Do COVID-19 Related Prostate Cancer Treatment Delays Impact Oncological Outcomes?
DELAYS in nonemergent surgery for prostate cancer (PC), as a result of the coronavirus 2019 (COVID-19) pandemic, have been shown to not adversely affect oncological outcomes according to results from a large European cohort.
Currently, COVID-19 is transforming urological practice with most urological societies recommending the deferral of any surgical treatment for patients with PC. Because it is not clear whether a delay between diagnosis and surgical management may impose a disadvantageous effect on oncologic outcomes of these patients, researchers at Université Libre de Bruxelles, Brussels, Belgium, aimed to assess the impact of such surgical delay.
The study recruited 926 males undergoing radical prostatectomy for intermediate- and high-risk PC across Europe. Using multivariable analysis the association between surgical delay and upgrading on final pathology, lymph-node invasion, pathological locally advanced disease, need for adjuvant therapy, and biochemical recurrence was tested and Kaplan–Meier analysis was used to estimate biochemical recurrence-free survival after surgery as a function of surgical delay using a 3 month cut-off.
The median surgical delay was 2.8 months for the patients with high-risk disease and significantly shorter than those with intermediate-risk disease (3.5 months). Results found no association between surgical delay and the aforementioned variables; furthermore, no significant association was made between surgery delay and biochemical recurrence across the entire population and within the risk groups. Dr Diamand, Université Libre de Bruxelles, commented: “Our data support a safely deferred approach for PC patients awaiting surgery in this time of COVID-19 pandemic.”
Although the study was limited by potential bias because of the retrospective nature of the analysis, Dr Diamand emphasised that: “One must bear in mind that designing a prospective trial postponing treatment of oncologic patients is technically and ethically impossible.” Importantly, most patients underwent surgery within a 3-month period and therefore, the researches urge that “care must be taken to the interpretation of our results for longer treatment delays.” Ultimately, these findings provide reassurance to patients and urologists during this pandemic and suggest that PC treatment delays may not have worse oncologic outcomes.