Impact of time from biopsy to surgery on complications, functional and oncologic outcomes following radical prostatectomy

Westerman, Mary E.; Vp, Sharma; Bailey, George C.; Boorjian, Stephen A.; Frank, Igor; Gettman, Matthew T.; Thompson, R. Houston; Tollefson, Matthew K.; Karnes, R. Jeffrey

doi:10.1590/s1677-5538.ibju.2018.0196

Cited by 17 publications

(26 citation statements)

References 28 publications

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“…Other studies using biochemical recurrence as the end point found 3 to 6 months as a cutoff point. 31,32 There were similar findings for patients considering radiation therapy, where they had a higher likelihood of PSA failure with high risk disease after a 2.5-month period, similar to the outcomes for surgical delay. 33 Other studies have suggested that it is possible to delay surgery for longer periods of time.…”

Section: Prostate Cancersupporting

confidence: 55%

Delaying Cancer Cases in Urology during COVID-19: Review of the Literature

et al. 2020

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Purpose: Coronavirus disease 2019 (COVID-19) is a global pandemic affecting hospital systems and the availability of resources for surgical procedures. Our aim is to provide guidance for urologists to help prioritize urological cancer surgeries. Materials and Methods: We reviewed published literature on bladder cancer, upper tract urothelial carcinoma, penile cancer, testis cancer, prostate cancer, renal cancer and adrenal cancer. Results: For muscle invasive bladder cancer delays should be less than roughly 10 weeks and neoadjuvant chemotherapy should be considered. Patients with nonmuscle invasive bladder cancer should be counseled appropriately based on risk and intravesical therapies can continue. Upper tract urothelial carcinoma should also be treated with minimal delays for high risk patients, especially with ureteral tumors. Surgery for T1 renal cancers when indicated can be delayed until adequate resources are available. Patients with T2 renal cancer should be considered for early surgery if there are unfavorable preoperative characteristics. Higher stage renal tumors should be considered for early surgery. An early multidisciplinary approach is recommended for metastatic renal cancers. High risk prostate cancer may need preferential treatment and consideration of neoadjuvant hormonal therapy. Penile cancer can have worse sexual or oncologic outcomes with prolonged surgical delay. Likewise, adrenal cancer is aggressive and needs early surgical treatment. Testicular cancer should be treated in a timely manner with surgery or chemotherapy, as indicated. Conclusions: This review should further assist urologists in recognizing patients with potentially aggressive tumor biology that warrants early treatment.

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Section: Prostate Cancersupporting

confidence: 55%

Delaying Cancer Cases in Urology during COVID-19: Review of the Literature

et al. 2020

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“…While the majority of oncologic surgeries have maintained priority worldwide, most urologic associations have recommended to defer prostate cancer (PCa) surgeries [2][3][4]. This is based on several retrospective studies reporting the absence of poor oncologic results for PCa no matter the delay between diagnosis and surgery, although high-risk patients could be potentially at risk of higher risk of biochemical recurrence when the surgery was delayed [5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic

et al. 2020

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Purpose The current COVID-19 pandemic is transforming our urologic practice and most urologic societies recommend to defer any surgical treatment for prostate cancer (PCa) patients. It is unclear whether a delay between diagnosis and surgical management (i.e., surgical delay) may have a detrimental effect on oncologic outcomes of PCa patients. The aim of the study was to assess the impact of surgical delay on oncologic outcomes. Methods Data of 926 men undergoing radical prostatectomy across Europe for intermediate and high-risk PCa according to EAU classification were identified. Multivariable analysis using binary logistic regression and Cox proportional hazard model tested association between surgical delay and upgrading on final pathology, lymph-node invasion (LNI), pathological locally advanced disease (pT3-4 and/or pN1), need for adjuvant therapy, and biochemical recurrence. Kaplan-Meier analysis was used to estimate BCR-free survival after surgery as a function of surgical delay using a 3 month cutoff. Results Median follow-up and surgical delay were 26 months (IQR 10-40) and 3 months (IQR 2-5), respectively. We did not find any significant association between surgical delay and oncologic outcomes when adjusted to pre-and post-operative variables. The lack of such association was observed across EAU risk categories. Conclusion Delay of several months did not appear to adversely impact oncologic results for intermediate and high-risk PCa, and support an attitude of deferring surgery in line with the current recommendation of urologic societies.

