AUA 2019: Evaluating the Impact of Length of Time from Diagnosis to Surgery in Patients with Unfavorable Intermediate to Very High-Risk Clinically Localized Prostate Cancer
The authors examined their institutional data set to identify patients who were diagnosed with high-grade (Gleason Grade Group ≥3) prostate cancer on diagnostic prostate biopsy who subsequently went on to radical prostatectomy between 2005 and 2018. They excluded patients who had a delay of greater than 6 months between diagnostic prostate biopsy and radical prostatectomy. They then stratified the cohort according to the time from biopsy to radical prostatectomy: those who underwent surgery within 3 months of biopsy and those who underwent surgery between 3-6 months following biopsy. They then examined oncologic outcomes including receipt of adjuvant therapies, positive surgical margin rates, extraprostatic extension, seminal vesicle invasion, lymph node involvement, biochemical recurrence-free survival, and metastasis-free survival, stratified by histologic GGG.
2303 patients were identified who met study inclusion criteria: GGG3 was found in 1244 (54%), GGG4 was found in 608 (26%), and GGG5 was found in 451 (20%). 72% underwent RP within 3 months of biopsy and 28% underwent RP between 3-6 months following biopsy. Stratified by GGG, there were no differences identified in rates of adjuvant therapy or adverse pathological features (positive surgical margin rates, extraprostatic extension, seminal vesicle invasion, lymph node involvement) for patients who had earlier or later radical prostatectomy. Among 1568 patients who had at least one year of follow-up following radical prostatectomy, there were no significant differences in biochemical recurrence-free survival based on radical prostatectomy timing (GGG3 p=0.6, GGG4 p=0.4, GGG5 p=0.2). Similarly, there were no differences in two-, five-, or ten-year metastasis-free survival on the basis of radical prostatectomy timing.
The authors conclude that, even among patients with unfavorable intermediate-risk to very high-risk prostate cancer, there is no evidence of adverse outcomes associated with delaying prostatectomy up to 6 months following prostate biopsy. However, there may be a lack of granularity using a dichotomized, rather than continuous, exposure definition which could obscure differences.
Presented by: Natasha Gupta, MD, Department of Urology, Johns Hopkins Medicine, Baltimore, Maryland
Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, @WallisCJD at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois