{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:40:22Z","timestamp":1777344022663,"version":"3.51.4"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T00:00:00Z","timestamp":1601424000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T00:00:00Z","timestamp":1601424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Gazprom Germania"},{"DOI":"10.13039\/501100012681","name":"Universit\u00e4tsklinikum K\u00f6ln","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012681","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To report on long-term outcomes of patients treated with active surveillance (AS) for localized prostate cancer (PCa) in the daily routine setting.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>HAROW (2008\u20132013) was a non-interventional, health service research study about the management of localized PCa in the community setting, with 86% of the study centers being office-based urologists. A follow-up examination of all patients who opted for AS as primary treatment was carried out. Overall, cancer-specific, and metastasis-free survival, as well as discontinuation rates, were determined.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 329 patients, 62.9% had very-low- and 21.3% low-risk tumours. The median follow-up was 7.7\u00a0years (IQR 4.7\u20139.1). Twenty-eight patients (8.5%) died unrelated to PCa, of whom 19 were under AS or watchful waiting (WW). Additionally, seven patients (2.1%) developed metastasis. The estimated 10-year overall and metastasis-free survival was 86% (95% CI 81.7\u201390.3) and 97% (95% CI 94.6\u201399.3), respectively. One hundred eighty-seven patients (56.8%) discontinued AS changing to invasive treatment: 104 radical prostatectomies (RP), 55 radiotherapies (RT), and 28 hormonal treatments (HT). Another 50 patients switched to WW. Finally, 37.4% remained alive without invasive therapy (22.2% AS and 15.2% WW). Intervention-free survival differed between the risk groups: 47.8% in the very-low-, 33.8% in the low- and 34.6% in the intermediate-\/high-risk-group (<jats:italic>p<\/jats:italic>\u2009=\u20090.008). On multivariable analysis, PSA-density\u2009\u2265\u20090.2\u00a0ng\/ml<jats:sup>2<\/jats:sup> was significantly predictive for receiving invasive treatment (HR 2.55; <jats:italic>p<\/jats:italic>\u2009=\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Even in routine care, AS can be considered a safe treatment option. Our results might encourage office-based urologists regarding the implementation of AS and to counteract possible concerns against this treatment option.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-020-03471-x","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T22:37:36Z","timestamp":1601505456000},"page":"2515-2523","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1667-5200","authenticated-orcid":false,"given":"Jan","family":"Herden","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Schwarte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorsten","family":"Werner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Behrendt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Heidenreich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lothar","family":"Weissbach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,9,30]]},"reference":[{"key":"3471_CR1","first-page":"618","volume":"71","author":"N Mottet","year":"2017","unstructured":"Mottet N, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. EurUrol 71:618\u2013629","journal-title":"EurUrol"},{"key":"3471_CR2","first-page":"479","volume":"17","author":"JL Mohler","year":"2019","unstructured":"Mohler JL, Antonarakis ES, Armstrong AJ et al (2019) Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J NatlComprCancNetw 17:479\u2013505","journal-title":"J NatlComprCancNetw"},{"key":"3471_CR3","doi-asserted-by":"publisher","first-page":"2727","DOI":"10.1200\/JCO.2015.61.1517","volume":"33","author":"L Klotz","year":"2015","unstructured":"Klotz L, Vesprini D, Sethukavalan P et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33:2727","journal-title":"J Clin Oncol"},{"key":"3471_CR4","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1056\/NEJMoa1606220","volume":"375","author":"FC Hamdy","year":"2016","unstructured":"Hamdy FC, Donovan JL, Lane JA et al (2016) 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375:1415\u20131424","journal-title":"N Engl J Med"},{"key":"3471_CR5","first-page":"243","volume":"7","author":"M Komisarenko","year":"2018","unstructured":"Komisarenko M, Martin LJ, Finelli A (2018) Active surveillance review: contemporary selection criteria, follow-up, compliance and outcomes. TranslAndrolUrol 7:243\u2013255","journal-title":"TranslAndrolUrol"},{"key":"3471_CR6","doi-asserted-by":"publisher","first-page":"e814","DOI":"10.1016\/j.clgc.2019.05.005","volume":"17","author":"FB Thomsen","year":"2019","unstructured":"Thomsen FB, R\u00f8der MA, Jakobsen H et al (2019) Active surveillance versus radical