INTRODUCTION AND OBJECTIVE:
The effect of treatment delays for men with prostate cancer (PC) is unclear: in particular, there are limited data regarding important long-term outcomes among men with intermediate/high-risk disease. Further, in the current pandemic, some guidelines have recommended neoadjuvant androgen deprivation therapy (nADT) during treatment delays while others have rejected this approach.
We identified 4072 men (3962 hormone naïve and 110 who received neoadjuvant ADT) with intermediate- or high-risk disease from the SEARCH cohort treated with radical prostatectomy (RP) from 1988-2018. Cox proportional hazard models assessed the association between time from biopsy to RP and time to CRPC, metastasis, and all-cause mortality. Interaction terms were used to test for effect modification by risk group and use of nADT.
Among 3962 hormone naïve patients, 167 (4.2%) developed CRPC, 248 (6.3%) men developed metastases and 884 (22%) died. We observed a small protective effect of delays between biopsy and RP on CRPC in both the univariable (HR=0.89, 95% CI: 0.80-0.97, p=0.009) and multivariable model (HR=0.88, 95% CI: 0.80-0.98, p=0.02), independent of risk group (interaction p>0.05). We found no statistically significant association between length of time to surgery and risk of developing metastases in either model (p=0.49 and 0.85), again with no significant difference in risk group (p>0.05). Finally, we found evidence of effect modification on the association between time to RP and all-cause mortality (p=0.009 and 0.027 in univariable and multivariable models, respectively). However, after multivariable adjustment, time to RP was not significantly associated with the risk of all-cause mortality in either the intermediate- (HR=0.96, 95% CI: 0.92-1.01, p=0.12) or high-risk (HR 1.05, 95% CI 0.99-1.11, p=0.12) cohorts. Use of nADT did not significantly modify the relationship between treatment delays and any of the examined outcomes (all p≥0.69).
Among men with intermediate- and high-risk prostate cancer, treatment delays do not appear to be associated with long-term outcomes including CRPC, metastasis, and death. Further, nADT does not appear to confer benefit in this setting.
Source of Funding:
Support for this study was provided by the NIH/NCI under Award Number R01CA231219 and NIH K24 CA160653