Evaluating the Safety of Delaying Surgery Beyond 9 Months in Localized Prostate Cancer Patients: Results From a Prospective Study With Propensity Score Matching.

OBJECTIVES

The optimal timing of radical prostatectomy (RP) after prostate cancer diagnosis is controversial, particularly concerning the impact of surgical delays on oncological outcomes. While active surveillance is standard for low-risk prostate cancer, the effects of delaying surgery in intermediate- and high-risk patients are less clear. We aimed to evaluate the impact of surgical delays exceeding 9 months on pathological outcomes: upstaging (pT ≥ 3a), upgrading (ISUP ≥ 4) and biochemical recurrence (BCR) in patients undergoing RP with a localized disease.

METHODS

A prospective cohort study was conducted across four French academic hospitals between June 2013 and June 2021, including consecutive patients scheduled for RP according to established clinical guidelines. A 9-month surgical delay threshold between prostate biopsies and surgery was chosen. The primary endpoint was BCR rates while secondary endpoints included International Society of Urological Pathology (≥ ISUP 4) upgrading and ≥ pT3a upstaging. A propensity score was used to homogenize PSA levels, biopsy ISUP, and D'Amico risk categories between both populations.

RESULTS

After propensity score matching, 881 patients were analyzed, with a median surgical delay of 3.5 months IQR (2.6-4.6). After a median follow-up of 48.0 months IQR (25.0-60.0), BCR occurred in 156 patients (17.7%). Delaying surgery of more than 9 months was not significantly associated with worse BCR-free survival in patients with PSA < 20 ng/mL and ISUP grade < 4 (D'Amico low to intermediate high). Upgrading (ISUP ≥ 4) and/or upstaging (≥ pT3a) occurred in 35% of patients, but was not impacted by a surgical delay of more than 9 months in the multivariate model.

CONCLUSION

Delaying surgery over 9 months does not seem to adversely impact pathological outcomes and BCR rates in nonhigh-risk patients undergoing RP for localized prostate cancer.

TRIAL REGISTRATION: NCT02235142.