The objective of this study is to compare the early oncological outcomes of delayed (>90 days) versus scheduled (≤90 days) radical prostatectomy (RP).
Patients with prostate cancer due to undergo surgery between March 2020 and June 2020 who were enrolled in the COVIDSurg-Cancer international, observational study were prospectively followed up for 1 year. Time to surgery was defined as the difference between the operation date and the multi-disciplinary team decision to offer surgery. The primary outcome was the positive surgical margin (PSM) rate. Biochemical recurrence (BCR), upgradation and upstaging were secondary oncological outcomes. The Independent t-test and Mann Whitney U test were used to compare means between groups and regression models and were used to investigate factors associated with the primary outcome.
Four hundred seventy-six (78.7%) patients underwent RP from 605 that were eligible. Three hundred seven (64.5%) patients underwent scheduled RP, and 169 (35.5%) underwent delayed RP. A small proportion of men (n = 35, 6.8%) did not undergo RP within the 1-year follow-up period. More men with high-risk disease (72.8%) underwent scheduled RP compared to men with intermediate-risk disease (60.2%) (p < 0.05). There was no statistically significant difference in the PSM rate between the two groups (p = 0.512). Delay in surgery was not associated with an increased PSM or BCR on univariable or multivariable analyses. There was statistically significantly greater upstaging (p < 0.05) in the delayed group but no difference in upgradation.
High-risk men were prioritised for surgery during the COVID-19 pandemic. Our prospective data support previous retrospective, cancer-registry evidence suggesting no adverse oncological impact after delaying RP across all risk groups. Our study is limited by the short follow-up period, and therefore, longer term conclusions cannot be drawn.
BJUI compass. 2024 Oct 17*** epublish ***
Arjun Nathan, Chuanyu Gao, Alexander Light, Cameron Alexander, Vinson Chan, Kevin Gallagher, Sinan Khadhouri, Kevin G Byrnes, Michael Ng, Michael Walters, Terry Hughes, Rita J Perry, Kelvin Okoth, Laura Magill, Thomas Pinkney, Yuhao Zhang, James Blackmur, Eric Etchill, Stanley Tang, Damián García Escudero, Alan McNeill, Krishna Narahari, Grant D Stewart, Veeru Kasivisvanathan, COVIDSurg Collaborative
Division of Surgery and Interventional Sciences University College London London UK., British Urology Researchers in Surgical Training (BURST) Research Collaborative London UK., Urology Department Royal Devon and Exeter NHS Foundation Trust Exeter UK., Birmingham Centre for Observational and Prospective Studies Birmingham UK., Stepping Hill Hospital, Stockport NHS Foundation Trust Stockport UK., Department of Urology Addenbrooke's Hospital Cambridge UK., Johns Hopkins Hospital Baltimore Maryland USA., Hospital General Reina Sofía Murcia Spain., Department of Urology NHS Lothian Edinburgh UK., University Hospital of Wales Cardiff and Vale University Health Board Cardiff UK., Department of Surgery University of Cambridge Cambridge UK.