Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis

Abstract

What ' s known on the subject? and What does the study add? For patients electing surgical treatment, the question of the effect of surgical delay on clinical outcomes in prostate cancer is controversial. In this study we examined the effect of delay from diagnosis to surgery on outcomes in men with localized prostate cancer and found no association between time to surgery and risk of biochemical recurrence, even for patients with longer delays and high-risk disease. Men with localized prostate cancer can be reassured that reasonable delays in treatment will not infl uence disease outcomes. OBJECTIVE• To examine the effect of time from last positive biopsy to surgery on clinical outcomes in men with localized prostate cancer undergoing radical prostatectomy (RP). PATIENTS AND METHODS• We conducted a retrospective review of 2739 men who underwent RP between 1990 and 2009 at our institution.• Clinical and pathological features were compared between men undergoing RP ≤ 60, 61 -90 and > 90 days from the time of prostate biopsy.• A Cox proportional hazards model was used to analyse the association between clinical features and surgical delay with biochemical progression. Biochemical recurrence (BCR)-free rates were assessed using the Kaplan -Meier method. RESULTS• Of the 1568 men meeting the inclusion criteria, 1098 (70%), 303 (19.3%) and 167 (10.7%) had a delay of ≤ 60, 61 -90 and > 90 days, respectively, between biopsy and RP. A delay of > 60 days was not associated with adverse pathological fi ndings at surgery.• The 5-year survival rate was similar among the three groups (78 -85%, P = 0.11).• In a multivariate Cox model, men with higher PSA levels, clinical stages, Gleason sums, and those of African-American race were all at higher risk for developing BCR.• A delay to surgery of > 60 days was not associated with worse biochemical outcomes in a univariate and multivariate model. CONCLUSIONS• A delay of > 60 days is not associated with adverse pathological outcomes in men with localized prostate cancer, nor does it correlate with worse BCR-free survival.• Patients can be assured that delaying treatment while considering therapeutic options will not adversely affect their outcomes. KEYWORDStime factors , prostatic neoplasm/surgery , prostatic neoplasm/pathology , disease progression Study Type -Therapy (case series) Level of Evidence 4

Does surgical delay for radical prostatectomy affect patient pathological outcome? A retrospective analysis from a Canadian cohort

“…Several studies have previously observed negative associations between prolonged SWT and adverse outcomes 24,25,27,29,31,32 or have demonstrated positive association only on UVA that became negative on MVA after adjustment. 33,34 The majority of such reports were conducted on low-risk patients.…”

“…10,[23][24][25][26] Furthermore, the overall SWT was divided into time from biopsy to booking of surgery (overall mean of 87.1 days) and time from booking to surgery (overall mean of 76.6 days). To the best of our knowledge, this is the first unique reporting of SWT categorization.…”

Timing of Curative Treatment for Prostate Cancer: A Systematic Review

“…Two studies reported that the delay group was followed with a fixed AS protocol [11,25], two reported on expectant management without fixed criteria [13,23], and one stated that AS was frequently applied [16]. Korets et al excluded men on AS [15]. …”

Fifteen-year mortality after radical prostatectomy: Which factors are available for patient counselling?

“…The finding of unaltered PCSM after up to 1 year postdiagnosis deferral of RP may therefore be clinically important, although the relatively low number of patients does not permit risk group stratification of this analysis. Korets et al [26] published similar observations for patients in whom RP was deferred for up to 90 days. Neither could Holmstrøm et al [27] detect significant differences in the presence of adverse pathological features or in PCSM comparing primary versus deferred RP in men with low/intermediate-risk prostate cancer.…”