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Study: No Need to Rush Surgery for High-Risk Prostate Cancer

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Radical prostatectomy (RP) for high-risk clinically localized prostate cancer (PCa) can be delayed safely for up to 6 months after diagnosis, a finding that could have implications for management planning during the coronavirus 2019 (COVID-19) era, according to investigators.

“Our study adds to the literature regarding the safety window of delaying treatment and patients can be assured that they should take a reasonable amount of time before making the final decision [about definitive management],” investigators concluded in a paper published in JAMA Network Open. “Taking the time to apply thorough patient-centered preference assessments can improve satisfaction with care among patients with localized prostate cancer.”

Using the National Cancer Database, Leilei Xia, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania, and colleagues analyzed data from 32,184 men (median age 64 years; 79.4% non-Hispanic White) who underwent RP for high-risk clinically localized PCa from 2006 to 2016. The study excluded patients who received neoadjuvant androgen deprivation therapy (ADT). The investigators categorized men according to surgical delay time (SDT): 31-60, 61-90, 91-120, 121-150, and 151-180 days.

Compared with an SDT of 31-60 days, an SDT of up to 180 days was not associated with increased risks for adverse pathologic outcomes such as pT3-T4 disease, node-positive disease, and positive surgical margins, Dr Xia’s team reported. In addition, an SDT of up to 180 days was not associated with increased mortality.

“These findings suggest that prostate cancer surgery can be safely delayed up to 6 months and should be considered as low priority compared with other emergent and cancer surgeries when health care resources need to be prioritized during special times, such as the coronavirus disease 2019 pandemic,” the authors wrote.

As far as Dr Xia and colleagues are aware, the study is the largest in the literature specifically evaluating the effect of surgical delay on pathologic outcomes of high-risk PCa, according to the report.

In a study of 128,062 men with intermediate- and high-risk PCa published recently in The Journal of Urology, Kevin B. Ginsburg, MD, of Wayne State University in Detroit, found no significant difference in the odds of adverse oncologic outcomes among men undergoing RP within 3 months of diagnosis and those who delayed RP for up to 12 months. A subgroup analysis of patients with grade group 4 and 5 cancer did not demonstrate an association between delayed RP and worse oncologic outcomes.

References

Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. Surgical delay and pathologic outcomes for clinically localized high-risk prostate cancer. Published online December 8, 2020. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.28320.

Ginsburg KB, Curtis GL, Timar RE, et al. Delayed radical prostatectomy is not associated with adverse oncologic outcomes: Implications for men experiencing surgical delay due to the COVID-19 pandemic. Published online May 1, 2020. J Urol. doi:10.1097/JU.0000000000001089

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