Delaying Prostate Cancer Surgery Safe in Low-Risk Patients

Researchers find no increased risk of adverse pathologic outcomes among men who put off radical prostatectomy for up to 12 months.
Researchers find no increased risk of adverse pathologic outcomes among men who put off radical prostatectomy for up to 12 months.

Men with low-risk prostate cancer (PCa) in the United States can delay undergoing radical prostatectomy (RP) for up to 12 months after their cancer diagnosis without experiencing an increased risk of adverse of pathologic outcomes, according to a new study.

“Men may safely use the time following their initial biopsy to consider management options and obtain a restaging biopsy, if recommended,” researchers concluded in Urologic Oncology: Seminars and Original Investigations (published online ahead of print).

The study also found that approximately half of men with low-risk PCa experience an adverse pathologic outcome at RP.

A team at the University of Chicago led by Scott E. Eggener, MD, analyzed data from the National Cancer Database in 2010 and 2011 on 17,943 patients with low-risk PCa who underwent RP. They identified patients who delayed RP by more than 6 months after cancer diagnosis and measured the effect of delayed RP on pathologic upgrading, upstaging, nodal metastases, and positive surgical margins.

Dr. Eggener's group reported that 16,818 patients underwent RP within 6 months or less, whereas 894 had RP at 6– 9 months, 169 at 9–12 months, and 62 at more than 12 months from their diagnostic biopsy. Upgrading, upstaging, and nodal metastases occurred in 45% of men. 

In multivariable analysis, higher PSA level, more than 2 positive biopsy cores, 34% or more positive biopsy cores, time from biopsy more than 12 months, and black race each independently and significantly increased the composite risk of adverse pathology.

Compared with patients who had a PSA level of 0.1–2.4 ng/mL, those with a level of 4.1–9.9 ng/mL had an 87% increased odds of adverse pathology. The presence of more than 2 positive biopsy cores and 34% or more positive biopsy cores were associated with 68% and 28% increased odds, respectively. 

Black race was associated with 16% increased odds compared with whites.

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