Excessive waitlists and delays to treatment with low-dose-rate brachytherapy predict an increased risk of recurrence and metastases in intermediate-risk prostatic carcinoma

Rutvij A Khanolkar,Harvey Quon,Kundan Thind,Michael Sia,Michael Roumeliotis,Siraj Husain,Philip Mcgeachy,Tyler Meyer,Kevin Martell

doi:10.1016/j.ctro.2021.06.008

Rutvij A Khanolkar, Harvey Quon + Show 7 more

Open Access

https://doi.org/10.1016/j.ctro.2021.06.008

Copy DOI

Abstract

PurposeIt has previously been shown that increased wait times for prostatectomy are associated with poorer outcomes in intermediate-risk prostatic carcinoma (PCa). However, the impact of wait times on PCa outcomes following low-dose-rate brachytherapy (LDR-BT) are unknown. Methods and MaterialsWe retrospectively reviewed 466 intermediate-risk PCa patients that underwent LDR-BT at a single comprehensive cancer center between 2003 and 2016. Wait times were defined as the time from biopsy to LDR-BT. The association of wait times with outcomes was evaluated using Cox and Fine-Gray regression in both univariate and multivariate models. ResultsMedian (interquartile range) follow-up and wait time for all patients were 8.1 (6.3–10.4) years and 5.1 (3.9–6.9) months, respectively. Among NCCN unfavourable intermediate-risk (UIR) patients (n = 170; 36%), increased wait times predicted both a greater cumulative incidence of recurrence [MHR = 1.01/month of wait time (95% CI: 1.00–1.03); P = 0.044] and metastases [MHR = 1.04/month of wait time (95% CI: 1.02–1.06); P < 0.001] in multivariate modeling. In NCCN favourable intermediate-risk (FIR) patients, there was no significant association between wait time and recurrence or metastases risk. Among all intermediate-risk patients, wait time was associated with an increase in the incidence of metastases [MHR = 1.03/month of wait time (95% CI: 1.02–1.05); P < 0.001], but not recurrence in multivariate models. There was no association between wait time and overall survival in the UIR, FIR, or all intermediate-risk cohorts. ConclusionsResource constraints within this center’s public healthcare system have contributed to waitlists exceeding 5-months in length. This study finds that patients with UIR PCa experience a 1% increase in the risk of recurrence and 4% increase in the risk of metastases with each additional month of delay in definitive disease management. Preventing such extended management delays in LDR-BT may improve disease-related outcomes in patients with PCa.

Highlights

Prostate cancer (PCa) is one of the most commonly diagnosed ma lignant neoplasms in North America [1,2]
The current study aimed to evaluate whether these extremes of wait times for low-dose-rate brachytherapy (LDR-BT) were associated with worse outcomes for patients with intermediate-risk PCa
No statistically significant association was found between increased wait times and overall survival in univariate [UHR = 0.97 (0.93–1.03); p = 0.340] or multivariate [MHR = 0.96 (0.91–1.01); p = 0.126] models

Summary

Introduction

Prostate cancer (PCa) is one of the most commonly diagnosed ma lignant neoplasms in North America [1,2]. The number of patients requiring treatment, and the overall economic burden of prostate cancer, is expected to increase over the decade [3,4,5,6] This is important in resource constrained environments such as the Canadian health care system where an increased incidence of disease often leads to prolonged waitlists for treatment while infrastructure and resources are implemented. These increased wait times could become a source of anxiety for patients and may affect patient outcomes. Some studies suggest short delays to treatment are safe, several other international studies have found that delays in surgical treatment for PCa predict poorer outcomes in patients [10,11,12]

Methods

Results

Conclusion