prostatectomy in favorable-risk localized prostate cancer. Clin Genitourin Cancer 17:e814\u2013e821","journal-title":"Clin Genitourin Cancer"},{"issue":"19","key":"3471_CR7","first-page":"30961","volume":"S0302\u20132838","author":"JJ Tosoian","year":"2020","unstructured":"Tosoian JJ, Mamawala M, Epstein JI et al (2020) Active surveillance of grade group 1 prostate cancer: long-term outcomes from a large prospective cohort. EurUrol S0302\u20132838(19):30961\u201330963","journal-title":"EurUrol"},{"key":"3471_CR8","first-page":"830","volume":"109","author":"FB Thomsen","year":"2014","unstructured":"Thomsen FB, Brasso K, Klotz LH, R\u00f8der MA, Berg KD, Iversen P (2014) Active surveillance for clinically localized prostate cancer\u2014a systematic review. J SurgOncol 109:830\u2013835","journal-title":"J SurgOncol"},{"key":"3471_CR9","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1007\/s00345-015-1675-4","volume":"34","author":"L Weissbach","year":"2016","unstructured":"Weissbach L, Stuerzebecher S, Mumperow E, Klotz T, Schnell D (2016) HAROW: the first comprehensive prospective observational study comparing treatment options in localized prostate cancer. World J Urol 34:641\u2013647","journal-title":"World J Urol"},{"key":"3471_CR10","first-page":"329","volume":"113","author":"J Herden","year":"2016","unstructured":"Herden J, Ansmann L, Ernstmann N, Schnell D, Weissbach L (2016) The treatment of localized prostate cancer in everyday practice in Germany. DtschArztebl Int 113:329\u2013336","journal-title":"DtschArztebl Int"},{"key":"3471_CR11","first-page":"68","volume":"53","author":"A Heidenreich","year":"2008","unstructured":"Heidenreich A, Aus G, Bolla M et al (2008) EAU guidelines on prostate cancer. EurUrol 53:68\u201380","journal-title":"EurUrol"},{"key":"3471_CR12","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1016\/S0022-5347(05)65174-9","volume":"167","author":"R Choo","year":"2002","unstructured":"Choo R, Klotz L, Danjoux C et al (2002) Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and\/or clinical progression. J Urol 167:1664\u20131669","journal-title":"J Urol"},{"key":"3471_CR13","first-page":"1560","volume":"52","author":"RC van den Bergh","year":"2007","unstructured":"van den Bergh RC, Roemeling S, Roobol MJ, Roobol W, Schr\u00f6der FH, Bangma CH (2007) Prospective validation of active surveillance in prostate cancer: the PRIAS study. EurUrol 52:1560\u20131563","journal-title":"EurUrol"},{"key":"3471_CR14","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1007\/s00345-018-2175-0","volume":"36","author":"J Herden","year":"2018","unstructured":"Herden J, Weissbach L (2018) Utilization of active surveillance and watchful waiting for localized prostate cancer in the daily practice. World J Urol 36:383\u2013391","journal-title":"World J Urol"},{"key":"3471_CR15","first-page":"831","volume":"58","author":"MS Soloway","year":"2010","unstructured":"Soloway MS, Soloway CT, Eldefrawy A, Acosta K, Kava B, Manoharan M (2010) Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. EurUrol 58:831\u2013835","journal-title":"EurUrol"},{"key":"3471_CR16","first-page":"981","volume":"64","author":"ED Selvadurai","year":"2013","unstructured":"Selvadurai ED, Singhera M, Thomas K et al (2013) Medium-term outcomes of active surveillance for localised prostate cancer. EurUrol 64:981\u2013987","journal-title":"EurUrol"},{"key":"3471_CR17","first-page":"954","volume":"70","author":"LP Bokhorst","year":"2016","unstructured":"Bokhorst LP, Valdagni R, Rannikko A et al (2016) A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment. EurUrol 70:954\u2013960","journal-title":"EurUrol"},{"key":"3471_CR18","first-page":"760","volume":"70","author":"RA Godtman","year":"2016","unstructured":"Godtman RA, Holmberg E, Khatami A, Pihl CG, Stranne J, Hugosson J (2016) Long-term results of active surveillance in the G\u00f6teborg randomized, population-based prostate cancer screening trial. EurUrol 70:760\u2013766","journal-title":"EurUrol"},{"key":"3471_CR19","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.juro.2015.08.087","volume":"195","author":"LF Newcomb","year":"2016","unstructured":"Newcomb LF, Thompson IM Jr, Boyer HD et al (2016) Outcomes of active surveillance for clinically localized prostate cancer in the prospective, multi-institutional canary PASS cohort. J Urol 195:313\u2013320","journal-title":"J Urol"},{"key":"3471_CR20","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1016\/j.juro.2018.09.045","volume":"201","author":"FB Thomsen","year":"2019","unstructured":"Thomsen FB, Jakobsen H, Langkilde NC et al (2019) Active surveillance for localized prostate cancer: nationwide observational study. J Urol 201:520\u2013527","journal-title":"J Urol"},{"key":"3471_CR21","first-page":"523","volume":"75","author":"M Van Hemelrijck","year":"2019","unstructured":"Van Hemelrijck M, Ji X, Helleman J et al (2019) Reasons for discontinuing active surveillance: assessment of 21 centres in 12 