Comparison of Pathological Outcomes for Men with Low Risk Prostate Cancer from Diverse Practice Settings: Similar Results from Immediate Prostatectomy or Initial Surveillance with Delayed Prostatectomy

Abstract

Purpose We compare pathologic outcomes following radical prostatectomy for a population-based sample of men with low-risk prostate cancer managed with initial active surveillance and delayed prostatectomy versus those treated with immediate surgery in order to better understand this expectant management approach outside of the context of academic cohorts. We hypothesized that delays in surgery due to initial surveillance would not impact surgical pathological outcomes. Material and Methods We performed a prospective cohort study of two groups of patients with National Comprehensive Cancer Network low-risk prostate cancer from practices in the Michigan Urological Surgery Improvement Collaborative (MUSIC): men who chose initial active surveillance and went on to delayed prostatectomy and those who chose immediate prostatectomy. Diagnoses occurred from January 2011 through August 2015. For these two groups, we compared radical prostatectomy Gleason scores, and rates of extra-prostatic disease, positive surgical margins, seminal vesicle invasion, and lymph node metastases. Results During median follow-up of 506 days, 79 (6%) of 1,359 low-risk men choosing initial surveillance transitioned to prostatectomy. Compared to those treated with immediate prostatectomy (n=778), men undergoing delayed surgery were more likely to have Gleason score ≥7 (69.2% vs 48.8% respectively, p=0.004), but no more likely to have positive margins, extra-prostatic extension, seminal vesicle invasion, or lymph node metastases. Conclusions Patients with low risk prostate cancer that enter active surveillance have higher grade disease at prostatectomy compared to those undergoing immediate surgery. However, the lack of differences in other adverse pathologic outcomes suggests preservation of the window of curability.

Does time from diagnosis to treatment of high‐ or very‐high‐risk prostate cancer affect outcome?

“…The data analysing the importance of time to treatment specifically in high-risk and VHR prostate cancer are limited, with prior studies mainly using mixed cohorts of low-to intermediate-risk disease [11][12][13]. More recently, Zanaty et al [14] evaluated the impact of surgical wait time (time from TRUS biopsy to RP) in a contemporary surgical cohort that included a subset of D'Amico high-risk patients.…”

“…The data analysing the importance of time to treatment specifically in high‐risk and VHR prostate cancer are limited, with prior studies mainly using mixed cohorts of low‐ to intermediate‐risk disease . More recently, Zanaty et al.…”

Optimizing Time to Treatment to Achieve Durable Biochemical Disease Control after Surgery in Prostate Cancer: A Multi-Institutional Cohort Study

“…However, the study design used in most of these contemporary studies utilized arbitrary or a priori-determined cutoff points to categorize time to treatment and then used these categories to predict prostate cancer outcome (14,15,(18)(19)(20)(21). This approach is susceptible to misclassification bias as it ignores the important factors such as clinical characteristics which have a direct association with treatment planning and may affect time to treatment (2,10,27). Furthermore, most studies often fail to acknowledge that prostate cancer progression is not fixed and alterations in the tumor characteristics as a result of biological changes are inevitable due to lack of definite treatment.…”

Delayed Radical Prostatectomy is Not Associated with Adverse Oncologic Outcomes: Implications for Men Experiencing Surgical Delay Due to the COVID-19 Pandemic

“…In the current literature, controversy exists regarding whether or not delays from diagnosis to RP are associated with worse oncological outcomes. Many of these studies are retrospective, performed at single institutions, and focused on the low-risk or active surveillance population [4][5][6][7] . To our knowledge, no studies have examined the impact that delay in RP has on oncologic outcomes in the setting of intermediate and high-risk PC in a contemporary, nationwide patient cohort.…”