Phillips JJ et al. (2007) Does a delay in initiating definitive therapy affect biochemical recurrence rates in men with clinically localized prostate cancer? Urol Oncol 25: 196–200

Whether the outcomes of patients diagnosed as having clinically localized prostate cancer are affected by a delay before initiation of definitive therapy is a subject of current debate. Phillips and colleagues, therefore, retrospectively evaluated the effect of such a delay before radical prostatectomy or radiation therapy on biochemical recurrence-free survival in patients treated between 1991 and 2004.

Radical prostatectomy was performed in 245 of the 393 patients (mean age 63.1 years, range 39.7–79.5 years) included in the final analysis; the remaining 148 underwent radiation therapy (external beam radiation therapy [n = 62], brachytherapy [n = 78] or both [n = 8]). Patients in the final analysis did not receive any systemic therapy. Follow-up involved visits every 3 months during year 1, every 6 months during year 2 and annually thereafter.

Median follow-up was 2.3 years (range 0.1–14.0 years). The median delay between diagnosis and treatment was 57 days (range 8–2,927 days); 79% of patients were treated within 3 months. Univariate and multivariate analyses showed that delayed treatment (>3 months) did not affect biochemical recurrence-free survival; only pretreatment serum PSA risk category (PSA <10 ng/ml, low risk; PSA 10–20 ng/ml, intermediate risk; PSA >20 ng/ml, high risk) was associated with biochemical recurrence-free survival.

The authors conclude that, in their cohort of predominantly low-risk and intermediate-risk patients, there is no association between a treatment delay of >3 months and biochemical recurrence-free survival. Further studies that include patients with high-risk Gleason scores and pretreatment PSA levels are warranted.