Does Delaying Surgery Affect Outcomes in Localized High-Risk Prostate Cancer?
Posted: Tuesday, March 2, 2021
Among patients with localized high-risk prostate cancer, it may be possible to delay radical prostatectomy safely for up to 6 months after diagnosis without affecting overall survival, according to a cohort study of more than 32,000 patients from the U.S. National Cancer Database. This analysis was published by Daniel J. Lee, MD, MS, of the University of Pennsylvania Perelman School of Medicine, and colleagues in JAMA Network Open.
“These findings suggest that prostate cancer surgery can be safely delayed up to 6 months and should be considered as low priority compared with other emergent and cancer surgeries when health-care resources need to be prioritized during special times, such as the coronavirus disease 2019 pandemic,” concluded the authors.
Researchers utilized the U.S. National Cancer Database to identify 32,184 patients with localized, high-risk prostate adenocarcinoma. Patients included were diagnosed between 2006 and 2016 and had undergone radical prostatectomy. The surgical delay time was defined by the number of days between the initial cancer diagnosis and radical prostatectomy. Five groupings were used: 31–60 days (42.9% of patients), 61–90 days (36.5%), 91–120 days (14.0%), 121–150 days (4.7%), and 151–180 days (2%).
When compared with a surgery delay time of 31 to 60 days, those with longer delays did not have a higher risk of having any adverse pathologic outcomes (odds ratio = 0.95, P = 0.53). There appeared to be no association specifically between longer surgery delay time and T3 or T4 disease (odds ratio = 0.99, P = 0.87), node-positive disease (odds ratio = 0.88, P = 0.12), or positive surgical margins (odds ratio = 0.88, P = 0.17). Delayed surgical time was not associated with an adverse pathologic score of 2 or higher when compared with the 31- to 6- day group (odds ratio = 0.90, P = 0.17). Overall survival was similarly not impacted by a longer time to surgery (for 151–180 days, hazard ratio = 1.12, P = 0.53).
Disclosure: The study authors reported no conflicts of interest.
