Delay from biopsy to RP: Who is at risk of recurrence?

The risk of prostate cancer relapse after radical prostatectomy increases with lengthening delay between diagnosis and surgery. The impact, however, is significant only in high-risk patients, and even in those men, there may be a window of up to 12 months during which it may be relatively safe to postpone surgery, reported researchers from Milan, Italy.

Milan, Italy-The risk of prostate cancer relapse after radical prostatectomy increases with lengthening delay between diagnosis and surgery. The impact, however, is significant only in high-risk patients, and even in those men, there may be a window of up to 12 months during which it may be relatively safe to postpone surgery, reported researchers from Milan, Italy.

Read: Large prostate Ca study evaluates RP, radiation, monitoring

“The impact of time elapsed from prostate cancer diagnosis to radical prostatectomy on cancer control remains controversial, as studies examining this issue report conflicting results,” said Vito Cucchiara, MD, urology resident at IRCCS San Raffaele Hospital, Milan, Italy, who worked on the study with Alberto Briganti, MD, and colleagues.

“We have always recommended that patients with high-risk prostate cancer undergo surgery as soon as possible. Based on the findings of our study, however, we can tell such men they should not postpone radical prostatectomy longer than 12 months after diagnosis,” said Dr. Cucchiara, who presented the findings at the AUA annual meeting in San Diego.

To investigate how delaying radical prostatectomy after diagnosis affects oncologic outcomes, the authors identified 2,803 patients operated on at their institution between 2006 and 2015. After excluding men who had received prior radiation therapy, hormonal therapy, or initial management with active surveillance and those without data on PSA at diagnosis, clinical stage, or oncologic follow-up, the evaluable cohort included 2,653 men. Based on D’Amico classification, about one-third of the patients had low-risk disease, almost half were categorized as intermediate-risk, and 16% had high-risk disease. Median time from biopsy to surgery was 2.8 months.

Oncologic outcomes assessed included biochemical recurrence (BCR), defined as two consecutive PSA values ≥0.2 ng/mL, and clinical recurrence (CR), defined as positive imaging during follow-up after the onset of BCR. After a median follow-up of 56 months from radical prostatectomy, 281 men experienced BCR and 84 developed CR.

Next: Time from biopsy to RP linked to BCR risk

Time from biopsy to RP linked to BCR risk

In a multivariable Cox regression analysis including clinical stage, biopsy Gleason score, and percentage of positive cores as covariates, a statistically significant association was found between time from biopsy to radical prostatectomy and risk of both BCR (p=.0005) and CR (p=.0002).

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A second multivariable analysis using locally weighted scatter plot smoothing methods was done to graphically explore the relationship between time from biopsy to surgery and the oncologic outcomes. Its results showed the risk of both BCR and CR increased significantly once surgery was delayed about 18 months in the overall population.

Sensitivity analyses were performed with the patients stratified according to D’Amico risk groups, and their results showed the time from biopsy to surgery had no significant impact on oncologic outcomes in the low-risk or intermediate-risk groups. For men in the high-risk group, their existing risk of BCR increased 0.1% per month for patients whose surgery was delayed up to 6 months, 0.5% per month for men who underwent surgery from 7 to 12 months after diagnosis, 1% per month when surgery was delayed 12 to 18 months, and 2% per month when the time from diagnosis to surgery reached 18 to 24 months.