Pandemic-induced delays in radical prostatectomy unlikely to cause adverse oncological outcomes

Delayed radical prostatectomy (RP) does not increase the risk of early adverse oncological outcomes compared with immediate RP in men with intermediate- and high-risk prostate cancer, according to a retrospective analysis published in the Journal of Urology.^1,2

Compared with patients receiving RP within 3 months of diagnosis, patient undergoing surgery 4 to 12 months after diagnosis did not have increased odds of adverse pathology, upgrading on RP, or node-positive disease. The investigators hope their findings offer some reassurance to urologists and patients trying to balance medical decisions with safety precautions during the COVID-19 pandemic.

“In men who had radical prostatectomies for intermediate and high-risk disease, we found that a delay of up to 12 months did not result in any worse outcomes compared to immediate surgery within three months of diagnosis. The men who had delay had equivalent final pathology reports, and they did not undergo additional secondary treatments at a higher rate compared with men who had immediate surgery,” senior study author Michael Cher, MD, professor and chair of urology, Wayne State University School of Medicine, said in a press release.

The investigators accrued data from the National Cancer Database for men with intermediate- and high-risk prostate cancer who received RP between 2010 and 2016. Surgery ≤3 months from diagnosis was defined as immediate RP, with delayed RP being evaluated in 3-month intervals up to 12 months (4-6 months, 7-9 months, 10-12 months).

Overall, the analysis included 128,062 patients with a median age of 63 years (IQR, 58-67) and a median PSA at diagnosis of 6.3 ng/mL. Just over half (50.1%) of the patients had GG2 disease. The median interval between diagnosis and treatment was 3 months (IQR, 2-4). Overall, 73.2% (n = 93,764) of patients underwent RP within 0 to 3 months of diagnosis, 23.7% (n = 30,337) within 4 to 6 months, 2.5% (n = 3213) within 7 to 9 months, and 0.6% (n = 748) within 10 to 12 months.

Compared with the immediate RP group, the odds of adverse pathology were not higher with the delays of 4 to 6 months (odds ratio [OR], 0.98; 95% CI, 0.94-1.02; P = .310), 7 to 9 months (OR, 1.02; 95% CI, 0.91-1.13; P = .773), and 10 to 12 months (OR, 1.00; 95% CI, 0.80-1.26; P = .98). Separate subgroup analyses of men with GG 2/3 and GG 4/5 disease also did not show a significant difference in adverse pathology between any of the 3 delay intervals compared with immediate RP.

There was also no link between delayed RP and pathologic upgrading. The odds of pathologic upgrading at RP were similar between the delayed RP cohorts compared with the immediate RP cohort: 4 to 6 months (OR, 1.0; 95% CI, 0.95-1.05; P = .922), 7 to 9 months (OR, 1.09; 95% CI, 0.95-1.24, P = .228), and 10 to 12 months (OR, 1.06; 95% CI, 0.82-1.37; P = .649). The odds of nodal metastases were similarly not higher for the delayed RP cohorts compared with the immediate RP cohort.

In an accompanying editorial, Geoffrey H Rosen, MD, and coauthors wrote, “In this work, Ginsburg and colleagues present a timely, important analysis of a large nationwide database, where they do not find correlation between time to treatment and adverse outcomes. This practice informing study could be furthered with more details about the sample, outcomes, and models. This work is an excellent addition to the literature on timing of intervention for prostate cancer that has taken on new relevance in the setting of COVID-19.”³

References

1. Ginsburg KB, Curtis GL, Timar RE, et al. Delayed radical prostatectomy is not associated with adverse oncological outcomes: implications for men experiencing surgical delay due to the COVID-19 pandemic [published online May 1, 2020]. J Urol. doi: 10.1097/JU.0000000000001089

2. Study shows men with higher-risk prostate cancers could delay treatment during pandemic. Published online July 14, 2020. https://bit.ly/32qr6IC. Accessed July 15, 2020.

3. Rosen GH, Golzy M, Murray KS. Re: delayed radical prostatectomy is not associated with adverse oncological outcomes: implications for men experiencing surgical delay due to the COVID-19 pandemic [published online July 1, 2020]. J Urol. doi: 10.1097/JU.0000000000001192