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Prostate Cancer: Localized: Surgical Therapy VI (MP64): Moderated Poster 64: Monday, September 13, 2021

MP64-15 ASSOCIATION BETWEEN DELAY TO SURGERY AND CLINICALLY MEANINGFUL OUTCOMES AMONG PATIENTS WITH INTERMEDIATE- AND HIGH-RISK LOCALIZED PROSTATE CANCER TREATED WITH RADICAL PROSTATECTOMY: AN ASSESSMENT OF THE SEARCH DATABASE WITH INSIGHT INTO THE ROLE OF NEOADJUVANT ANDROGEN DEPRIVATION THERAPY

Lee, Maggie C.; Erikson, Tyler R.; Stock, Shannon; Howard, Lauren E.; Amling, Christopher L.; Aronson, William J.; Cooperberg, Matthew R.; Kane, Christopher J.; Terris, Martha K.; Klaassen, Zachary; Freedland, Stephen J.; Wallis, Christopher J. D.

doi: 10.1097/JU.0000000000002104.15
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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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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

© 2021 by American Urological Association Education and Research, Inc.