Effects of Delayed Radical Prostatectomy and Active Surveillance on Localised Prostate Cancer-A Systematic Review and Meta-Analysis.

External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle-Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited.

Cancers. 2021 Jun 30*** epublish ***

Vinson Wai-Shun Chan, Wei Shen Tan, Aqua Asif, Alexander Ng, Olayinka Gbolahan, Eoin Dinneen, Wilson To, Hassan Kadhim, Melissa Premchand, Oliver Burton, Jasmine Sze-Ern Koe, Nicole Wang, Jeffrey J Leow, Gianluca Giannarini, Nikhil Vasdev, Shahrokh F Shariat, Dmitry Enikeev, Chi Fai Ng, Jeremy Yuen-Chun Teoh

School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK., Division of Surgery and Interventional Science, University College London, London W1W 7TS, UK., UCL Medical School, University College London, London WC1E 6DE, UK., Department of Urology, Royal Free Hospital, London NW3 2QG, UK., Department of Urology, Ipswich Hospital, Ipswich IP4 5PD, UK., Department of Urology, Northwick Park Hospital, London HA1 3UJ, UK., Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK., Department of Urology, Tan Tock Seng Hospital, Singapore 308433, Singapore., Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy., Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital Stevenage, School of Medicine and Life Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK., Department of Urology, Medical University of Vienna, 1090 Vienna, Austria., Institute for Urology and Reproductive Health, Sechenov University, 119991 Moscow, Russia., S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.