The Treatment of Localized Prostate Cancer in Everyday Practice in Germany
Prostate cancer is now often diagnosed in the localized, welldifferentiated stage. In the HAROW study, we investigated the care situation with respect to the various treatment options for localized prostate cancer in everyday clinical practice in Germany. Study physicians for this prospective, multi...
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| Veröffentlicht in: | Deutsches Ärzteblatt international 2016-05, Vol.113 (19), p.329-336 |
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| creator | Herden, Jan Ansmann, Lena Ernstmann, Nicole Schnell, Dietrich Weißbac, Lotharh |
| description | Prostate cancer is now often diagnosed in the localized, welldifferentiated stage. In the HAROW study, we investigated the care situation with respect to the various treatment options for localized prostate cancer in everyday clinical practice in Germany.
Study physicians for this prospective, multicenter observational study were recruited through the Federation of German Urologists. At six-month intervals, clinical variables were recorded (T category, prostate-specific antigen [PSA], Gleason score, d'Amico risk profile, Charlson Comorbidity Index [CCI]) and patients filled out questionnaires (QLQ-C30) regarding their indicationrelated quality of life (QoL). Covariance analysis was used to adjust for the variable distribution of patient features among the treatment groups.
Data from 2957 patients were available for analysis. The mean followup time was 28.4 months overall, and 47.6 months in the active surveillance (AS) group. Younger patients and patients with a CCI of 0 or 1 predominated in the AS and surgery groups; older patients and patients with a CCI of 2 or above predominated in the groups in which palliative treatment strategies such as hormone therapy (HT) and watchful waiting were applied. The HT group had the highest percentage of patients with a Gleason score of 8 or above (21.2%), while the AS group had the highest percentage of patients with a Gleason score of 6 or below (92.5%), as well as the lowest mean PSA value (5.8 ± 3.4 ng/mL) and the highest percentage of patients with a low-risk profile (82.5%). Of 468 patients in the AS group, 170 (36.3%) underwent a change of treatment strategy. After adjustment for the severity of disease, no significant difference with respect to the global quality of life was found between AS and the curative treatment options over the long term.
The study physicians drew a clear distinction between curative and palliative treatment strategies, and the inclusion criteria for AS were largely respected. The observed preference for surgery in low-risk patients indicates overtreatment in this patient group. |
| doi_str_mv | 10.3238/arztebl.2016.0329 |
| format | Article |
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Study physicians for this prospective, multicenter observational study were recruited through the Federation of German Urologists. At six-month intervals, clinical variables were recorded (T category, prostate-specific antigen [PSA], Gleason score, d'Amico risk profile, Charlson Comorbidity Index [CCI]) and patients filled out questionnaires (QLQ-C30) regarding their indicationrelated quality of life (QoL). Covariance analysis was used to adjust for the variable distribution of patient features among the treatment groups.
Data from 2957 patients were available for analysis. The mean followup time was 28.4 months overall, and 47.6 months in the active surveillance (AS) group. Younger patients and patients with a CCI of 0 or 1 predominated in the AS and surgery groups; older patients and patients with a CCI of 2 or above predominated in the groups in which palliative treatment strategies such as hormone therapy (HT) and watchful waiting were applied. The HT group had the highest percentage of patients with a Gleason score of 8 or above (21.2%), while the AS group had the highest percentage of patients with a Gleason score of 6 or below (92.5%), as well as the lowest mean PSA value (5.8 ± 3.4 ng/mL) and the highest percentage of patients with a low-risk profile (82.5%). Of 468 patients in the AS group, 170 (36.3%) underwent a change of treatment strategy. After adjustment for the severity of disease, no significant difference with respect to the global quality of life was found between AS and the curative treatment options over the long term.
