The influence of the delay between prostate biopsy and radical prostatectomy for patients with localized prostate cancer is controversial. The objective of this study was to establish a time limit between prostate biopsy and radical prostatectomy beyond which the risks of upgradging and biochemical recurrence (BCR) are increased.
Between January 2013 and January 2017, a retrospective analysis of the clinical, biological and histological data of 513 patients treated with radical prostatectomy for localized prostate cancer was performed in a single center. The primary endpoint was the assessment of the risk of BCR by the difference between post-biopsy USCF-CAPRA and post-surgical CAPRA-S scores. The secondary endpoint was the evaluation of the upgrading by the difference between the Gleason score on biopsy and on surgical specimen. The risks of BCR and upgrading were compared by Student test according to different delays between prostate biopsy and radical prostatectomy. The shortest delays for which a significant difference was found were reported.
In this study, 513 patients were included. The median age at the time of the biopsy was 65 years (IQR: 60-69). The median preoperative PSA was 7.30ng/mL (IQR: 5.60-9.94). The median time between biopsy and surgery was 108 days (IQR: 86-141). For the entire cohort, the risk of BCR was significantly higher above a threshold of 90 days (P=0.039). No threshold was found for Gleason 6(3+3) patients. A 90-day threshold was found for Gleason 7(3+4) patients (P=0.038). Gleason patients≥8 had more upgrading beyond a 60-day threshold (P=0.040).
Our study showed that after a 3 months delay, the risk of BCR was significantly higher for localized prostate cancer. It seemed possible to extend this period for low-risk patients, whereas it seemed necessary to keep it for intermediate-risks and to reduce it to 2 months for high-risks.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2018 Jun 12 [Epub ahead of print]
M E Meunier, Y Neuzillet, C Radulescu, C Cherbonnier, J-M Hervé, M Rouanne, V Molinié, T Lebret
Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France., Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France. Electronic address: ., Service d'anatomopathologie, hôpital Foch, 92151 Suresnes, France., Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France., Service d'anatomopathologie, centre hospitalier de Martinique, 93232 Le Lamentin, France.