Delayed Radical Prostatectomy is Not Associated with Adverse Oncologic Outcomes: Implications for Men Experiencing Surgical Delay Due to the COVID-19 Pandemic.

Abstract

The 2019 novel Coronavirus (COVID-19) pandemic has forced many health care organizations to divert efforts and resources to emergent patient care, delaying many elective oncologic surgeries. We investigated an association between delay in radical prostatectomy and oncologic outcomes. This is a retrospective review of men with intermediate and high risk prostate cancer in the National Cancer Database undergoing radical prostatectomy from 2010 to 2016. Immediate radical prostatectomy was defined as radical prostatectomy within 3 months of diagnosis, while delayed radical prostatectomy was analyzed in 3-month intervals up to 12 months. Multivariable logistic regression models were fit to test for associations between levels of delayed radical prostatectomy and outcomes of interest (adverse pathology, upgrading on radical prostatectomy, node positive disease and post-radical prostatectomy secondary treatments) compared with men undergoing immediate radical prostatectomy. We identified 128,062 men with intermediate and high risk prostate cancer treated with radical prostatectomy. After adjustment, we did not appreciate a significant difference in odds of adverse pathology, upgrading, node positive disease or post-radical prostatectomy secondary treatments between men treated with immediate radical prostatectomy and any level of delay up to 12 months. Subgroup analysis of men with Grade Group 4 and 5 prostate cancer did not demonstrate an association between delayed radical prostatectomy and worse oncologic outcomes. In the National Cancer Database delayed radical prostatectomy was not associated with early adverse oncologic outcomes at radical prostatectomy. These results may provide reassurance to patients and urologists balancing care in the current pandemic.