Evaluating the Safety of Delaying Surgery Beyond 9 Months in Localized Prostate Cancer Patients: Results From a Prospective Study With Propensity Score Matching.

[OBJECTIVES] The optimal timing of radical prostatectomy (RP) after prostate cancer diagnosis is controversial, particularly concerning the impact of surgical delays on oncological outcomes. While active surveillance is standard for low-risk prostate cancer, the effects of delaying surgery in intermediate- and high-risk patients are less clear. We aimed to evaluate the impact of surgical delays exceeding 9 months on pathological outcomes: upstaging (pT ≥ 3a), upgrading (ISUP ≥ 4) and biochemical recurrence (BCR) in patients undergoing RP with a localized disease.

[METHODS] A prospective cohort study was conducted across four French academic hospitals between June 2013 and June 2021, including consecutive patients scheduled for RP according to established clinical guidelines. A 9-month surgical delay threshold between prostate biopsies and surgery was chosen. The primary endpoint was BCR rates while secondary endpoints included International Society of Urological Pathology (≥ ISUP 4) upgrading and ≥ pT3a upstaging. A propensity score was used to homogenize PSA levels, biopsy ISUP, and D'Amico risk categories between both populations.

[RESULTS] After propensity score matching, 881 patients were analyzed, with a median surgical delay of 3.5 months IQR (2.6-4.6). After a median follow-up of 48.0 months IQR (25.0-60.0), BCR occurred in 156 patients (17.7%). Delaying surgery of more than 9 months was not significantly associated with worse BCR-free survival in patients with PSA < 20 ng/mL and ISUP grade < 4 (D'Amico low to intermediate high). Upgrading (ISUP ≥ 4) and/or upstaging (≥ pT3a) occurred in 35% of patients, but was not impacted by a surgical delay of more than 9 months in the multivariate model.

[CONCLUSION] Delaying surgery over 9 months does not seem to adversely impact pathological outcomes and BCR rates in nonhigh-risk patients undergoing RP for localized prostate cancer.

[TRIAL REGISTRATION] NCT02235142.