Presentation Authors: Natasha Gupta*, Trinity J. Bivalacqua, Misop Han, Michael A. Gorin, Baltimore, MD, Ben J. Challacombe, London, United Kingdom, Alan W. Partin, Mufaddal K. Mamawala, Baltimore, MD
Introduction: The impact of delaying radical prostatectomy (RP) among patients diagnosed with clinically localized prostate cancer (PCa) for whom active surveillance is not an option is unclear. Therefore, we sought to evaluate the impact of length of time from diagnostic biopsy to RP on oncologic outcomes among men diagnosed with unfavorable intermediate to very high-risk PCa.
Methods: We performed a retrospective review of men with a diagnosis of Gleason grade group (GG)â‰¥ 3 PCa on a biopsy who underwent RP within 6 months of diagnosis at our institution between 2005 and 2018. We assessed patient demographics and pre-biopsy disease characteristics. We categorized time between biopsy and RP into two intervals ( < 3 months and 3-6 months). For each GG, we compared receipt of adjuvant therapy, pathological outcomes at RP [positive surgical margin (PSM), extraprostatic extension (EPE), seminal vesicle invasion (SVI), and lymph node involvement (LNI)], risk of 2- and 5-year biochemical recurrence-free survival (BCRFS), and 2-, 5-, and 10-year metastasis-free survival (MFS) between patients who underwent RP < 3 months versus 3-6 months after diagnosis.
Results: Among 2,303 men who met study inclusion criteria, 1,244 (54%) had GG3, 608 (26%) had GG4, and 451 (20%) had GG5 disease. 72% underwent RP < 3 months after diagnosis. For each diagnostic GG, there was no significant difference in rates of adjuvant therapy, PSM, EPE, SVI, or LNI in men who had RP < 3 months versus 3-6 months after diagnosis. 1,568 men had follow-up post-RP for >1 year. For each diagnostic GG, there was no significant difference in 2- and 5-year BCRFS between patients who had RP < 3 months versus 3-6 months after diagnosis (GG3: 78% vs. 83% and 69% vs. 66%, respectively, p=0.6; GG4: 68% vs. 74% and 51% vs. 57%, respectively, p=0.4; GG5: 58% vs. 74% and 48% vs. 54%, respectively, p=0.2). Similarly, for each diagnostic GG, there was no significant difference in 2-, 5-, and 10-year MFS between patients who had RP < 3 months versus 3-6 months after diagnosis, although we were not able to calculate 10-year MFS for patients with GG5 disease due to limited follow-up in that group (GG3: 98%, 92%, and 84% vs. 97%, 95%, and 91%, respectively, p=0.4; GG4: 97%, 90%, and 72% vs. 94%, 91%, and 81%, respectively, p=0.8; GG5: 89% and 81% vs. 91% and 71%, respectively, p = 0.9).
Conclusions: Waiting for RP up to 6 months after diagnosis is not associated with adverse outcomes among patients with unfavorable intermediate-risk to very high-risk PCa.