Photo Credit: iStock.com/ALIOUI Mohammed Elamine

The following is a summary of “Evaluating the Safety of Delaying Surgery Beyond 9 Months in Localized Prostate Cancer Patients: Results From a Prospective Study With Propensity Score Matching,” published in the June 2025 issue of International Journal of Urology by Pattou et al. 

The optimal timing of radical prostatectomy (RP) after prostate cancer diagnosis was controversial, especially regarding the impact of surgical delays on oncological outcomes, with less clarity on the effects of delaying surgery in intermediate- and high-risk patients compared to the established active surveillance for low-risk cases.  

Researchers conducted a retrospective study to assess the impact of surgical delays over 9 months on upstaging, upgrading, and biochemical recurrence (BCR) in patients undergoing RP for localized prostate cancer.  

They enrolled consecutive patients from June 2013 to June 2021 at 4 French academic hospitals who were scheduled for RP according to clinical guidelines. A 9-month delay threshold between prostate biopsy and surgery was applied. The primary outcome was BCR rates, while secondary outcomes included upgrading to the International Society of Urological Pathology (≥ ISUP 4) and upstaging to ≥ pT3a. Propensity scoring was used to balance prostate-specific antigen levels, biopsy ISUP grades, and D’Amico risk categories between groups.  

The results showed that after propensity score matching, 881 patients were analyzed with a median surgical delay of 3.5 months (IQR: 2.6–4.6). Over a median follow-up of 48.0 months (IQR: 25.0–60.0), BCR occurred in 156 patients (17.7%). Surgical delays beyond 9 months were not significantly linked to worse BCR-free survival in patients with prostate-specific antigen below 20 ng/mL and ISUP grade ≥ 4 and D’Amico low to intermediate high. Upgrading (ISUP ≥ 4) and/or upstaging (≥ pT3a) were observed in 35% of patients, with no significant effect from surgical delay over 9 months in multivariate analysis.  

Investigators concluded that delaying surgery beyond 9 months did not adversely affect pathological outcomes or BCR rates in non–high-risk patients undergoing RP for localized prostate cancer.  

Source: onlinelibrary.wiley.com/doi/10.1111/iju.70142