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“…However, most available studies investigating this topic reported no significant influence of delayed prostatectomy on oncological outcomes (5,7,11,12,17,23). For example, Morini et al recently published a study examining the impact in patients with localized prostate cancer reporting no correlation in timefrom-biopsy-to-prostatectomy and impaired pathological results or risk of BCR (15).…”

Section: Discussionmentioning

confidence: 99%

“…Further potential reasons for delayed treatment include patient's anxiety, desire to obtain more detailed information regarding therapeutic options, necessity for treatment of comorbidities or limited surgical capacities and long waiting lists. Most studies show no influence of the time from diagnosis to surgery of low or intermediate risk prostate cancer on the oncological outcome (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, a recent Canadian multicentre study observed a higher risk FIGURE 1 | Inclusion-and exclusion criteria for our study of patients undergoing immediate (≤3 months) vs. delayed (>3 and <6 months) radical prostatectomy for intermediate-or high-risk prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Impact of “Time-From-Biopsy-to-Prostatectomy” on Adverse Oncological Results in Patients With Intermediate and High-Risk Prostate Cancer

et al. 2020

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Objective: Many patients with localized prostate cancer (PCa) do not immediately undergo radical prostatectomy (RP) after biopsy confirmation. The aim of this study was to investigate the influence of "time-from-biopsy-to-prostatectomy" on adverse pathological outcomes. Materials and Methods: Between January 2014 and December 2019, 437 patients with intermediate-and high risk PCa who underwent RP were retrospectively identified within our prospective institutional database. For the aim of our study, we focused on patients with intermediate-(n = 285) and high-risk (n = 151) PCa using D'Amico risk stratification. Endpoints were adverse pathological outcomes and proportion of nerve-sparing procedures after RP stratified by "time-from-biopsy-to-prostatectomy": ≤3 months vs. >3 and < 6 months. Medians and interquartile ranges (IQR) were reported for continuously coded variables. The chi-square test examined the statistical significance of the differences in proportions while the Kruskal-Wallis test was used to examine differences in medians. Multivariable (ordered) logistic regressions, analyzing the impact of time between diagnosis and prostatectomy, were separately run for all relevant outcome variables (ISUP specimen, margin status, pathological stage, pathological nodal status, LVI, perineural invasion, nerve-sparing). Results: We observed no difference between patients undergoing RP ≤3 months vs. >3 and <6 months after diagnosis for the following oncological endpoints: pT-stage, ISUP grading, probability of a positive surgical margin, probability of lymph node invasion (LNI), lymphovascular invasion (LVI), and perineural invasion (pn) in patients with intermediate-and high-risk PCa. Likewise, the rates of nerve sparing procedures were 84.3 vs. 87.4% (p = 0.778) and 61.0% vs. 78.8% (p = 0.211), for intermediate-and high-risk PCa patients undergoing surgery after ≤3 months vs. >3 and <6 months, respectively. In multivariable adjusted analyses, a time to surgery >3 months did not significantly worsen any of the outcome variables in patients with intermediate-or high-risk PCa (all p > 0.05). Engl et al. Time-From-Biopsy-to-Prostatectomy Conclusion: A "time-from-biopsy-to-prostatectomy" of >3 and <6 months is neither associated with adverse pathological outcomes nor poorer chances of nerve sparing RP in intermediate-and high-risk PCa patients.

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Impact of time from biopsy to surgery on complications, functional and oncologic outcomes following radical prostatectomy

Cited by 17 publications

References 28 publications

Delaying Cancer Cases in Urology during COVID-19: Review of the Literature

Delaying Cancer Cases in Urology during COVID-19: Review of the Literature

Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic

Impact of “Time-From-Biopsy-to-Prostatectomy” on Adverse Oncological Results in Patients With Intermediate and High-Risk Prostate Cancer

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