Impact of surgical waiting list on oncological outcomes of radical prostatectomy in patients with intermediate- and high-risk prostate cancer.

INTRODUCTION

The prognosis of localized prostate cancer (PCa) following radical treatment is generally favorable, although up to 46% of patients may still experience adverse outcomes. The impact of delayed surgery in intermediate-risk (IR) or high-risk (HR) patients remains under discussion. This study evaluates its association with oncological outcomes.

MATERIALS AND

METHODS

Retrospective study of 2296 patients with IR and HR PCa who underwent radical prostatectomy (RP) between 1986 and 2025. Upgrading, upstaging, positive margins, PSA persistence, and lymph node involvement were analyzed. Waiting time was grouped into <3, 3-6, and >6 months.

RESULTS

The median waiting time was 3.5 months. Eighty-five percent of patients were operated on within 6 months. At 5 years, no difference was detected between waiting time and time to biochemical recurrence (BCR) when comparing the <3-month group with the 3-6-month group (HR 0.93; 95% CI 0.76-1.13) and the >6 months group (HR 0.74; 95% CI 0.53-1.04) among IR patients. In HR patients, no differences were observed either: 3-6 months (HR 0.85; 95% CI 0.71-1.01) and >6 months (HR 0.79; 95% CI 0.61-1.03). No increased risk of adverse pathological outcomes was found with longer delays.

CONCLUSIONS

A waiting time of ≤6 months was not associated with worse oncological prognosis, supporting its safety in IR or HR PCa.