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.
“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.