Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Urol. 2021 May;205(5):1263-1274. doi: 10.1097/JU.0000000000001601. Epub 2021 Jan 14.
Prostate cancer is most commonly an indolent disease, especially when detected at a localized stage. Unlike other tumors that may benefit from timely receipt of definitive therapy, it is generally accepted that treatment delays for localized prostate cancer are acceptable, especially for low risk prostate cancer. Since treatment delay for intermediate risk and high risk disease is more controversial, we sought to determine if delays for these disease states negatively impacted oncological outcomes.
We conducted a systematic review of the literature with searches of Medline, EMBASE and the Cochrane Database of Systematic Reviews from inception to June 30, 2020. General study characteristics as well as study population and delay information were collected. The outcomes of interest extracted included biochemical recurrence, pathological features (positive surgical margins, upgrading, extracapsular extension, and other pathological features), cancer specific survival and overall survival.
After identifying 1,793 unique references, 24 manuscripts met criteria for data extraction, 15 of which were published after 2013. Based on our review, delays up to 3 months are safe for all localized prostate cancer and are not associated with worse oncological outcomes. Some studies identified worse oncological outcomes as a result of delays beyond 6 to 9 months. However, these studies are counterbalanced by others finding no statistically significant association with delays up to 12 months. Studies that did find worse outcomes as a result of delays identified a higher risk of biochemical recurrence and worse pathological outcomes but not worse cancer specific or overall survival.
Definitive treatment for intermediate risk and high risk prostate cancer can be delayed up to 3 months without any oncological consequences. Some evidence suggests that there is a higher risk of biochemical recurrence and worse pathological outcomes associated with delays beyond 6 to 9 months. To date, there are no reports of worse cancer specific survival or overall survival as a result of delayed treatment for intermediate risk and high risk prostate cancer.
前列腺癌通常是一种惰性疾病，尤其是在局部阶段发现时。与其他可能因及时接受确定性治疗而受益的肿瘤不同，人们普遍认为局部前列腺癌的治疗延迟是可以接受的，尤其是对于低危前列腺癌。由于中危和高危疾病的治疗延迟更具争议性，我们试图确定这些疾病状态的延迟是否对肿瘤学结果产生负面影响。
我们对文献进行了系统评价，检索了 Medline、EMBASE 和 Cochrane 系统评价数据库，从成立到 2020 年 6 月 30 日。收集了一般研究特征以及研究人群和延迟信息。提取的感兴趣结果包括生化复发、病理特征（阳性手术切缘、升级、包膜外延伸和其他病理特征）、癌症特异性生存和总生存。
在确定了 1793 条独特的参考文献后，有 24 篇文献符合数据提取标准，其中 15 篇发表于 2013 年之后。根据我们的综述，所有局部前列腺癌的延迟 3 个月是安全的，与肿瘤学结果无恶化相关。一些研究发现，延迟超过 6 至 9 个月会导致肿瘤学结果恶化。然而，这些研究被其他研究结果所平衡，这些研究发现延迟长达 12 个月与肿瘤学结果无统计学显著关联。发现延迟导致结果恶化的研究表明，生化复发和更差的病理结果的风险更高，但癌症特异性或总生存率没有更差。
中危和高危前列腺癌的确定性治疗可以延迟 3 个月而不会产生任何肿瘤学后果。一些证据表明，延迟超过 6 至 9 个月与生化复发和更差的病理结果的风险增加相关。迄今为止，尚无关于中危和高危前列腺癌延迟治疗导致癌症特异性或总体生存率更差的报道。
