Delaying Radical Surgery for Low-Risk Prostate Cancer Could Worsen Outcomes

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SAN FRANCISCO—Men with low-risk prostate cancer who delay undergoing radical prostatectomy (RP) for six months or more after diagnosis may have worse outcomes post-operatively than those who undergo RP within six months, according to researchers. These worse outcomes include an increased risk of biochemical recurrence.

Gustavo Carvalhal, MD, of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues studied 1,111 men who had low-risk prostate cancer as defined by D'Amico criteria (clinical stage T1c/T2a, PSA less than 10 ng/mL, and biopsy Gleason score of 6 or less. Of these patients, 59 patients delayed RP for six months or more and 1,052 did not.

After five years of follow-up, biochemical recurrence occurred in 12% of the delayed surgery group compared with 5% of the patients who had surgery within six months, a difference that translated into 2.9 times increased risk of biochemical recurrence in the delayed-surgery group.      

Presenting study findings at the American Urological Association annual meeting, Dr. Carvalhal told listeners that low-risk patients should be counseled that delaying surgery may increase the possibility of worse pathological outcomes and greater biochemical recurrence rates.

Men in the delayed-surgery group were older than the patients in the other group (61 vs. 59 years) and had a higher proportion of African-American patients  and patients with clinical stage T2a (vs. T1) disease.

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