Letters to the Editor
In Reply
We thank our correspondents for their careful reading and valuable additions to our article on the management of localized prostate cancer (1). The mention of the HAROW Study was in fact justified and underlines the importance of this prospective investigation for urological health services research in Germany, which could have been mentioned in the introduction to our article.
Our publication aimed to reflect on the basis of population based registry data the current therapeutic situation for localized prostate cancer and to shed light on the duration of active surveillance in routine healthcare practice. “The probability of remaining under active surveillance” referred methodologically to the event-free survival probability. Such a time-to-event approach was also taken in one of three named publications of the results of the HAROW cohort (2). However, comparability is limited by the fact that recruitment for the HAROW Study was done by participating urologists, reflected primarily the urban healthcare situation, the mean age (67 years) was above that of the ProjuMa cohort (U60), and not all patients met the D’Amico criteria for a low to intermediate risk (3).
Regardless of this, we explicitly share—as one of the two key messages of our article—the view that active surveillance should have a more important role in the guideline-conform treatment of patients with prostate cancer and a low to favorable intermediate risk. This also applies to patients younger than 60.
The comments on PSA diagnostics also address an important aspect. In the current S3 guideline on prostate cancer, testosterone measurement is not among the criteria for the indication of active surveillance (4) nor a component of the oncological core dataset (oBDS). As we explained in our article (1), the PSA measurement was, however, one of the variables that are subject to mandatory notification to the state cancer registries, but in practice they are submitted to an incomplete degree. The resulting gaps make it difficult to determine the risk profile to a valid degree and also hamper the assessment of the indication and the course of active surveillance.
This is the second key message of our article: for the purposes of real-world health services research regarding prostate cancer under active surveillance, the notification behavior of the service providers vis-à-vis the state cancer registries requires further improvement, in order to sustainably strengthen data-aided urologic care in Germany.
DOI: 10.3238/arztebl.m2025.0194
On behalf of the authors
Prof. Dr. med. Kevin Claaßen
Landeskrebsregister NRW, Fachbereich Epidemiologie, Bochum, Germany
MSH Medical School Hamburg, Department Humanmedizin, Hamburg, Germany
kevin_claassen@outlook.de
Conflict of interest statement
The authors of all letters to the editor declare that no conflict of interest exists.
| 1. | Claassen K, Justenhoven C, Hermann S, et al.: The probability of remaining under active surveillance for localized prostate cancer: An analysis of young patients in the framework of the multicenter ProjuMa registry study. Dtsch Arztebl Int 2025; 122: 401–5 CrossRef MEDLINE PubMed Central VOLLTEXT |
| 2. | Herden J, Schwarte A, Werner T, Behrendt U, Heidenreich A, Weissbach L: Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: Results from a prospective non-interventional study. World J Urol 2021; 39: 2515–23 CrossRef MEDLINE PubMed Central |
| 3. | Weissbach L, Stuerzebecher S, Mumperow E, Klotz T, Schnell D: HAROW: The first comprehensive prospective observational study comparing treatment options in localized prostate cancer. World J Urol 2016; 34: 641–7 CrossRef MEDLINE |
| 4. | Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF: S3-Leitlinie Prostatakarzinom: Version 8.1, August 2025, AWMF-Registernummer: 043–022OL . |
