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  • Title: Reasonable delay of surgical treatment in men with localized prostate cancer--impact on prognosis?
    Author: Graefen M, Walz J, Chun KH, Schlomm T, Haese A, Huland H.
    Journal: Eur Urol; 2005 Jun; 47(6):756-60. PubMed ID: 15925069.
    Abstract:
    PURPOSE: In many centers patients with clinically localized prostate cancer might be confronted with a delay in therapy due to not immediately available treatment capacity at that specific center. Furthermore, a growing amount of patients want to have a second or third opinion before they finally decide what therapeutic option to choose. We investigated whether a reasonable delay from diagnosis to definitive treatment impact recurrence free survival rates in men undergoing radical prostatectomy (RP) for localized prostate cancer. MATERIAL AND METHODS: Preoperative data of 795 men treated for localized prostate cancer by RP between 1/1992 and 6/2000 were evaluated including pretreatment PSA, clinical stage and biopsy Gleason score. In addition, time from biopsy to the date of RP was obtained and investigated as a potential prognostic factor. The influence of the time gap between biopsy and surgery was statistically evaluated by univariate Cox regression analyses and Kaplan-Meier analyses; a multivariate Cox Modell was performed including all preoperative parameters. Relapse following RP was defined as a postoperative PSA level >0.1 ng/ml. RESULTS: Mean followup of the patients was 33 months (1-116 months). Twenty-five percent of the patients failed during that time period. Mean time gap between diagnosis and treatment was 62 days (median 54 days) ranging from 5 to 518 days. Univariate Cox regression analysis showed no significant correlation (p=0.062) of waiting time with recurrence rate. Multivariate Cox regression documented a highly significant association of PSA (p<0.001), clinical stage (p=0.001) and biopsy Gleason grade (p<0.001) but not not for time to treatment (p=0.841). In patients with high-grade cancer again no significant impact of treatment delay was found. CONCLUSION: Treatment delay in the investigated time span of a few months did not adversely affect recurrence free survival rates. Patients can be reassured that they can evaluate treatment options without compromising efficacy due to a delay in treatment.
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