The impact of a delay in initiating radiation therapy on prostate‐specific antigen outcome for patients with clinically localized prostate carcinoma

Abstract

BACKGROUNDTo determine whether a delay in initiating external beam radiation therapy (RT) following diagnosis could impact prostate‐specific antigen (PSA) outcome for patients with localized prostate cancer, 460 patients, who received 3D conformal RT to a median dose of 70.4 Gy for clinically localized prostate cancer between 1992 and 2001, were studied.METHODSThe primary endpoint was PSA failure (American Society for Therapeutic Radiology and Oncology definition). Estimates of PSA control were made using the Kaplan–Meier method. Delay was defined as the time between diagnosis and the start of RT. Risk groups were defined based on known predictors of PSA outcome, namely, baseline PSA level, clinical T‐category, Gleason score, and percentage of biopsy cores positive for tumor. Cox multivariate regression analysis was used to determine the ability of treatment delay to predict time to PSA failure after adjusting for the other known predictors.RESULTSTreatment delay independently predicted time to PSA failure following diagnosis for high‐risk (Adjusted Hazard Ratio = 1.08 per month; P = 0.029) but not low‐risk patients (P = 0.31). Patients with high‐risk disease (n = 240) had 5‐year estimates of PSA failure‐free survival of 55% versus 39% (Plog‐rank = 0.014) for those with delay < 2.5 months versus ≥ 2.5 months respectively. The median delay was 2.5 months.CONCLUSIONSTreatment delay adversely affected PSA outcome for high‐risk patients but not for low‐risk patients following RT. Cancer 2005. © 2005 American Cancer Society.

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

“…For high-risk prostate cancer, only a couple have identified association between SWT and oncological outcomes 9,23 -albeit few studies were conducted. No association was found in our subgroup analysis for high-risk patients.…”

“…Furthermore, very few studies have reported a trend toward increased risk of biochemical recurrence (BCR)-associated with surgical delays for prostate cancer. [9][10][11] Therefore, the true impact of surgical delay remains controversial and the acceptable wait time is currently unknown. As such, we sought to address the impact of SWT to RARP on pathological outcomes for patients in two major academic centres in Canada.…”

Robotic prostatectomy is associated with increased patient travel and treatment delay

“…Although it is very unlikely that treatment delays compromise cancer control for low-risk PCa, for higher-risk disease, delays may have an unfavourable impact on oncologic outcomes. [20][21][22] Although the quality of the evidence on the association between treatment delay and oncologic outcomes is weak, treatment delay ideally should not exceed 90 days for men with intermediate-or high-risk disease. 23 This study has some limitations.…”

Wait times in prostate cancer diagnosis and radiation treatment

“…Studies demonstrate that men with prostate cancer experience longer wait times for diagnosis and treatment than those observed for other cancers. [2][3][4][5][6] While the evidence that longer waits are associated with worse prognosis in prostate cancer is inconclusive, [7][8][9][10][11][12][13][14][15][16] it has been demonstrated that diagnostic and treatment delay are associated with patient and family psychosocial distress in this population. 17,18 The care pathway for localized prostate cancer is characterized by a sequence of events extending from suspicion …”