Important Studies Were not Mentioned

Letters to the editor regarding the article 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 by Kevin Claassen, Christina Justenhoven, Silke Hermann, Jana Brandhorst, Jale Lakes, Dominique Werner, Hiltraud Kajüter, Madeleine Karpinski, Volker Arndt, Andreas Stang, and Peter Albers in issue 15/2025

We read the article on the management of localized prostate cancer with great interest (1). We welcome in particular the fact that the option of active surveillance was mentioned and even presented as a relevant therapeutic strategy. This is an important contribution to promoting guideline-conform and minimally invasive care for patients with prostate cancer with a low or early intermediate risk constellation in Germany. Similarly worth highlighting is the evaluation of cancer registry data, which are of central importance to obtain a realistic picture of the healthcare situation.

We would, however, have wished for a more comprehensive literature search by the authors. Especially the sentence “No scientific analyses on the probability of remaining under active surveillance in Germany have been available as yet” is inadequate because readers are deprived of one of the most important German studies of the topic. For more than 10 years, the prospective, non-interventional HAROW Study has yielded valuable insights regarding the implementation of active surveillance in healthcare provision in Germany. The study’s 468 patients under active surveillance represent the first and to date the only prospectively studied active surveillance cohort in Germany. Its results have been published on numerous occasions, among others as an original article in Deutsches Ärzteblatt (2, 3, 4).

On entering in PubMed the terms “HAROW Study” and “active surveillance” one finds more than 10 publications that deal with precisely this topic. This study—organized by renowned German urologists, among others—should have been mentioned in such an article and its data should have been discussed. A more differentiated analysis of the already available healthcare data would certainly have helped the article and its discussion—and also patients in Germany who are still subjected to overtreatment, of which there continue to be too many.

DOI: 10.3238/arztebl.m2025.0192

Prof. Dr. med. Jan Herden

Urologische Partnerschaft Köln, PAN Klinik am Neumarkt

Gemeinschaftspraxis Urologie und Andrologie, Cologne, Germany

Prof. Dr. med. Lothar Weißbach

Gesundheitsforschung für Männer, Zweitmeinungszentrum, Berlin, Germany

References

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

2. Herden J, Ansmann L, Ernstmann N, Schnell D, Weißbac L: The treatment of localized prostate cancer in everyday practice in Germany. Dtsch Arztebl Int 2016 May; 113: 329–36

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

4. 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