Impact of Delay from Biopsy to Surgery on the Rate of Adverse Pathologic and Oncologic Outcomes for Clinically Localized Prostate Cancer

Abstract

Due to the widespread usage of prostate-specific antigen screening, the number of patients diagnosed with prostate cancer is steadily increasing. Many factors such as high operating room demand, insurance reimbursement, patients' desire to assess multiple treatment options, and anxiety can cause delays in radical treatment. In this study, we examined the effect of delay from prostate biopsy to surgery on outcomes of men with localized prostate cancer. Materials and Methods: The data of 359 patients who underwent radical prostatectomy (RP) in our clinic between 2008 and 2017 were analyzed retrospectively. Surgical delay was defined as the time from transrectal ultrasound-guided prostate biopsy to surgery. Patients were divided into 3 groups according to the interval between prostate biopsy and RP (≤60, 61-120, ≥120 days) and classified according to the D'Amico risk classification. Results: A total of 248 patients were included in the study. Of these patients, 107 (43.1%) were operated within 60 days of biopsy, 113 (45.6%) 61-120 days after biopsy, and 28 (11.3%) over 120 days after biopsy. Statistical analysis of patients with follow-up of at least 12 months did not reveal a significant difference between the groups in terms of biochemical recurrence (p=0.06). A delay of over 120 days was not associated with adverse pathological or oncological findings at surgery for the low-risk group. Extraprostatic invasion increased significantly in the intermediate-risk group with longer surgical delay (p=0.044). Conclusion: Our data demonstrated that a delay of more than 120 days was not associated with adverse pathological outcomes in men with low-risk localized prostate cancer. For men with intermediate-risk disease, delays over 60 days were significantly associated with risk of extraprostatic invasion. Our findings indicate that RP should be performed within 60 days of biopsy for intermediate-risk patients.

Oncologic impact of delaying radical prostatectomy in men with intermediate- and high-risk prostate cancer: a systematic review

“…Nineteen studies were finally included in the present systematic review [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Table 1 summarizes the studies and their main findings.…”

“…We found a significant heterogeneity across the studies in terms of delayed RP definitions. Most of the studies used 3-month intervals between diagnosis and RP [9,10,[20][21][22]; three studies used 2-month intervals [23][24][25]. Diamand [14][15][16].…”

“…Two studies reported data on survival outcomes, particularly on prostate cancer-specific mortality (PCSM) [25] and metastasis-free survival (MFS) [22]. Nine studies reported data on biochemical recurrence (BCR) [9,13,15,[21][22][23][24]26]. Fourteen studies reported data on adverse pathologic outcomes such as upgrading, upstaging, positive surgical margins (PSM), extracapsular extension (ECE), seminal Fig.…”

Time Intervals From Onset of Clinical Manifestations to Treatment in Patients With Cancer at Hospital General San Felipe, Tegucigalpa, Honduras

“…Regardless, the mean time interval to start any oncology treatment was 86 days, more than 12 weeks after the biopsy report was obtained; this is a substantial delay in initiating therapy and, presumably, caused worse outcomes. 18,19…”

“…Taken together, these long delays to treatment, which were as long as 6 months from the time of biopsy and pathologic diagnosis, may negatively affect the probability of survival. 19,20,21…”