Clinical Report: Impact of Delaying Radical Prostatectomy in Intermediate-High Risk Prostate Cancer
Overview
This systematic review evaluated the oncological consequences of postponing radical prostatectomy (RP) in men with intermediate- and high-risk prostate cancer (PCa). Evidence suggests that delays up to three months generally do not significantly affect survival or pathologic outcomes, though longer delays may increase risks of disease progression.
Background
The COVID-19 pandemic has disrupted cancer care, leading to substantial reductions in surgical procedures including RP for prostate cancer. While treatment delays in low-risk PCa are often safe due to active surveillance strategies, the impact of deferring surgery in intermediate- and high-risk patients remains unclear. Medical societies have issued guidelines to balance COVID-19 risks with cancer progression risks, emphasizing the need for evidence-based prioritization of surgical interventions. This review systematically assessed survival and pathologic outcomes associated with deferred RP in this patient population.
Data Highlights
Study
Delay Definition
Risk Group
Outcomes Assessed
Key Findings
Most studies (e.g., refs 9,10,20-22)
3 months delay
Intermediate & High risk
Survival, Pathologic outcomes
No significant impact on oncologic outcomes for delays ≤3 months
Filippou et al. (ref 11)
>6 months delay
Mixed risk
Pathologic outcomes
Longer delays associated with worse pathologic features
Patel et al. (ref 12)
Monthly intervals up to 6 months
Intermediate & High risk
Recurrence, Survival
Delays beyond 3 months showed increased risk of recurrence
Westerman et al.
≤3, 4–6, 7–12, 12–26 weeks
Intermediate & High risk
Survival, Pathologic outcomes
Delays >6 months linked to adverse outcomes
Key Findings
Delays in radical prostatectomy up to 3 months generally do not significantly affect survival or pathologic outcomes in intermediate- and high-risk prostate cancer patients.
Longer delays beyond 3 to 6 months may increase the risk of disease progression and adverse pathologic features.
There is heterogeneity in defining treatment delay across studies, with most using 3-month intervals as a cutoff.
Some studies included low-risk patients without separate subgroup analyses, potentially confounding results.
High-level evidence remains limited, and most data derive from retrospective cohort studies.
Clinical Implications
Clinicians can consider deferring radical prostatectomy for up to three months in intermediate- and high-risk prostate cancer patients without significant compromise in oncologic outcomes, especially when balancing risks such as COVID-19 exposure. However, prolonged delays beyond this period should be avoided due to potential increased risk of disease progression. Individualized patient monitoring and risk assessment remain essential to optimize timing of surgery.
Conclusion
Current evidence supports that short-term delays (up to 3 months) in radical prostatectomy for intermediate- and high-risk prostate cancer do not significantly impact survival or pathologic outcomes. Nonetheless, longer postponements may adversely affect oncologic control, underscoring the importance of timely treatment.
References
Systematic Review on Deferred Radical Prostatectomy Outcomes
by Ekaterina Laukhtina, Reza Sari Motlagh, Keiichiro Mori, Fahad Quhal, Victor M. Schuettfort, Hadi Mostafaei, Satoshi Katayama, Nico C. Grossmann, Guillaume Ploussard, Pierre I. Karakiewicz, Alberto Briganti, Mohammad Abufaraj, Dmitry Enikeev, Benjamin Pradere, Shahrokh F. Shariat
