PD30-06 ASSESSING THE ROLE OF TIME FROM PROSTATE CANCER DIAGNOSIS TO RADICAL PROSTATECTOMY: CAN SURGERY BE POSTPONED SAFELY?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2016PD30-06 ASSESSING THE ROLE OF TIME FROM PROSTATE CANCER DIAGNOSIS TO RADICAL PROSTATECTOMY: CAN SURGERY BE POSTPONED SAFELY? Vito Cucchiara, Nicola Fossati, Nazareno Suardi, Andrea Gallina, Armando Stabile, Marta Picozzi, Emanuele Zaffuto, Giorgio Gandaglia, Paolo Dell’Oglio, Alessandro Larcher, Andrea Salonia, Francesco Montorsi, and Alberto Briganti Vito CucchiaraVito Cucchiara More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Armando StabileArmando Stabile More articles by this author , Marta PicozziMarta Picozzi More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Paolo Dell’OglioPaolo Dell’Oglio More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.537AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of time elapsed from prostate cancer (PCa) diagnosis to radical prostatectomy (RP) on cancer control remains controversial. We hypothesized that time from biopsy to surgery is significantly associated with an increased risk of biochemical recurrence (BCR) and clinical recurrence (CR) after RP METHODS The study included 2,767 patients treated with RP between 2000 and 2015. The evaluated outcomes were BCR and CR. Biochemical recurrence was defined as two consecutive PSA values ≥0.2ng/ml. Clinical recurrence was defined as positive imaging during follow-up after the onset of BCR. Multivariable Cox regression analysis was used to test the association between time from biopsy to RP and oncologic outcomes (namely, BCR and CR). Covariates consisted of PSA level at diagnosis, clinical stage (T1 vs. T2 vs. T3), biopsy Gleason score (≤6 vs. 7 vs. ≥8), and percentage of positive cores. Multivariable locally weighted scatter plot smoothing (st-lowess) methods were used to graphically explore the relationship between time from biopsy to RP and oncologic outcomes. Sensitivity analyses were repeated in the sub-group of low-, intermediate-, and high-risk patients, according to D'Amico classification RESULTS At median follow-up of 56 months (inter-quartile range [IQR]: 26, 92), 283 (10%) patients experienced BCR, and 84 (3.0%) patients developed clinical recurrence. Median time from PCa diagnosis to surgery was 2.8 months (1.6, 4.7). At multivariable Cox regression analysis, time from biopsy to RP was significantly associated with an increased risk of BCR (HR: 1.02; 95% CI: 1.01, 1.03; p=0.0005) and CR (HR: 1.03; 95% CI: 1.01, 1.04; p=0.0002), after adjusting for all covariates. Using st-lowess methods, a significant increased risk of BCR and CR after approximately 18 months from biopsy to RP was observed. However, when sensitivity analyses were repeated according to risk-groups, this effect was maintained in high-risk patients only, where such time interval was reduced to 12 months (Figure 1). CONCLUSIONS Despite the overall trend on higher rate of cancer relapse after RP, the effect of treatment delay from biopsy to RP was significantly evident in high-risk patients only. Even in high-risk patients surgical treatment can be postponed safely, but not beyond the 12-month landmark © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e713-e714 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Vito Cucchiara More articles by this author Nicola Fossati More articles by this author Nazareno Suardi More articles by this author Andrea Gallina More articles by this author Armando Stabile More articles by this author Marta Picozzi More articles by this author Emanuele Zaffuto More articles by this author Giorgio Gandaglia More articles by this author Paolo Dell’Oglio More articles by this author Alessandro Larcher More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...