Early oncological outcomes of delayed radical prostatectomy: a prospective, international, follow-up analysis of the COVIDSurg-Cancer study

Nathan, Arjun, Gao, Chuanyu, Light, Alexander, Alexander, Cameron, Chan, Vinson, Gallagher, Kevin, Khadhouri, Sinan, Byrnes, Kevin G., Ng, Michael, Walters, Michael, Hughes, Terry, Perry, Rita J., Okoth, Kelvin, Magill, Laura, Pinkney, Thomas, Zhang, Yuhao, Blackmur, James, Etchill, Eric, Tang, Stanley, García Escudero, Damián, McNeill, Alan, Narahari, Krishna ORCID: https://orcid.org/0000-0003-0257-7033, Stewart, Grant D., Kasivisvanathan, Veeru and COVIDSurg, Collaborative 2024. Early oncological outcomes of delayed radical prostatectomy: a prospective, international, follow-up analysis of the COVIDSurg-Cancer study. BJUI Compass 5 (12) , pp. 1314-1323. 10.1002/bco2.433

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Abstract

Objectives: The objective of this study is to compare the early oncological outcomes of delayed (>90 days) versus scheduled (≤90 days) radical prostatectomy (RP). Patients and methods: 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. Results: 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. Conclusion: 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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	Wiley Open Access
ISSN:	2688-4526
Funders:	The Urology Foundation
Date of First Compliant Deposit:	26 November 2024
Date of Acceptance:	12 August 2024
Last Modified:	26 Feb 2025 11:33
URI:	https://orca.cardiff.ac.uk/id/eprint/173933

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