SUO 2017: Does Time From Diagnosis To Treatment Of Very High Or High Risk Prostate Cancer Affect

Washington, DC ( Introduction: Limited data exist on the effect of time from diagnosis to treatment in high or very high risk (VHR) prostate cancer (PCa). The relevance of this issue beyond logistics and access to care is increasing with the advent of many neoadjuvant treatment protocols which may inherently delay local therapy. IN this study the authors examined whether time from diagnosis to treatment impacted outcomes in a large multi-institutional cohort of high and VHR PCa patients undergoing radical prostatectomy (RP).

Methods: 1392 patients from three tertiary referral institutions (Cleveland Clinic, Johns Hopkins, and MD Anderson) that underwent RP for either NCCN high risk or VHR disease from 2005-2015 were reviewed, after excluding patients who received neo-adjuvant ADT. The cohort was divided into tertiles based on time from diagnostic biopsy to RP (1st: 12-61 days, 2nd: 62-98 days, 3rd: 99-3640 days). K-M estimates for time to BCR, time to metastasis, PCa specific mortality (PCSM), and all -cause mortality (ACM) were calculated for each tertile. Additionally, a Cox-proportional hazards regression model was done, to adjust for factors that were significantly different among tertiles on univariate analyses (PCa grade group at diagnosis, race, institution).

Results: Median age was 63 years (IQR 57-67). Median PSA at diagnosis was 7.0 (IQR 4.9-13.2). Mean time from biopsy to RP was 77±10.6 days. Mean follow up was 32 months (IQR 13-57). 483 (34%) patients experienced BCR. 93 (7%) developed metastasis. 20 (1.4%) died from PCa. 251 patients (18%) received adjuvant ADT and 306 (22%) underwent radiotherapy. K-M estimates of BCR (p=0.64), time to metastasis (p=0.28), PCSM (p=0.11), and ACM (p=0.23) did not significantly differ between tertiles. Cox-proportional hazards regression for BCR, time to metastasis, PCSM and ACM also did not significantly differ between tertiles for VHR patients.

Conclusion: In this cohort of high and VHR prostate cancer patients two thirds of whom underwent radical
prostatectomy within 12 weeks of diagnostic biopsy. It would appear that time from diagnosis to radical prostatectomy did not appear to significantly contribute to differences in clinical outcome.

Presented by: Chad Reichard, MD Anderson Cancer Center Houston, TX, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC

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