The study physicians drew a clear distinction between curative and palliative treatment strategies, and the inclusion criteria for AS were largely respected. The observed preference for surgery in low-risk patients indicates overtreatment in this patient group.</description><identifier>EISSN: 1866-0452</identifier><identifier>DOI: 10.3238/arztebl.2016.0329</identifier><identifier>PMID: 27232362</identifier><language>eng</language><publisher>Germany</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents - therapeutic use ; Combined Modality Therapy - utilization ; Germany - epidemiology ; Health Care Surveys ; Humans ; Male ; Middle Aged ; Palliative Care - utilization ; Patient Satisfaction - statistics & numerical data ; Practice Patterns, Physicians' - statistics & numerical data ; Prevalence ; Prostatectomy - utilization ; Prostatic Neoplasms - diagnosis ; Prostatic Neoplasms - epidemiology ; Prostatic Neoplasms - therapy ; Quality of Life - psychology ; Radiotherapy - utilization ; Risk Factors ; Treatment Outcome ; Urologists - statistics & numerical data ; Utilization Review</subject><ispartof>Deutsches Ärzteblatt international, 2016-05, Vol.113 (19), p.329-336</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1479-d432c99515137b46b919950520f22605c203b31718ed5fe014b49606e3bc6aa63</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27232362$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Herden, Jan</creatorcontrib><creatorcontrib>Ansmann, Lena</creatorcontrib><creatorcontrib>Ernstmann, Nicole</creatorcontrib><creatorcontrib>Schnell, Dietrich</creatorcontrib><creatorcontrib>Weißbac, Lotharh</creatorcontrib><title>The Treatment of Localized Prostate Cancer in Everyday Practice in Germany</title><title>Deutsches Ärzteblatt international</title><addtitle>Dtsch Arztebl Int</addtitle><description>Prostate cancer is now often diagnosed in the localized, welldifferentiated stage. In the HAROW study, we investigated the care situation with respect to the various treatment options for localized prostate cancer in everyday clinical practice in Germany.
Study physicians for this prospective, multicenter observational study were recruited through the Federation of German Urologists. At six-month intervals, clinical variables were recorded (T category, prostate-specific antigen [PSA], Gleason score, d'Amico risk profile, Charlson Comorbidity Index [CCI]) and patients filled out questionnaires (QLQ-C30) regarding their indicationrelated quality of life (QoL). Covariance analysis was used to adjust for the variable distribution of patient features among the treatment groups.
Data from 2957 patients were available for analysis. The mean followup time was 28.4 months overall, and 47.6 months in the active surveillance (AS) group. Younger patients and patients with a CCI of 0 or 1 predominated in the AS and surgery groups; older patients and patients with a CCI of 2 or above predominated in the groups in which palliative treatment strategies such as hormone therapy (HT) and watchful waiting were applied. The HT group had the highest percentage of patients with a Gleason score of 8 or above (21.2%), while the AS group had the highest percentage of patients with a Gleason score of 6 or below (92.5%), as well as the lowest mean PSA value (5.8 ± 3.4 ng/mL) and the highest percentage of patients with a low-risk profile (82.5%). Of 468 patients in the AS group, 170 (36.3%) underwent a change of treatment strategy. After adjustment for the severity of disease, no significant difference with respect to the global quality of life was found between AS and the curative treatment options over the long term.
The study physicians drew a clear distinction between curative and palliative treatment strategies, and the inclusion criteria for AS were largely respected. The observed preference for surgery in low-risk patients indicates overtreatment in this patient group.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Combined Modality Therapy - utilization</subject><subject>Germany - epidemiology</subject><subject>Health Care Surveys</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Palliative Care - utilization</subject><subject>Patient Satisfaction - statistics & numerical data</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Prevalence</subject><subject>Prostatectomy - utilization</subject><subject>Prostatic Neoplasms - diagnosis</subject><subject>Prostatic Neoplasms - epidemiology</subject><subject>Prostatic Neoplasms - therapy</subject><subject>Quality of Life - psychology</subject><subject>Radiotherapy - utilization</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><subject>Urologists - statistics & numerical data</subject><subject>Utilization Review</subject><issn>1866-0452</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1T8tKAzEUDYLYWv0AN5Klm6nJzWOapZRalYIu6npIMndwZB41yQjTr3fEujqcJxxCbjhbChCrexuOCV2zBMb1kgkwZ2TOV1pnTCqYkcsYPxnT3IC4IDPIYSppmJOX_QfSfUCbWuwS7Su6671t6iOW9C30MdmEdG07j4HWHd18YxhLO06e9an2-CtuMbS2G6_IeWWbiNcnXJD3x81-_ZTtXrfP64dd5rnMTVZKAd4YxRUXuZPaGT4xpoBVAJopD0w4wXO-wlJVyLh00mimUTivrdViQe7-dg-h_xowpqKto8emsR32Qyx4Pp3MgSk5RW9P0cG1WBaHULc2jMX_f_EDhWFZ2w</recordid><startdate>20160513</startdate><enddate>20160513</enddate><creator>Herden, Jan</creator><creator>Ansmann, Lena</creator><creator>Ernstmann, Nicole</creator><creator>Schnell, Dietrich</creator><creator>Weißbac, Lotharh</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20160513</creationdate><title>The