The impact of treatment delays on Prostate Cancer (PCa) specific outcomes remains ill-defined. This study investigates the effect of time to treatment on biochemical disease control after prostatectomy.
This retrospective study includes 1,807 patients who received a prostatectomy as a primary treatment at two large tertiary referral centers from 1987 - 2015. Multivariate cox model with restricted cubic spline were used to identify optimal time to receive treatment and estimate the risk of Biochemical recurrence.
Median follow up time of the study was 46 (IQR 18 - 86) months. Time to treatment was subcategorized based on multivariate cubic spline cox model. In multivariate spline model, adjusted for all the pertinent pretreatment variables, inflection point in the risk of biochemical recurrence was observed around 3 month which further increased after 6 months. Based on spline model, time to treatment was then divided into 0-3 months (61.5%), >3-6 months (31.1%) and 6 months (7.4%). In the adjusted cox model, initial delays up to 6 months did not adversely affect the outcome, however, time to treatment >6 month had significantly higher risk of biochemical recurrence, Hazard Ratio = 1.84, 95% CI, 1.30 - 2.60, p < 0.01.
The initial delays up to 6 months in prostate cancer primary treatment may be sustainable without adversely affecting the outcome. However, significant delays beyond 6 months can unfavorably impact biochemical disease control.
Time to treatment can aide clinicians in the decision making of PCa treatment recommendation and educate patients against unintentional treatment delays.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2018 Nov 09 [Epub ahead of print]
Shivanshu Awasthi, Travis Gerke, Jong Y Park, Francis A Asamoah, Vonetta L Williams, Angelina K Fink, Rajesh Balkrishnan, David I Lee, S Bruce Malkowicz, Priti Lal, Jasreman Dhillon, Julio M Pow-Sang, Timothy R Rebbeck, Kosj Yamoah
Cancer Epidemiology, H.Lee Moffitt Cancer Center., Cancer Epidemiology, Moffitt Cancer Center., Radiation Oncology, H.Lee Moffitt Cancer Center., Collaborative Data Services Core, H. Lee Moffitt Cancer Center., University of Virginia., Medicine, University of Pennsylvania., University of Pennsylvania and Veterans Affairs Medical Center., Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania., Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute., Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute., Dana-Farber Cancer Institute., Cancer Epidemiology, Radiation Oncology, H.Lee Moffitt Cancer Center .