IMPACT OF SURGICAL DELAY ON LONG-TERM CANCER CONTROL FOR CLINICALLY LOCALIZED PROSTATE CANCER MASOOD A. KHAN, LESLIE A. MANGOLD, JONATHAN I. EPSTEIN, JOHN K. BOITNOTT, PATRICK C. WALSH AND ALAN W. PARTIN* From the Departments of Urology (MAK, LAM, PCW, AWP) and Pathology (JIE, JKB), The James Buchanan Brady Urological Institute and The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland ABSTRACT Purpose: Radical retropubic prostatectomy (RRP) as definitive management for clinically localized prostate cancer is commonly performed within months of diagnosis. Despite patient anxiety there is little evidence to suggest that a delay of several months from diagnosis to RRP is associated with a worse cancer control rate. However, a recent study cast doubt on the safety of such a delay with respect to cancer control. Therefore, in a contemporary series we determined long-term cancer control in men who underwent RRP for clinically localized prostate cancer with some treated early and others treated after a longer delay. Materials and Methods: We analyzed data on 926 men who underwent RRP between January 1989 and December 1994. Age, preoperative serum prostate specific antigen (PSA), biopsy Gleason score, clinical and pathological stage, and biochemical recurrence were compared be- tween 162 men who underwent RRP 60 days or less from biopsy and 764 who underwent RRP after a greater delay. Disease-free (PSA less than 0.2 ng/ml) survival rates were compared using Kaplan-Meier analysis. Pathological staging was compared using logistic regression. Results: The different groups were well matched for age, serum PSA, pathological stage and followup. However, significantly more men who underwent RRP between 121 and 150 days, and 151 days or greater had T1c disease (48% and 57% vs 35%, p 0.04 and 0.0001, respectively). In addition, significantly more men operated on at 151 days or greater had biopsy Gleason scores 2 to 6 (86% vs 65%, p 0.0001) and significantly fewer had Gleason score 7 disease (13% vs 30%, p 0.002). Men who underwent RRP after 60 or less days had 5 and 10-year biochemical disease-free survival rates comparable to those in men who underwent RRP after 61 to 90, 91 to 120 and 121 to 150 days after diagnosis (82% and 78%, 86% and 78%, 86% and 75%, and 86% and 82%, respectively). Those operated on at 151 days or greater had significantly greater 5 and 10-year biochemical disease-free survival rates (89% and 87%, p 0.04). However, when patients were stratified into different subgroups based on clinical stage, serum PSA and biopsy Gleason score a delay of 150 days or greater no longer impacted differently on long-term cancer control rates. Conclusions: Delays of up to several months from prostate cancer diagnosis to RRP do not appear to impact long-term biochemical cancer control rates. Therefore, patients can be reas- sured that there is no immediate urgency to perform RRP after prostate cancer diagnosis, especially in those with T1c disease and biopsy Gleason scores less than 7. KEY WORDS: prostate, prostatectomy, prostatic neoplasms Since the late 1980s, there has been a dramatic change in our approach to the treatment of prostate cancer. The avail- ability of serum prostate specific antigen (PSA) as a marker for prostate cancer diagnosis has resulted in the detection of prostate cancer earlier in its natural history. 1–3 In turn, this has been associated with improved ability to provide defini- tive curative surgical therapy to address this common dis- ease. 4 Accordingly, radical retropubic prostatectomy (RRP) is now routinely offered as an option for the management of clinically localized prostate cancer. Despite the absence of evidence implicating adverse long- term cancer control with a delay in surgery, RRP is com- monly performed within a few months of biopsy diagnosis. This is predominantly to permit patients to seek multiple opinions before making a final decision. However, a recent study of Nam et al cast doubt on the safety of a delay beyond 3 months in maintaining optimal long-term cancer control rates. 5 Therefore, in a contemporary series we determined whether a delay of several months from the time of biopsy diagnosis of prostate cancer and RRP are indeed associated with poor long-term biochemical cancer control rates. MATERIALS AND METHODS Patient population and inclusion criteria. Between Janu- ary 1989 and December 1994, 951 men underwent anatomi- cal RRP with pelvic lymph node dissection for clinically lo- calized adenocarcinoma of the prostate (T1c, T2 or T3a) at our institution, as performed by a single urologist. A total of 926 men (97.4%) were included in the study and 25 (2.6%) were excluded due to the lack of followup in 5 (0.5%), imme- diate adjuvant radiation therapy in 6 (0.6%), preoperative hormonal therapy in 8 (0.9%), immediate adjuvant hormonal Accepted for publication June 25, 2004. Study received internal review board approval. Supported by National Institutes of Health/National Cancer Insti- tute SPORE Grant P50CA58236. * Correspondence: The James Buchanan Brady Urological Insti- tute, The Johns Hopkins Hospital, Jefferson Building, Room 157, 600 North Wolfe St., Baltimore, Maryland 21287-2101 (telephone: 410-614-4876; FAX: 410-614-8096; e-mail: apartin@jhmi.edu). 0022-5347/04/1725-1835/0 Vol. 172, 1835–1839, November 2004 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2004 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000140277.08623.13 1835