Open Access

ARTICLE

Does prolonging the time to prostate cancer surgery impact long-term cancer control: a systematic review of the literature

Fred Saad¹, Antonio Finelli², George Dranitsaris³, Larry Goldenberg⁴, Scott Bagnell⁵, Martin Gleave⁴, Neil Fleshner²

1 University of Montreal, CHUM, Hôpital Notre-Dame, Montreal, Quebec, Canada
2 University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
3 Outcomes Research Consultant, Toronto, Ontario, Canada
4 University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
5 Saint John Regional Hospital, Saint John, New Brunswick, Canada
Address correspondence to Dr. Fred Saad, CHUM/Hôpital Notre-Dame, 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1 Canada

Canadian Journal of Urology 2006, 13(Suppl.3), 16-24.

Abstract

Background: The wait times for prostate cancer surgery in Canada have increased over the past 2 decades. Prolonged wait times have a negative impact on patient quality of life but the effect on long-term cancer control is undefined. We conducted a systematic literature review to examine the best available evidence addressing the following key questions:
• What is the reported time interval for prostate cancer patients from the decision to operate until the day of cancer surgery?
• Are there recommendations/guidelines in the urological cancer literature and, if so, how do the Canadian times compare?
• Is there a known association between duration of wait time beyond the recommended standard and clinical outcome (i.e. recurrence-free survival, overall survival)?
Methods: A structured literature search of Medline, PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of Reviews of Effects, Healthstar and Google Scholar was performed from January 1980 to January 2006 for published epidemiological studies and international guidelines/consensus documents that evaluated surgical wait times for prostate cancer. Data extracted from eligible studies included median time to prostate cancer surgery from the point of patient contact and adjusted hazard ratios (HR) for wait times. All HR from the included studies were examined for the possibility of statistical pooling via meta-analytic techniques.
Results: Thirteen studies evaluating wait times for prostate cancer were identified, six of which measured the HR for prostate-specific antigen (PSA) recurrence in patients with prolonged wait times. Differences in study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings. Median wait times from various points of patient contact ranged from 42 days to 244 days. In the six Canadian studies identified, wait times ranged from 42 days (consultation to operation) to 83 days (consultation to hospital admission). This was in contrast to national and international guidelines, which recommended a maximum wait time for prostatectomy between 2 to 4 weeks. The association between surgical delay and disease recurrence remained controversial where only two of six epidemiological studies reported at least a statistical trend for an increased risk of PSA recurrence-free survival in patients with surgical delays of 3 months or more.
Conclusions: Unlike comparable countries, surgical wait times in Canada appear to be increasing and are well beyond the threshold recommended by national and international expert bodies. Even though the association between surgical delay and disease recurrence remains unclear, there is an ongoing concern that the psychological impact of prolonged waiting could negatively impact patient outcomes. To address these important issues, the surgical wait times (SWAT) initiative is mandated to provide the necessary guidance and recommendations to the federal and provincial governments. Through a partnership of the key stakeholders, it is the vision of SWAT to ultimately improve the care and quality of life of prostate cancer patients and their families.

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