countries in the Movember GAP3 consortium. EurUrol 75:523\u2013531","journal-title":"EurUrol"},{"key":"3471_CR22","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1111\/bju.13715","volume":"120","author":"J Herden","year":"2017","unstructured":"Herden J, Heidenreich A, Weissbach L (2017) Risk stratification: a tool to predict the course of active surveillance for localized prostate cancer? BJU Int 120:212\u2013218","journal-title":"BJU Int"},{"key":"3471_CR23","first-page":"534","volume":"72","author":"M Van Hemelrijck","year":"2017","unstructured":"Van Hemelrijck M, Garmo H, Lindhagen L, Bratt O, Stattin P, Adolfsson J (2017) Quantifying the transition from active surveillance to watchful waiting among men with very low-risk prostate cancer. EurUrol 72:534\u2013541","journal-title":"EurUrol"},{"key":"3471_CR24","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.juro.2016.02.2963","volume":"196","author":"S Loeb","year":"2016","unstructured":"Loeb S, Walter D, Curnyn C, Gold HT, Lepor H, Makarov DV (2016) How active is active surveillance? Intensity of follow-up during active surveillance for prostate cancer in the United States. J Urol 196:721\u2013726","journal-title":"J Urol"},{"key":"3471_CR25","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.juro.2014.09.094","volume":"193","author":"CJ Welty","year":"2015","unstructured":"Welty CJ, Cowan JE, Nguyen H et al (2015) Extended follow up and risk factors for disease reclassification in a large active surveillance cohort for localized prostate cancer. J Urol 193:807\u2013811","journal-title":"J Urol"},{"key":"3471_CR26","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1097\/JU.0000000000000541","volume":"203","author":"M Baunacke","year":"2020","unstructured":"Baunacke M, Schmidt ML, Groeben C et al (2020) Decision regret after radical prostatectomy does not depend on surgical approach: 6-year follow up of a large German cohort undergoing routine care. J Urol 203:554\u2013561","journal-title":"J Urol"},{"key":"3471_CR27","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1111\/bju.14705","volume":"124","author":"AS Glass","year":"2019","unstructured":"Glass AS, Dall'Era MA (2019) Use of multiparametric magnetic resonance imaging in prostate cancer active surveillance. BJU Int 124:730\u2013737","journal-title":"BJU Int"},{"key":"3471_CR28","first-page":"910","volume":"75","author":"NJ Sathianathen","year":"2019","unstructured":"Sathianathen NJ, Konety BR, Alarid-Escudero F, Lawrentschuk N, Bolton DM, Kuntz KM (2019) Cost-effectiveness analysis of active surveillance strategies for men with low-risk prostate cancer. EurUrol 75:910\u2013917","journal-title":"EurUrol"},{"key":"3471_CR29","first-page":"S411","volume":"7","author":"ZA Glaser","year":"2018","unstructured":"Glaser ZA, Porter KK, Thomas JV, Gordetsky JB, Rais-Bahrami S (2018) MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence. TranslAndrolUrol 7:S411\u2013S419","journal-title":"TranslAndrolUrol"},{"key":"3471_CR30","first-page":"443","volume":"78","author":"V Stavrinides","year":"2020","unstructured":"Stavrinides V, Giganti F, Trock B, Punwani S, Allen C, Kirkham A, Freeman A, Haider A, Ball R, McCartan N, Whitaker H, Orczyk C, Emberton M, Moore CM (2020) Five-year outcomes of magnetic resonance imaging-based active surveillance for prostate cancer: a large cohort study. EurUrol 78:443\u2013451","journal-title":"EurUrol"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-020-03471-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-020-03471-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-020-03471-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T01:26:35Z","timestamp":1632965195000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-020-03471-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,30]]},"references-count":30,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,7]]}},"alternative-id":["3471"],"URL":"https:\/\/doi.org\/10.1007\/s00345-020-03471-x","relation":{},"ISSN":["0724-4983","1433-8726"],"issn-type":[{"value":"0724-4983","type":"print"},{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,30]]},"assertion":[{"value":"23 June 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Jan Herden, Andreas Schwarte, Thorsten Werner, Uwe Behrendt and Axel Heidenreich declare that they have no conflict of interest. Lothar Weissbach has acted as a paid consultant for the Scientific Institute (WIdO) of the statutory AOK health insurance provider. He has received study support (third-party funding) from Gazprom Germania.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The HAROW study was approved by the ethics committee of the Bavarian State Board of Physicians (Nr. 08012). It was registered under study ID 479 at the DKSR (German Cancer Study Registry; February 2008). All procedures performed in the trial involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent to participate was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}