Reviewer: Neha Vapiwala, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 5, 2004
Presenter: P.L. Nguyen
Presenter's Affiliation: Harvard Medical School/ University of Pennsylvania
Type of Session: Scientific
It has been demonstrated that prolonged delay between cancer diagnosis and the start of radiation therapy (RT) is associated with decreased local control in head and neck cancer. This study sought to evaluate if a delay in administration of RT had an adverse outcome on PSA outcome following treatment of patients with localized prostate cancer. This question has not been extensively studied in the past. However, an abstract recently reported at the American Urology Association (AUA) conference earlier this year stated that a delay of greater than 3 months between diagnosis and prostatectomy led to worse outcome in patients with high-risk localized prostate cancer.
Materials and Methods
This study demonstrates that high-risk patients with localized prostate cancer have worse PSA survival if there is a delay between diagnosis and RT of > 2.5 months. This may be explained in part by the greater risk of disease dissemination during the delay period in patients with higher risk disease. Similarly, these high-risk patients are also more likely to have local disease progression during this time delay. Both of these aspects could lead to PSA failure by ASTRO criteria, and thus to lowered PSA survival.
Future studies might look closer at low-risk patients to determine what the maximal length of "safe" delay really is, as there may be a point beyond 2.5 months at which disease burden is no longer controllable with local RT alone. This study had very few patients whose delay extended beyond 6 months. Longer follow-up of this subgroup is needed to help answer these questions.
Regarding the high-risk group, this study raises the question of whether increasing the RT dose or adding hormonal agents to RT might overcome and counteract the increased failure risk caused by the time delay.
Finally, this study emphasizes the importance of timely, judicious management of prostate cancer patients and the importance of addressing any socioeconomic causes of treatment delay that might be potentially avoidable.
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