EAU 2018: The Impact of Time from Diagnosis to Primary Radical Prostatectomy on Prostate Cancer-Specific Mortality

Copenhagen, Denmark (UroToday.com) Norway has a high incidence of prostate cancer (PCa). In 2016 approximately 5,100 Norwegian men were diagnosed with PCa. About 90% of them had local disease without distant metastases, and most of these patients were candidates for curative treatment, with a life expectancy of 10 years or more. To eliminate unnecessary delay in diagnosis and treatment, the Norwegian health authorities introduced in 2015 a fast-track system stating that patients eligible for primary radical prostatectomy (RP) should undergo surgery within 32 days of decision-making (“RP-interval”), irrespective of the risk group allocation. 

Although the psychological benefit is undeniable, most studies have not shown significant impact of the duration of the RP-interval on long-term oncological outcomes in low-risk cancers. Only limited impact has been shown in higher-risk cancers, when RP is delayed for months or even years. Alluding to the Norwegian fast-track system, the aim of this study was to investigate the impact of time from diagnosis to RP as primary treatment of non-metastatic PCa on long-term PC specific mortality (PCSM), stratifying for risk groups.

Based on data from the Cancer Registry of Norway (CRN) and the Norwegian Prostate Cancer Registry (NoPCR), the authors identified 1,642 patients diagnosed with PCa between 2001 and 2005, who underwent RP within 6 months of diagnosis. None of the patients had known metastatic disease. Patients were stratified according to EAU contemporary risk groups (low, intermediate, high) and time interval from diagnosis to RP (≤60, 61-90, 91-120, 121-180 days). The time interval ≤60 days corresponded to the estimated time from the first cancer positive biopsy to RP performed within the time limit defined by the fast-track system. PCSM was calculated using Kaplan-Meier estimates, based on a median observation time of 12 years (range 0-16).

The median age of patients was 61 years (39-76). A total of 24%, 36% and 41% of patients had low-, intermediate- and high-risk disease, respectively. Two hundred ninety-two (18%), 556 (34%), 414 (25%) and 380 (23%) patients were treated with RP ≤60, 61-90, 91-120, and 121-180 days from diagnosis, respectively. No statistically significant association was found between the duration of the RP-interval and PCSM in any risk group. For patients in the high-risk group with RP-intervals of ≤60, 61-90, 91-120, and 121-180 days, the PCSM was respectively 18.5% (CI 0- 38.5), 4.7% (CI 1.3-8.1), 1.6% (0-4.8) and 3.1% (0-6.3), respectively.

The authors concluded, that the time interval from diagnosis to primary RP performed within 180 days of diagnosis did not affect PCSM in any risk group at a median follow-up of 12 years. The authors concluded that patients and physicians should be aware of these data when prostatectomy is planned.

Presented by: Aas K, Oslo University Hospital, Dept. of Surgery, Oslo, Norway

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark