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

Abstract

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.

Oncologic impact of delaying radical prostatectomy in men with intermediate- and high-risk prostate cancer: a systematic review

“…Nineteen studies were finally included in the present systematic review [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Table 1 summarizes the studies and their main findings.…”

“…In contrast, Diamand et al observed no association between RP delay of more than 3 months after diagnosis with BCR (HR 0.97, 95% CI 0.91-1.04, p = 0.6) in both intermediate-and high-risk patients [26]. In agreement with these results, Gupta et al reported that there was no significant difference in 2-and 5-year biochemical recurrencefree survival (BCRFS) in both intermediate-and high-risk patients who had RP < 3 months vs. those who had between 3 and 6 months after diagnosis [22].…”

“…Two studies reported data on survival outcomes, particularly on prostate cancer-specific mortality (PCSM) [25] and metastasis-free survival (MFS) [22]. Nine studies reported data on biochemical recurrence (BCR) [9,13,15,[21][22][23][24]26]. Fourteen studies reported data on adverse pathologic outcomes such as upgrading, upstaging, positive surgical margins (PSM), extracapsular extension (ECE), seminal Fig.…”

“…[9-12, 16, 20-27]. Five studies reported data on the need of secondary therapy after surgery [20,22,23,26,27].…”

“…Five studies found no significant impact of treatment delay on BCR [21][22][23][24]26], while four studies found that treatment delay had an unfavorable impact in intermediate- [9] and high-risk [13][14][15] PCa patients (Table 2). Abern et al suggested 9 months as a threshold for association with BCR (HR 2.10, p = 0.01) among men with intermediate-risk PCa [9].…”