Treatment of Localized Prostate Cancer in Everyday Practice in Germany</title><author>Herden, Jan ; Ansmann, Lena ; Ernstmann, Nicole ; Schnell, Dietrich ; Weißbac, Lotharh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1479-d432c99515137b46b919950520f22605c203b31718ed5fe014b49606e3bc6aa63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Combined Modality Therapy - utilization</topic><topic>Germany - epidemiology</topic><topic>Health Care Surveys</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Palliative Care - utilization</topic><topic>Patient Satisfaction - statistics & numerical data</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Prevalence</topic><topic>Prostatectomy - utilization</topic><topic>Prostatic Neoplasms - diagnosis</topic><topic>Prostatic Neoplasms - epidemiology</topic><topic>Prostatic Neoplasms - therapy</topic><topic>Quality of Life - psychology</topic><topic>Radiotherapy - utilization</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><topic>Urologists - statistics & numerical data</topic><topic>Utilization Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Herden, Jan</creatorcontrib><creatorcontrib>Ansmann, Lena</creatorcontrib><creatorcontrib>Ernstmann, Nicole</creatorcontrib><creatorcontrib>Schnell, Dietrich</creatorcontrib><creatorcontrib>Weißbac, Lotharh</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Deutsches Ärzteblatt international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Herden, Jan</au><au>Ansmann, Lena</au><au>Ernstmann, Nicole</au><au>Schnell, Dietrich</au><au>Weißbac, Lotharh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Treatment of Localized Prostate Cancer in Everyday Practice in Germany</atitle><jtitle>Deutsches Ärzteblatt international</jtitle><addtitle>Dtsch Arztebl Int</addtitle><date>2016-05-13</date><risdate>2016</risdate><volume>113</volume><issue>19</issue><spage>329</spage><epage>336</epage><pages>329-336</pages><eissn>1866-0452</eissn><abstract>Prostate cancer is now often diagnosed in the localized, welldifferentiated stage. In the HAROW study, we investigated the care situation with respect to the various treatment options for localized prostate cancer in everyday clinical practice in Germany.
Study physicians for this prospective, multicenter observational study were recruited through the Federation of German Urologists. At six-month intervals, clinical variables were recorded (T category, prostate-specific antigen [PSA], Gleason score, d'Amico risk profile, Charlson Comorbidity Index [CCI]) and patients filled out questionnaires (QLQ-C30) regarding their indicationrelated quality of life (QoL). Covariance analysis was used to adjust for the variable distribution of patient features among the treatment groups.
Data from 2957 patients were available for analysis. The mean followup time was 28.4 months overall, and 47.6 months in the active surveillance (AS) group. Younger patients and patients with a CCI of 0 or 1 predominated in the AS and surgery groups; older patients and patients with a CCI of 2 or above predominated in the groups in which palliative treatment strategies such as hormone therapy (HT) and watchful waiting were applied. The HT group had the highest percentage of patients with a Gleason score of 8 or above (21.2%), while the AS group had the highest percentage of patients with a Gleason score of 6 or below (92.5%), as well as the lowest mean PSA value (5.8 ± 3.4 ng/mL) and the highest percentage of patients with a low-risk profile (82.5%). Of 468 patients in the AS group, 170 (36.3%) underwent a change of treatment strategy. After adjustment for the severity of disease, no significant difference with respect to the global quality of life was found between AS and the curative treatment options over the long term.
The study physicians drew a clear distinction between curative and palliative treatment strategies, and the inclusion criteria for AS were largely respected. The observed preference for surgery in low-risk patients indicates overtreatment in this patient group.</abstract><cop>Germany</cop><pmid>27232362</pmid><doi>10.3238/arztebl.2016.0329</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Antineoplastic Agents - therapeutic use Combined Modality Therapy - utilization Germany - epidemiology Health Care Surveys Humans Male Middle Aged Palliative Care - utilization Patient Satisfaction - statistics & numerical data Practice Patterns, Physicians' - statistics & numerical data Prevalence Prostatectomy - utilization Prostatic Neoplasms - diagnosis Prostatic Neoplasms - epidemiology Prostatic Neoplasms - therapy Quality of Life - psychology Radiotherapy - utilization Risk Factors Treatment Outcome Urologists - statistics & numerical data Utilization Review |
| title | The Treatment of Localized Prostate Cancer in Everyday Practice in Germany |
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