Abstract
There is a lack of data evaluating the association of surgical delay time (SDT) with outcomes in patients with localized, high-risk prostate cancer. To investigate the association of SDT of radical prostatectomy and final pathological and survival outcomes. This cohort study used data from the US National Cancer Database (NCDB) and identified all patients with clinically localized (cT1-2cN0cM0) high-risk prostate adenocarcinoma diagnosed between 2006 and 2016 who underwent radical prostatectomy. Data analyses were performed from April 1 to April 12, 2020. SDT was defined as the number of days between the initial cancer diagnosis and radical prostatectomy. SDT was categorized into 5 groups: 31 to 60, 61 to 90, 91 to 120, 121 to 150, and 151 to 180 days. The primary outcomes were predetermined as adverse pathological outcomes after radical prostatectomy, including pT3-T4 disease, pN-positive disease, and positive surgical margin. The adverse pathological score (APS) was defined as an accumulated score of the 3 outcomes (0-3). An APS of 2 or higher was considered a separate outcome to capture cases with more aggressive pathological features. The secondary outcome was overall survival. Of the 32 184 patients included in the study, the median (interquartile range) age was 64 (59-68) years, and 25 548 (79.4%) were non-Hispanic White. Compared with an SDT of 31 to 60 days, longer SDTs were not associated with higher risks of having any adverse pathological outcomes (odds ratio [OR], 0.95; 95% CI, 0.80-1.12; P = .53), pT3-T4 disease (OR, 0.99; 95% CI, 0.83-1.17; P = .87), pN-positive disease (OR, 0.79; 95% CI, 0.59-1.06; P = .12), positive surgical margin (OR, 0.88; 95% CI, 0.74-1.05; P = .17), or APS greater than or equal to 2 (OR, 0.90; 95% CI, 0.74-1.05; P = .17). Longer SDT was also not associated with worse overall survival (for SDT of 151-180 days, hazard ratio, 1.12; 95% CI, 0.79-1.59, P = .53). Subgroup analyses performed for patients with very high-risk disease (primary Gleason score 5) and sensitivity analyses with SDT considered as a continuous variable yielded similar results. In this cohort study of patients who underwent radical prostatectomy within 180 days of diagnosis for high-risk prostate cancer, radical prostatectomy for high-risk prostate cancer could be safely delayed up to 6 months after diagnosis.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on individual patients and the modern practice of health care globally.[1]
Compared with an surgical delay time (SDT) of 31 to 60 days, longer SDTs were not associated with higher risks of having any adverse pathological outcomes, pT3-T4 disease (OR, 0.99; 95% CI, 0.83-1.17; P = .87), pN-positive disease (OR, 0.79; 95% CI, 0.59-1.06; P = .12), positive surgical margin (OR, 0.88; 95% CI, 0.74-1.05; P = .17), or adverse pathological score (APS) greater than or equal to 2 (OR, 0.90; 95% CI, 0.74-1.05; P = .17)
Longer SDT was not associated with worse overall survival
Summary
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on individual patients and the modern practice of health care globally.[1] Cancer care has become more complex, as clinicians and patients must balance concerns regarding COVID-19 exposure and resource allocation against cancer progression and patient anxiety.[2,3] Counseling surrounding the topic of surgical timing is of utmost importance. On the basis of a single institutional study,[5] the National Comprehensive Cancer Network (NCCN) released guidelines regarding the management of prostate cancer during the pandemic, stating that patients with unfavorable intermediate-risk to very-high-risk disease can safely delay further workup, staging, and definitive treatment up to 6 months. There are some other recommendations regarding delaying surgery for prostate cancer during COVID-19 pandemic published in the literature, but the evidence behind those recommendations was generally limited[2,6,7]
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