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| Impact of delay from transperineal biopsy to radical prostatectomy upon objective measures of cancer control |
Liang G. Qua,b,*( ),Gregory Jacka,b,Marlon Pereraa,b,Melanie Evansc,Sue Evansc,Damien Boltona,b,Nathan Papac
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a Department of Urology, Olivia Newton John Cancer Centre, Austin Health, Heidelberg VIC, Australia
b Department of Surgery, University of Melbourne, Melbourne VIC, Australia
c Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC, Australia |
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Abstract Objective: Treatment delays in prostate cancer have been characterised, although not explicitly in men undergoing transperineal prostate biopsies. We aimed to determine if delays to radical prostatectomy correlate with adverse outcomes using a contemporary population-based cohort of men diagnosed by transperineal biopsies. Methods: This study analysed men with prostate cancer of the International Society for Urological Pathology grade group ≥2, diagnosed by transperineal prostate biopsies who underwent prostatectomy, using the prospectively data from 1 January 2014 to 30 June 2018 Prostate Cancer Outcomes Registry-Victoria. Data were analysed according to stratified demographic and disease characteristics. Time intervals from biopsy (28, 60, 90, 120, and 270 days) were compared using odds ratios and regression analyses for proportion of upgrading, early biochemical recurrence, pT3 disease at prostatectomy, and positive surgical margins. Results: In total, 2008 men were analysed. There were 306 (16.7%) men with upgrading, 151 (8.4%) with biochemical recurrence, 1068 (54.1%) with pT3 disease, and 464 (23.1%) with positive surgical margins (percentages excluded patients with missing data). All adverse outcomes studied were significantly associated with higher prostate-specific antigen and grade at diagnosis. Delays of 120-270 days did not adversely alter the incidence of Gleason upgrading, pT3, or recurrence. Delays (most frequent 60-89 days, 28%) were associated with positive surgical margins but not monotonically. Regression modelling demonstrated no increased likelihood of most adverse outcomes for up to 270 days. Conclusion: Men with prostate cancer of grade group ≥2 diagnosed through transperineal biopsy may wait up to 270 days for a prostatectomy without a greater likelihood of upgrading, pT3 disease, positive surgical margins, or biochemical recurrence.
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Received: 17 December 2020
Available online: 20 April 2022
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Corresponding Authors:
Liang G. Qu
E-mail: liang.qu@austin.org.au
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| Characteristic | n (%) | Upgradinga | BCRb | pT3c | PSMd | | Proportion (%) | p-Value | Proportion (%) | p-Value | Proportion (%) | p-Value | Proportion (%) | p-Value | | Age at biopsy (year) | | | 0.002 | | 0.53 | | <0.001 | | 0.21 | | <50 | 66 (3) | 8 | | 5 | | 23 | | 15 | | | 50-59 | 436 (22) | 14 | | 8 | | 50 | | 21 | | | 60-69 | 1038 (52) | 16 | | 8 | | 54 | | 24 | | | ≥70 | 468 (23) | 22 | | 10 | | 62 | | 24 | | | PSA at diagnosis (ng/mL) | | | <0.001 | | <0.001 | | <0.001 | | 0.001 | | <5 | 494 (25) | 11 | | 4 | | 39 | | 14 | | | 5-9.9 | 1096 (55) | 17 | | 7 | | 55 | | 22 | | | 10-19.9 | 338 (17) | 24 | | 14 | | 67 | | 35 | | | ≥20 | 80 (4) | 20 | | 28 | | 83 | | 43 | | | Date of diagnosis | | | 0.79 | | 0.14 | | 0.027 | | 0.52 | | 1/2014-6/2015 | 357 (18) | 17 | | 10 | | 61 | | 26 | | | 7/2015-6/2016 | 455 (23) | 16 | | 10 | | 54 | | 22 | | | 7/2016-6/2017 | 629 (31) | 16 | | 7 | | 52 | | 23 | | | 7/2017-6/2018 | 567 (28) | 18 | | 7 | | 52 | | 22 | | | Biopsy ISUP grade group | | | <0.001 | | <0.001 | | <0.001 | | <0.001 | | 2 | 1080 (54) | 19 | | 3 | | 41 | | 17 | | | 3 | 547 (27) | 11 | | 12 | | 64 | | 25 | | | 4 | 203 (10) | 19 | | 12 | | 63 | | 30 | | | 5 | 178 (9) | N/A | | 30 | | 91 | | 47 | | | Operative technique (10 missing) | | | 0.078 | | <0.001 | | 0.34 | | <0.001 | | Robot-assisted approache | 1428 (71) | 16 | | 7 | | 53 | | 18 | | | Open approach | 570 (29) | 19 | | 12 | | 56 | | 35 | | | Interval (biopsy to RP) (day) | | | 0.60 | | 0.43 | | 0.013 | | 0.018 | | 28-59 | 1028 (51) | 17 | | 9 | | 56 | | 21 | | | 60-89 | 518 (26) | 15 | | 8 | | 56 | | 28 | | | 90-119 | 229 (11) | 17 | | 8 | | 50 | | 23 | | | 120-270 | 233 (12) | 19 | | 6 | | 45 | | 20 | |
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Characteristics of the study sample with percentages for grade group upgrade, BCR, pT3 disease at RP, and PSM.
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| Time interval (day) | Response variable, adjusted OR (95% CI) | | Grade group upgrading | BCR | pT3 at RP | Margin positive | | 28-59 | 1.0 | 1.0 | 1.0 | 1.0 | | 60-89 | 0.88 (0.65-1.20) | 1.00 (0.65-1.52) | 1.11 (0.88-1.40) | 1.60 (1.23-2.07) | | 90-119 | 1.04 (0.70-1.55) | 1.10 (0.60-2.00) | 0.89 (0.66-1.22) | 1.23 (0.85-1.77) | | 120-270 | 1.23 (0.84-1.81) | 1.07 (0.55-2.08) | 0.87 (0.64-1.19) | 1.23 (0.85-1.79) |
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Adjusted OR estimates for upgrading, pT3 at RP, positive surgical margins, and BCR per categories of time interval from biopsy to prostatectomy.
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Predicted adjusted probability of grade groups by interval from biopsy to RP. (A) Upgrading; (B) Positive surgical margin; (C) pT3 disease at RP; (D) BCR. BCR, biochemical recurrence; RP, radical prostatectomy.
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Predicted adjusted probability of upgrading by GG 2 (blue line, with dotted line as 95% CI) and by GG 3 and 4 (green line, with dotted line as 95% CI), following multivariable logistic regression. CI, confidence interval; GG, grade group; RP, radical prostatectomy.
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