The impact of treatment delay from diagnosis to prostatectomy on the biochemical recurrence rate.

Abstract

34 Background: In this study, we evaluate the impact of treatment delay on the biochemical recurrence (BCR) rate specifically in patients with NCCN intermediate to high-risk prostate cancer (PCa). Methods: We reviewed our institutional database of patients who underwent radical prostatectomy (RP) between 2004-2014. A validated preoperative nomogram was used to predict the 5-year BCR-free probability. We evaluated the actual risk of BCR (PSA>0.2) stratified by time from diagnosis to treatment controlling for age and preoperative nomogram derived risk of BCR. We did subset analysis in the cohort of NCCN defined intermediate/high-risk categories. Results: A total of 3029 patients met the inclusion criteria. Median age for the entire cohort was 60 years. Median time from diagnosis to treatment was 77 days (IQR 54-110). Median overall follow-up time was 25 months. Group 1 (61.7%) experienced delay of less than 90 days, Group 2 (31.5%) 90-180 days, and Group 3 (6.7%) >180 days. BCR occurred in 9.6%, 9.6%, and 4.9% of patients in Groups 1, 2, and 3 respectively (p=0.08). Out of the entire cohort, 1837 (60.6%) patients had NCCN intermediate or high-risk disease. On cox multivariable analysis, there was no significant difference in risk of BCR stratified by time to RP in the entire cohort as well in the patients with intermediate/high-risk disease (see table). Conclusions: In our cohort of patients, the delay in treatment did not have significant effect on the risk of BCR. While patients with high-risk pathology should receive prompt treatment, our data suggests that patients and urologists have time to obtain genomic or imaging information, seek second opinions or referral for surgery without significantly affecting the BCR. [Table: see text]