Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer

Abstract

Key Points Question Is delayed radical prostatectomy for high-risk prostate cancer associated with negative patient outcomes? Findings In this cohort study of 32 184 patients from the US National Cancer Database who underwent radical prostatectomy within 180 days of diagnosis for high-risk prostate cancer, increased surgical delay time was not associated with higher risks of adverse pathological features (pT3-4 disease, node positivity, or positive margin). Meaning These findings suggest that prostate cancer surgery can be safely delayed up to 6 months and should be considered as low priority compared with other emergent and cancer surgeries when health care resources need to be prioritized during special times, such as the coronavirus disease 2019 pandemic.

Impact of the COVID-19 Pandemic on Surgical Treatment Patterns for Colorectal Cancer in a Tertiary Medical Facility in Korea

“…However, contradictory results regarding the influence of COVID on treatment outcomes in cancer patients were observed. COVID-associated delays would likely not be fatal in patients with breast and prostate cancer, especially during their early stages [ 19 , 20 ]. By contrast, the proportion of lung cancer patients diagnosed with advanced non-small-cell lung cancer was higher during the COVID period [ 4 ].…”

“…Although cancer was thought to be exacerbated by the epidemic, more aggressive disease does not indicate a more advanced pathologic stage. Neither COVID nor colorectal cancer stage had a significant effect on pathologic tumor distribution [ 21 , 28 ], nor on pathologic stage in other tumor types [ 19 , 20 ]. The pandemic caused delays in diagnosis or treatment at any disease control stage, and this is still ongoing.…”

Effects of Delayed Radical Prostatectomy and Active Surveillance on Localised Prostate Cancer—A Systematic Review and Meta-Analysis

“…A delay of 30 days or more has generally found to be associated with worsened BCRFS [10,21,24,34]. However, multiple studies have also found a delay of up to 180 days not to be associated with worsened BCRFS [19,[38][39][40][41]. A delay of 30 days or more is also associated with worsened pathological outcomes [21] in one study.…”

“…A total of 13 studies [10,[18][19][20][21]24,26,29,30,34,[38][39][40][41] reported outcomes of delayed RP compared to immediate RP in high-risk patients. A delay of 30 days or more has generally found to be associated with worsened BCRFS [10,21,24,34].…”

Versorgungssituation urologischer Patienten in Praxen und Kliniken während der Coronaviruspandemie in Deutschland

“…So zeigen kleine Nierentumore oft ein geringes Wachstum und ein niedriges Metastasierungsrisiko und für das Prostatakarzinom deuten aktuelle Daten an, dass eine Verzögerung der Behandlung sogar bei hohem Risiko bis zu 6 Monate möglich ist. Der Einzelfall und die psychische Belastung einer Pandemie-bedingten Verzögerung der Therapie eines („Hoch-Risiko-“)Karzinoms bleibt dabei jedoch unbeachtet und sollte nicht unterschätzt werden [ 6 , 10 ]. Dies mag einer der Gründe sein, warum verschiedene urologische Gesellschaften unter anderem auch dem Hoch-Risiko-Prostatakarzinom eine mittlere bis hohe Priorität eingeräumt haben [ 4 , 11 ].…”