 May 21 [Epub ahead of print]

Frederik B Thomsen, M Andreas Røder, Henrik Jakobsen, Niels Christian Langkilde, Michael Borre, Erik B Jakobsen, Anders Frey, Lars Lund, Dagmar Lunden, Claus Dahl, Klaus Brasso

Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen, Denmark. Electronic address: ., Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen, Denmark; Department of Urology, Rigshospitalet, Copenhagen, Denmark., Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark., Department of Urology, Aalborg University Hospital, Aalborg, Denmark., Department of Urology, Aarhus University Hospital, Skejby, Denmark., Department of Urology, Zealand University Hospital, Roskilde, Denmark., Department of Urology, Sydvestjysk Sygehus, Esbjerg, Denmark., Department of Clinical Research Urology, University of Southern Denmark, Odense, Denmark; Department of Urology, Odense University Hospital, Odense, Denmark., Department of Urology, Hospitalsenhed Midt, Viborg, Denmark.