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

Abstract

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.

The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre

“…Contrary to this, a delay of 3-6 months was not associated with adverse pathological outcomes for men with intermediate or highrisk prostate cancer. [19][20][21] Ginsburg et al, 22 reviewed delayed prostatectomy (of up to 12 months) in the National Cancer Database and found no early adverse oncological effect. This was the basis of guidelines recommending deferred treatment at the beginning of the pandemic but given we are now living with COVID-19 for over 12 months, we need to consider the impact of ongoing delays.…”

Time from biopsy to radical prostatectomy by race in an equal‐access healthcare system: Results from the SEARCH cohort

“…Days from biopsy to RP were dichotomized into cut‐offs of ≤90/>90 and ≤180/>180 days to determine the risks of delays associated with PC recurrence using multivariable logistic regression models among the entire cohort and within each quartile of biopsy year. The timeframe cut‐offs were selected a priori as they have previously been shown to have clinical relevance in determining the PC risk of recurrence associated with delays in surgery 23–26 …”

“…The timeframe cut-offs were selected a priori as they have previously been shown to have clinical relevance in determining the PC risk of recurrence associated with delays in surgery. [23][24][25][26] In sensitivity analyses, we examined if our results for race and time to RP were modified following the exclusion of men who: (i) may have initially opted for AS and later deciding to have surgery or (ii) were at very low, low or unknown risk using criteria in the NCCN Clinical Practice Guidelines in Oncology given that these men may also have been advised to be on AS. 22 In item (i), owing to a lack of data elements in the SEARCH Cohort to identify men who initially chose AS for primary mode of treatment, we used a 1-year cut-off as a proxy criterion for AS, consistent with our previous work 27 and that of other observational studies.…”

Time pressure predicts decisional regret in men with localized prostate cancer: data from a longitudinal multicenter study

“…Defined time limits for treatment decision and initiation could amplify time pressure. However, for low/intermediate risk tumors, an oncological deterioration within three to six months after diagnosis is not very likely [24,25]. Many men may not be aware of this.…”