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

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.