Is a Treatment Delay in Radical Prostatectomy Safe in Individuals with Low-Risk Prostate Cancer?

Introduction. Many patients diagnosed with localized prostate cancer (PCa) are presented with several treatment modalities, which may require time to understand these options before making an informed decision regarding treatment. Aim. The aim of this study was to compare the effect of radical prostatectomy (RP) delay on postoperative functional outcomes and mortality in a North American population-based cohort. Methods. Overall, 17,153 men treated with RP for non-metastatic clinical stage T1-2, low-grade PCa between years 1995 and 2005 within the U.S. Surveillance, Epidemiology, and End Results Medicare-linked database were abstracted. Main Outcome Measures. The effect of treatment delay (from PCa diagnosis to RP of >3 months) on pathological upstaging at surgery (≥pT3) and postoperative functional outcomes (urinary incontinence and erectile dysfunction) was examined using logistic regression analyses. The 10-year PCa mortality rates were computed using cumulative incidence rates. Results. Overall, 2,576 (15%) patients underwent RP>3 months after diagnosis. A treatment delay of >3 months was associated with a 24% and 33% higher rate of erectile dysfunction diagnosis and procedure, respectively (both P≤0.001). Treatment delay was also associated with 6% higher rate of urinary incontinence procedure (P=0.01). Furthermore, a dose-response effect was detected with respect to increasing durations of RP delay (≤3 vs. 3-5 vs. 5-9 vs. ≥9 months) the rates of erectile dysfunction and urinary incontinence diagnoses/procedures. Treatment delay was not associated with pathological upstaging and PCa mortality. Conclusions. Customarily, the timing of RP following biopsy is dictated by tumor aggressiveness. In general, patients with more unfavorable characteristics are operated sooner. This may obliterate the potential detriments of delayed RP. The treatment delay between biopsy and RP may result in more extensive periprostatic tissue resection and may adversely affect postoperative continence and erectile function.