Open Access

ARTICLE

Delay in surgical therapy for clinically localized prostate cancer and biochemical recurrence after radical prostatectomy

Robert K. Nam¹, Michael A. S. Jewett¹, Murray D. Krahn², Michael A. Robinette¹, John Tsihlias¹, Ants Toi³, Minnie Ho¹, Andrew Evans⁴, Joan Sweet⁴, John Trachtenberg¹

1 Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
2 General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
3 Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
4 Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Address correspondence Dr. Robert K. Nam, Division of Urology, Sunnybrook and Women’s College Health Sciences Centre, 2075 Bayview Ave., Rm MG-406, Toronto, Ontario, M4N 3M5 Canada

Canadian Journal of Urology 2003, 10(3), 1891-1898.

Abstract

Background: In Canada, waiting times for cancer care have been increasing, particularly for patients with genitourinary malignancies. We examined whether delay from diagnosis for patients undergoing surgery for clinically localized prostate cancer affects cancer cure rates.
Methods: We conducted a historical cohort study among 645 patients who underwent radical prostatectomy between 1987 and 1997, using biochemical recurrence (PSA elevation) and metastasis as endpoints. We examined whether patients who underwent surgery ≥3 months (delayed surgery group) from the date of diagnosis had reduced recurrence-free survival, compared to patients who had surgery <3 months (early surgery group) from the date of diagnosis, adjusting for grade, stage and PSA level at diagnosis.
Results: The crude 10-year recurrence-free and metastasis-free survival rates for all patients were 71.1% (95% CI: 64.9%-77.3%) and 95.3% (95% CI: 91.3%-99.3%), respectively. Of the 645 patients, 189 (29.3%) had surgery ≥3 months after diagnosis. The median time from the date of diagnosis to surgery was 68 days (range 15 to 951 days). The 10-year recurrence-free survival was higher for patients who underwent early surgery (74.6%, 95% CI: 67.9%-81.4%) compared to patients in the delayed surgery group (61.3%, 95% CI: 46.7%-76.0%, p=0.05). The crude and adjusted hazard ratios for developing biochemical recurrence for patients in the delayed surgery group were 1.58 (95% CI: 1.0-2.4, p=0.04) and 1.46 (95% CI: 0.9-2.3, p=0.09), respectively, compared to patients who underwent early surgery.
Conclusions: There may exist a possible relationship between delays from diagnosis for radical prostatectomy and prostate cancer cure rates. These findings may have many biases that could not be properly accounted in this retrospective analysis and larger cohort analyses will be required to confirm these findings.

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