UROLOGICAL ONCOLOGY

Delay of Radical Prostatectomy and Risk of Biochemical Progression in Men with Low Risk Prostate Cancer
Freedland SJ, Kane CJ, Amling CL, Aronson WJ, Presti JC Jr, Terris MK
Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
J Urol. 2006;175: 1298-302

• Purpose: Men newly diagnosed with prostate cancer are faced with multiple treatment options. Understanding these options and their associated side effects, and making a decision often requires time, resulting in a delay before receiving treatment. This is particularly pertinent in men with low risk disease who may be considered candidates for watchful waiting and, thus, may not experience strong pressure to undergo treatment promptly. Whether delays and especially prolonged delays, eg greater than 180 days, before RP negatively impact the disease outcome is unclear.
• Materials and Methods: We examined the association between time from diagnosis to surgery, and pathological features of the RP specimen and risk of biochemical progression in 895 men with low risk prostate cancer (prostate specific antigen less than 10 ng/ml and biopsy Gleason sum 6 or less) treated with RP between 1988 and 2004 in the Shared-Equal Access Regional Cancer Hospital Database using logistic regression and Cox proportional hazards, respectively.
• Results: Time from biopsy to surgery was not significantly related to high grade disease in the RP specimen, positive surgical margins or extraprostatic extension (all p-trend >0.05). After adjustment for multiple clinical covariates a longer time from biopsy to surgery was significantly associated with an increased risk of biochemical progression (p-trend = 0.002). However, this increased risk of progression was only apparent in men with delays greater than 180 days (median 263, vs 90 or fewer days RR 2.73, 95% CI 1.51 to 4.94).
• Conclusions: Our data suggest that patients with low risk prostate cancer can be reassured that immediate treatment is not necessary. Whether long delays (greater than 180 days) decrease the likelihood of curability in some patients requires further study.
  
• Editorial Comment
  In contrast to the recent papers on surgery delay in bladder cancer a delay in radical prostatectomy for prostate cancer does not seem to be of equal consequences.
  In accordance with the slower proliferation time in (most, but not all!) prostate cancers a negative impact of delay was seen in patients with more than 180 days in time to surgery.
  Interestingly, in a subgroup analysis of 27 men there was no significant association between pre-prostatectomy PSA velocity and the risk of progression.
  It is worthwhile to read the 2 editorial comments to this study, which give some comments on the impact these data may have on “wait-and-see” strategies.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany