Pathologic outcomes for low-risk prostate cancer after delayed radical prostatectomy in the United States

Abstract

Objectives: To measure adverse pathologic outcomes following radical prostatectomy (RP) for men with low-risk prostate cancer in the United States based on time from diagnosis to surgery.

Methods: We extracted data from the National Cancer Database in 2010 and 2011 on 17,943 low-risk patients (Gleason score = 3+3, prostate-specific antigen < 10 ng/ml, and cT1-T2) who underwent RP. We identified men who delayed RP by>6 months after diagnosis and measured the effect of delayed RP on pathologic upgrading, upstaging, nodal metastases, and positive surgical margins.

Results: Overall, 16,818 underwent RP ≤ 6 months, 894 at 6 to 9 months, 169 at 9 to 12 months, and 62 at>12 months from diagnostic biopsy. Furthermore, upgrading occurred in 43%, upstaging in 9%, positive surgical margins in 16%, and nodal metastases in 0.3% of men. Upgrading, upstaging, or nodal metastases occurred in 45% of men. On multivariable analysis, higher prostate-specific antigen (4.1-9.9 ng/ml vs. 0.1-2.4 ng/ml; odds ratio [OR] = 1.87, 95% CI: 1.66-2.10),>2 positive biopsy cores (OR = 1.68, 95% CI: 1.57-1.81), ≥ 34% positive biopsy cores (OR = 1.28, 95% CI: 1.18-1.39), black race (OR = 1.16, 95% CI: 1.05-1.28), and time from biopsy to RP>12 months (vs. ≤ 6 mo: OR = 1.70, 95% CI: 1.01-2.84) each independently increased the composite risk of adverse pathology (all P< 0.05).

Conclusion: In the United States, nearly half of men with low-risk prostate cancer experience at least one adverse pathologic outcome at RP. Delaying RP up to 12 months did not change the risk of adverse pathology. Men may safely use the time following their initial biopsy to consider management options and obtain a restaging biopsy, if recommended.

Keywords: Active Surveillance; Pathology; Prostatic neoplasms; Radical prostatectomy; United States/epidemiology; Watchful waiting.