Two Retrospective Analyses Show No Associated Adverse Outcomes With Delayed RP

September 21, 2020
Kevin Wright

Oncology, ONCOLOGY Vol 34 Issue 9, Volume 34, Issue 9

Two recent studies indicate oncological outcomes were not affected by delayed radical prostatectomy, supporting current recommendations for management of intermediate- and high-risk patients with prostate cancer during the COVID-19 pandemic.

The results of 2 studies showed no association between delayed radical prostatectomy (RP) and adverse oncological outcomes, supporting current recommendations of urologic societies for surgical treatment of patients with intermediate- and high-risk prostate cancer during the coronavirus disease 2019 (COVID-19) pandemic.

A retrospective analysis published in the Journal of Urology indicated that a delay of up to 12 months did not result in worse outcomes when compared with immediate surgery within 3 months of diagnosis.1

When compared with patients receiving RP within 3 months of diagnosis, patients 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 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 (interquartile range [IQR], 58-67) and a median PSA at diagnosis of 6.3 ng/mL. Just over half (50.1%) of the patients had Grade Group (GG) 2 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 4/5 disease also did not show a significant difference in adverse pathology among 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 among 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).

European Study Results Align With Recommendations

A second study, published in World Journal of Urology, analyzed the outcomes of 926 men undergoing RP for intermediate- and high-risk prostate cancer across Europe. Median follow-up and surgical delay were 26 months (IQR, 10-40) and 3 months (IQR, 2-5) respectively. No significant association between surgical delay and oncologic outcomes were found.2

The findings lend support to the current National Comprehensive Cancer Network guideline for prostate cancer management during the COVID-19 pandemic.3

Data were retrospectively gathered from 1139 patients receiving surgery between March 2012 and September 2019 across European centers in Belgium, France, Switzerland, and Italy. Patients in the study were categorized according to the European Association of Urology (EAU) risk categories, with time from diagnosis counted as a continuous variable.

The multivariable analysis demonstrated no significant association between surgical delay and upgrading on final specimen (OR, 0.98; 95% CI, 0.94-1.02; P = .3), pathologically locally advanced disease (OR, 1.00; 95% CI, 0.97-1.03; P = .8), need for adjuvant therapy (OR, 0.96; 95% CI, 0.84-1.11; P = .6), or lymph node invasion (OR, 0.88; 95% CI, 0.77-1.01; P = .07). The lack of impact was observed across all EAU risk categories.

While the investigators noted that most men in the study were operated on within a postdiagnosis period of close to 3 months, and they warned of extrapolating the results for much longer treatment delays, similar studies demonstrated that proposals of delays of up to 6 months for high-risk disease were reasonable, while low- and intermediate-risk groups could be delayed further.

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. J Urol. Published online May 1, 2020. doi:10.1097/JU.0000000000001089
  2. Diamand R, Ploussard G, Roumiguié M, et al. Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic. World J Urol. 2020;1-8. doi:10.1007/s00345-020-03402-w
  3. Management of prostate cancer during the COVID-19 pandemic. National Comprehensive Cancer Network. 2020. Accessed August 18, 2020. https://www.nccn.org/covid-19/pdf/NCCN_PCa_COVID_guidelines.pdf
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