Introduction

The optimal interval between prostate biopsy and radical prostatectomy (RP) is unknown. Therefore we sought to determine the impact of time from biopsy to surgery on outcomes following RP._x000D_

Methods

13,265 men who underwent RP at our institution between 1992 and 2012 had a prostate biopsy within one year of surgery. Men were divided into four groups based on the interval between biopsy and surgery: 1) ≤3 weeks (n=2511), 2) 4-6 weeks (n=2493), 3) 7-12 weeks (n=5273), 4) >12 weeks (n=2998) to assess for complications. Oncologic outcomes were compared between those waiting ≤3 weeks (n=2511) versus ≥6 months (n=443), stratified by NCCN risk category. Logistic regression was performed to assess the impact of time on postoperative complications, functional and oncologic outcomes.

Results

Mean time from biopsy to surgery was 63 days (±51 days) and the overall complication rate for the cohort was 19.8% with a 1.0% intraoperative complication rate. Men undergoing RP within 3 weeks of biopsy were older (63.4 vs 61.7; p<0.001), with higher pre-operative PSA (9.1 vs 7.6; p<0.001) and clinically higher risk disease (3.2% vs 1.9% with ≥2 NCCN high risk criteria; p<0.001) compared to those who waited more than 12 weeks until surgery. On multivariate analysis, waiting at least 7 weeks was associated with a lower likelihood of complications (OR: 0.8, p= 0.01) and higher likelihood of a nerve sparing procedure (OR: 1.6, p<0.001). Men waiting 12 weeks were least likely to have a positive margin (OR: 0.6, p<0.001). There was no significant difference in functional outcomes at 1 year. Finally, there was no clinically significant difference in oncologic outcomes among men undergoing early (≤3 weeks) compared to delayed (≥6 months) RP.

Conclusions

Waiting at least 6 weeks from biopsy to RP is associated with a lower overall complication and positive margin rate. There appears to be no oncologic harm in waiting 6-12 months between biopsy and RP, even for men with intermediate and high risk disease.

Funding

none