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Impact of Surgical Waiting List on Oncological Outcomes of Radical Prostatectomy in Patients with Intermediate- and High-Risk Prostate Cancer - Beyond the Abstract

Surgical waiting time remains a major source of concern for both clinicians and patients with intermediate- and high-risk prostate cancer. In health systems under increasing pressure, delays are often unavoidable, raising an essential question: Does waiting compromise oncological outcomes, or can radical prostatectomy be safely deferred within a reasonable timeframe?

In this large retrospective cohort of 2,296 patients treated with radical prostatectomy over nearly four decades, we evaluated the impact of surgical waiting time on key oncological endpoints. Patients were stratified according to delay from biopsy to surgery (<3 months, 3–6 months, and >6 months), and outcomes were analyzed separately for intermediate- and high-risk disease. The primary endpoint was time to biochemical recurrence, with secondary analyses including adverse pathological features such as upgrading, upstaging, positive surgical margins, PSA persistence, and lymph node involvement.

Our results demonstrate that a waiting time of up to six months was not associated with an increased risk of biochemical recurrence in either risk group. At five years, intermediate-risk patients showed no difference in biochemical recurrence when comparing surgery within <3 months to 3–6 months (HR 0.93; 95% CI 0.76–1.13) or >6 months (HR 0.74; 95% CI 0.53–1.04). Similarly, in high-risk patients, no significant differences were observed for delays of 3–6 months (HR 0.85; 95% CI 0.71–1.01) or >6 months (HR 0.79; 95% CI 0.61–1.03). Importantly, longer waiting times were not associated with higher rates of upgrading, upstaging, positive surgical margins, PSA persistence, or lymph node involvement.

These findings provide clinically meaningful reassurance in daily practice. Beyond oncological safety, they support a more balanced approach to surgical scheduling, allowing clinicians to optimize resources while reducing patient anxiety associated with unavoidable waiting periods. In the context of shared decision-making, our data reinforce the message that, for selected patients with intermediate- and high-risk prostate cancer, a reasonable delay to surgery can be safe without compromising long-term oncological control.

Written by: P. de Pablos-Rodríguez,1 P. Guedes Oliva,2 Á. Gómez Ferrer,1 M. Beamud Cortés,1 A. Wong Gutiérrez,1 C. Gutiérrez Castañé,1 A. Calatrava Fons,3 J. Aliaga Patiño,3 Á. García Cortés,1 J. Agustín López,1 A. Collado Serra,1 V. Rodríguez Part,1 J. L. Casanova Ramón Borja1

  1. Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain. 
  2. Departamento de Urología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.
  3. Departamento de Anatomía Patológica, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
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