Delayed radical prostatectomy due to COVID-19 does not lead to adverse oncologic outcomes

Delays in radical prostatectomy due to the novel coronavirus disease (COVID-19) pandemic does not result in adverse pathology, upgrading, nodal metastasis, or use of postsurgery secondary treatments, according to a recent study.

“In the National Cancer Database (NCDB) delayed radical prostatectomy was not associated with early adverse oncologic outcomes at radical prostatectomy,” the researchers said. “These results may provide reassurance to patients and urologists balancing care in the current pandemic.”

This retrospective review included a total of 128,062 men with intermediate and high-risk prostate cancer in the NCDB undergoing radical prostatectomy from 2010 to 2016. Immediate radical prostatectomy referred to surgery within 3 months of diagnosis; on the other hand, delayed radical prostatectomy was analysed in 3-month intervals up to 12 months.

The researchers used multivariable logistic regression models to test for associations between levels of delayed radical prostatectomy and outcomes of interest (ie, adverse pathology, upgrading on radical prostatectomy, node-positive disease, postsurgery secondary treatments) compared with men undergoing immediate radical prostatectomy.

No significant difference was observed in the likelihood of adverse pathology, upgrading, node-positive disease, and postsurgery secondary outcomes between men treated with immediate radical prostatectomy and any delay up to 12 months after adjustment. [J Urol 2020;204:720-725]

In subgroup analysis, delayed radical prostatectomy was not associated with worse oncologic outcomes in men with grade group 4 and 5 prostate cancer.

“Although [we] do not recommend intentionally delaying radical prostatectomy for intermediate or high-risk prostate cancer, the data presented here suggest that delaying [surgery] involuntarily due to the current global pandemic may not lead to worse oncologic outcomes,” the researchers said.

“While patients may experience distress from delaying curative treatment for prostate cancer, these data may help reduce anxiety in uncertain times,” they added.

Of note, patients undergoing radical prostatectomy usually require hospitalization postoperatively, which puts them at risk for COVID-19 exposure while utilizing critical hospital resources (eg, personnel, beds, masks, etc.) needed for the care of infected patients.

“The potential [for] increased risk of viral exposure could have more detrimental health risks than delaying radical prostatectomy, especially in a prostate cancer population that tends to be older and at elevated risk for COVID-19 related mortality,” the researchers said. [Lancet 2020;395:1054-1062]

On the other hand, literature concerning treatment delay in intermediate- and high-risk disease is divided, with several studies either supporting or refuting the association of worse oncologic outcomes associated with delayed radical prostatectomy. [Prostate 2013;73:409-417; Urol Oncol 2017;35:150.e9-150.e15; Prog Urol 2018;28:475-481; Int Urol Nephrol 2017;49:449-455; BJU Int 2019;124:268-274; BJU Int 2019;124:282-289]

“As the NCDB is estimated to record 70 percent of new cancer diagnoses in the US, our data add to these previously published studies by demonstrating that in a large, contemporary, and nationally representative cohort, we did not appreciate a significant difference in adverse pathology, upgrading, nodal metastasis, and [postsurgery] secondary treatments in men treated with radical prostatectomy up to 12 months after diagnosis compared with men treated within 3 months of diagnosis,” the researchers said. [www.facs.org/quality-programs/cancer/ncdb/about]