Interval from Prostate Biopsy to Radical Prostatectomy Does Not Affect Immediate Operative Outcomes for Open or Minimally Invasive Approach

Abstract

Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the <4-week and ≥4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval ≥4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time.Graphical Abstract

Short interval of biopsy to robotic-assisted laparoscopic radical prostatectomy does not render any adverse effects on the perioperative outcomes

“…In present study, we also analyzed other parameters may related to the perioperative outcomes, we found that higher BMI was associated with longer OT which consistent with previous studies, [ 10 , 25 , 26 ] higher PSA level before surgery was associated with higher drainage and longer hospital stay. Our experience suggested that this reflects the higher complexity of RALP in patients with higher BMI or PSA level.…”

“…[ 9 ] Park et al also reported that biopsy-to-surgery interval did not affect the perioperative outcomes, including the surgical margin, OT or EBL in open, laparoscopic, and robotic approach. [ 10 ] Another large retrospective study carried out by Jo et al has produced similar findings, [ 7 ] they have even found that surgery late after biopsy (after 6 weeks) associated with an increased OT [ 7 ] which may result from the processed inflammation. In fact, most studies supported the opinion that the interval between the biopsy and surgery was not related to the perioperative outcomes even in open prostatectomy.…”

“…And some studies have also shown that early RALP did not affect the perioperative outcomes of surgery and might even be beneficial in reducing the operative time (OT). [ 7 , 9 , 10 ] Meanwhile, urologist also considered that both the core numbers and the approaches of biopsy may affect the outcomes of RP. [ 11 , 12 ] It was widely agreed that sextant biopsy is inadequate and 10 to 14 cores were suggested for improving the detection of prostate cancer [ 13 ] which resulted in an increasing of biopsy core numbers in the past decades.…”

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

“…However, the impact of time interval between biopsy and RP has not been well established (4–9). While some observations have suggested early RP is associated with more overall complications and a greater risk of blood transfusion (8), others have found disparate results (5, 7, 9). Herein, we assess the impact of time from biopsy to surgery on complications, functional, and oncologic outcomes following radical prostatectomy.…”

Safety of urologic elective surgery in a Covid-hospital: our experience in Milan

“…Delaying cystectomy for MIBC by 90 days may cause an increase of the pN + rate [19], a decrease of the overall survival and progression-free survival [20,21]. High risk prostate cancer biochemical recurrence rates may be higher in patients if definitive treatments are delayed, but there is not a clear cut-off time for this treatment benefit [22,23,24]. It has also been observed that a 3-months delay to surgery for UTUC inevitably leads to disease progression [25].…”