Influencia de la demora quirúrgica en los hallazgos patológicos y el pronóstico de los pacientes con cáncer de próstata

Abstract

Purpose To determine if a delay between prostate biopsy (PB) and radical prostatectomy (RP) has an impact on pathological findings and prognosis of prostate cancer patients (PCa). Material and methods Patients (n = 232) who underwent RP, with at least two postoperative PSA readings. Design: retrospective observational cohort study. Period: May 2000 – March 2007. Delay was defined as time in months between PB and RP. Statistical analysis: delay was analysed as a continuous variable or else categorised according to the median (6 months). A multivariate logistic regression analysis was performed to define variables associated with extracapsular disease. Biochemical recurrence-free survival (BRFS) was studied using the Kaplan-Meier method and multivariate Cox proportional hazards analysis. Results Differences between delay groups ≤ and > 6 months were significant only with regards to age (p = 0.041), considering both groups as comparable. Differences between groups related to pathological variables were not observed in any case. Mean followup was not significantly different between both groups (p = 0.112). The probability of extracapsular disease varied significantly depending on PSA, biopsy Gleason score and the percentage of positive cores, while multivariate analysis found no relationship with delay. Biochemical relapse was detected in 39 cases (16.81%). BRFS in delay ≤ 6 months group was 86.1%, 78.4%, 78.4% and 78.4% at 1, 2, 5 and 7 years, while BRFS in delay > 6 months group was 88.9%, 82.8%, 77.4%, 77.4% and 77.4% at 1, 2, 5 and 7 years (p = 0.632). Delay was not associated with BRFS in multivariate analysis; only the percentage of positive cores independently predicted BRFS. In patients with high-grade PCa, percentage of positive cores was the only independent variable to predict extracapsular disease and BRFS. Delay was not associated with extracapsular disease or BRFS. Conclusions Reasonable surgical delay does not cause a significant negative impact on pathological findings of RP specimens, nor in the BRFS of patients with localized PCa.