Radical prostatectomy delay viable for localized high-risk prostate cancer
medwireNews: US researchers report that men with clinically localized, high-risk prostate cancer are no more likely to experience adverse pathologic outcomes if radical prostatectomy is delayed for up to 6 months rather than occurring within 31–60 days of diagnosis.
Leilei Xia and fellow investigators at the University of Pennsylvania in Philadelphia therefore suggest that prostate cancer surgery “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.”
Xia et al analyzed data pertaining to 32,184 patients included in the US National Cancer Database who were diagnosed with clinically localized, high-risk prostate cancer between 2006 and 2016. All patients underwent radical prostatectomy within 31–60 (42.9%), 61–90 (36.5%), 91–120 (14.0%), 121–150 (4.7%), or 151–180 (2.0%) days of their diagnosis.
Following radical prostatectomy, the majority (63.0%) of patients had at least one adverse pathologic outcome – namely pT3–T4 (54.2%), pN-positive disease (33.4%) or a positive surgical margin (10.6%) – with 33.1% having one, 24.6% having two, and 5.3% having three adverse outcomes.
Multivariable analysis showed that the risk for experiencing any or two or more adverse pathologic outcomes was not significantly increased for patients whose surgery was delayed beyond 60 days versus those who underwent surgery 31–60 days after diagnosis. Similarly, there was no significant difference in the individual risks for pT3–T4 disease, pN-positive disease, or a positive surgical margin.
There was, however, one exception; prostatectomy after a delay of 61–90 days was associated with a significantly lower risk for pN-positive disease than a delay of 31–60 days (odds ratio=0.85), but the researchers explain that this was likely due to selection bias and statistical variability.
Overall survival (OS) rates were also comparable among patient groups stratified by surgical delay time, at rates ranging from 5.9% to 6.6% during a median 41.7 months of follow-up.
But Xia and team warn that “follow-up time for OS was short, and this secondary outcome should be interpreted with extra caution.”
Furthermore, both the OS and adverse outcome findings persisted in a subgroup analysis of the 2348 patients with very-high-risk disease, indicated by a primary Gleason score of 5, and in sensitivity analyses considering surgical delay time as a continuous variable.
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