How Long Can Surgery for High-Risk Prostate Cancer Be Safely Delayed?

Prostate cancer surgery for patients with high-risk disease can be safely delayed up to six months following diagnosis, according to a new study published in JAMA Network Open.

The COVID-19 pandemic has resulted in widespread delays in medical treatments, including for cancer. Delays in surgery for low-risk prostate cancer has been found to result in minimal harm to the patient. However, there is a lack of data regarding the association between surgical delay time (SDT) with clinical outcomes in patients with localized, high-risk prostate cancer.

For this cohort study, researchers used data from the US National Cancer Database to identify 32,184 patients with clinically localized high-risk prostate adenocarcinoma who were diagnosed between 2006 and 2016 and who received radical prostatectomy, or the removal of the prostate gland and surrounding tissues.

SDT was defined as the number of days between initial cancer diagnosis and prostate cancer surgery, and was categorized into five groups: 31-60, 61-90, 91-120, 121-150, and 151-180 days. The primary outcomes were adverse pathological outcomes following surgery, including pT3-T4 disease, pN-positive disease, and positive surgical margin. The secondary outcome was overall survival.

Compared with an SDT of 31 to 60 days, longer SDTs were not associated with higher risks of any adverse outcomes (odds ratio 0.95; 95% confidence interval [CI] 0.80-1.12; P=0.53). An SDT of 151 to 180 was not associated with worse overall survival (hazard ratio 1.12; 95% CI 0.79-1.59; P=0.53). The researchers also performed subgroup analysis for patients with very high-risk disease and found similar results.

The researchers concluded, “In this large, contemporary cohort study of 32,184 patients with clinically high-risk localized prostate cancer who underwent radical prostatectomy within 180 days of diagnosis, increased SDT was not associated with higher risks of adverse pathological features or lower OS. Radical prostatectomy for high-risk prostate cancer could be safely delayed up to 6 months after diagnosis.”