Timing of curative treatment for prostate cancer: a systematic review

TY - JOUR

T1 - Timing of curative treatment for prostate cancer: a systematic review

AU - van den Bergh, Roderick C N

AU - Albertsen, Peter C

AU - Bangma, Chris H

AU - Freedland, Stephen J

AU - Graefen, Markus

AU - Vickers, Andrew

AU - van der Poel, Henk G

N1 - Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - CONTEXT: Delaying definitive therapy unfavourably affects outcomes in many malignancies. Diagnostic, psychological, and logistical reasons but also active surveillance (AS) strategies can lead to treatment delay, an increase in the interval between the diagnosis and treatment of prostate cancer (PCa).OBJECTIVE: To review and summarise the current literature on the impact of treatment delay on PCa oncologic outcomes.EVIDENCE ACQUISITION: A comprehensive search of PubMed and Embase databases until 30 September 2012 was performed. Studies comparing pathologic, biochemical recurrence (BCR), and mortality outcomes between patients receiving direct and delayed curative treatment were included. Studies presenting single-arm results following AS were excluded.EVIDENCE SYNTHESIS: Seventeen studies were included: 13 on radical prostatectomy, 3 on radiation therapy, and 1 combined both. A total of 34 517 PCa patients receiving radical local therapy between 1981 and 2009 were described. Some studies included low-risk PCa only; others included a wider spectrum of disease. Four studies found a significant effect of treatment delay on outcomes in multivariate analysis. Two included low-risk patients only, but it was unknown whether AS was applied or repeat biopsy triggered active therapy during AS. The two other studies found a negative effect on BCR rates of 2.5-9 mo delay in higher risk patients (respectively defined as any with T ≥ 2b, prostate-specific antigen >10, Gleason score >6, >34-50% positive cores; or D'Amico intermediate risk-group). All studies were retrospective and nonrandomised. Reasons for delay were not always clear, and time-to-event analyses may be subject to bias.CONCLUSIONS: Treatment delay of several months or even years does not appear to affect outcomes of men with low-risk PCa. Limited data suggest treatment delay may have an impact on men with non-low-risk PCa. Most AS protocols suggest a confirmatory biopsy to avoid delaying treatment in those who harbour higher risk disease that was initially misclassified.

AB - CONTEXT: Delaying definitive therapy unfavourably affects outcomes in many malignancies. Diagnostic, psychological, and logistical reasons but also active surveillance (AS) strategies can lead to treatment delay, an increase in the interval between the diagnosis and treatment of prostate cancer (PCa).OBJECTIVE: To review and summarise the current literature on the impact of treatment delay on PCa oncologic outcomes.EVIDENCE ACQUISITION: A comprehensive search of PubMed and Embase databases until 30 September 2012 was performed. Studies comparing pathologic, biochemical recurrence (BCR), and mortality outcomes between patients receiving direct and delayed curative treatment were included. Studies presenting single-arm results following AS were excluded.EVIDENCE SYNTHESIS: Seventeen studies were included: 13 on radical prostatectomy, 3 on radiation therapy, and 1 combined both. A total of 34 517 PCa patients receiving radical local therapy between 1981 and 2009 were described. Some studies included low-risk PCa only; others included a wider spectrum of disease. Four studies found a significant effect of treatment delay on outcomes in multivariate analysis. Two included low-risk patients only, but it was unknown whether AS was applied or repeat biopsy triggered active therapy during AS. The two other studies found a negative effect on BCR rates of 2.5-9 mo delay in higher risk patients (respectively defined as any with T ≥ 2b, prostate-specific antigen >10, Gleason score >6, >34-50% positive cores; or D'Amico intermediate risk-group). All studies were retrospective and nonrandomised. Reasons for delay were not always clear, and time-to-event analyses may be subject to bias.CONCLUSIONS: Treatment delay of several months or even years does not appear to affect outcomes of men with low-risk PCa. Limited data suggest treatment delay may have an impact on men with non-low-risk PCa. Most AS protocols suggest a confirmatory biopsy to avoid delaying treatment in those who harbour higher risk disease that was initially misclassified.

KW - Early Detection of Cancer

KW - Humans

KW - Male

KW - Multivariate Analysis

KW - Patient Selection

KW - Predictive Value of Tests

KW - Prostatectomy

KW - Prostatic Neoplasms

KW - Radiotherapy, Adjuvant

KW - Risk Factors

KW - Time Factors

KW - Time-to-Treatment

KW - Treatment Outcome

KW - Watchful Waiting

U2 - 10.1016/j.eururo.2013.02.024

DO - 10.1016/j.eururo.2013.02.024

M3 - SCORING: Journal article

C2 - 23453419

VL - 64

SP - 204

EP - 215

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 2

ER -