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, Terris MK; SEARCH Database Study Group
Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
J Urol. 2006; 175: 1298-302; discussion 1302-3

• 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 detrimental effects of delaying radical therapy in bladder cancer too long, the effect in prostate cancer treatment is different. Here, the window is open for a longer time, but still begins to close measurably after half a year. The practical advice is to give the patient time enough to evaluate his treatment options and not proceed in a hurry. Then do your job thoroughly.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: aboehle@badschwartau.helios-kliniken.de