Oncology - Prostate
Introduction & Objective :
There is limited evidence on whether delays in surgical therapy for prostate cancer lead to adverse outcomes in the long run. At our institution, patients referred from outside facilities for radical prostatectomy (RP) experienced longer time intervals between diagnostic biopsy and surgical intervention, when compared to patients from our own facility. Therefore, the goal of our investigation was to determine any association between delay in RP, and incidence of biochemical recurrence (BCR).
We performed a single-institution retrospective study of all patients undergoing RP at our institution between the years 2010 - 2011. Patients were stratified into two groups based on whether they were referred to our institution for surgical intervention, or whether they were already followed by our institution at time of initial biopsy. Patient characteristics and perioperative outcomes were identified. Primary outcome was incidence of biochemical recurrence (BCR), defined by American Urological Association guidelines as two subsequent PSA values ≥ 0.2 ng/mL. Secondary outcomes included time to biochemical recurrence, positive surgical margins, and Gleason score upgrade (defined as an increase in total Gleason score from initial biopsy to surgical pathology).
Results : A total of 71 patients underwent RP at our institution during the study period. Of these, 38 patients were referred from outside facilities (delayed group), and 33 were from our institution (home group). Preoperative characteristics were similar between delayed and home groups, apart from the interval between initial biopsy and surgical intervention (mean 211.9 and 134.4 days respectively, p < 0.001). The delayed group was followed for a mean of 6.5 ± 1.3 years, and the home group for a mean of 6.2 ± 1.4 years. Groups were similar in regards to method of RP (robotic vs. open), Gleason score on surgical pathology, Gleason score upgrade, and extra-capsular extension. There was a trend towards higher rates of positive surgical margins in the delayed group at 21.1% (8/38), vs. the home group at 6.3% (2/32), p = 0.069. The incidence of BCR was significantly higher in the delayed group at 36.8% (14/38), vs. the home group at 6.1% (2/33), p = 0.002. Among patients with BCR, time to recurrence was similar between delayed and home groups (mean 3.68 ± 1.9 vs. 2.88 ± 0.19 years), p = 0.817.
Our data suggest delays in radical prostatectomy may be associated with a higher rate of BCR in patients with prostate cancer, implying efforts should be made to minimize surgical delay.