Does a delay in external beam radiation therapy after tissue diagnosis affect outcome for men with prostate carcinoma?
BACKGROUND
Physicians involved in the care of men diagnosed with prostate carcinoma must assess the urgency of treatment. For those men who choose external beam radiation therapy (EBRT), the delay from the time of biopsy to treatment may be stressful. There are limited data on the consequences of radiation treatment delay. The purpose of the current study was to evaluate the effect of time to treatment (TTT) on outcomes.


METHODS
The authors of the current study analyzed 1322 patients who were treated with EBRT alone. Overall survival (OS), cause specific survival (CSS), distant metastasis (DM), and freedom from biochemical failure (FFBF) were calculated. TTT was first analyzed at 4 intervals: < 3, 3-6, 6-9 and > 9 months, and at the median TTT. Cox multivariate analysis (MVA) was then performed with 2002 American Joint Commission on Cancer T-stage, Gleason score, prostate specific antigen (PSA), radiation dose, and TTT as covariates.


RESULTS
There were no statistical differences in OS, CSS, DM, or FFBF among men whose EBRT began < 3, 3-6, 6-9, or > 9 months after diagnosis. This was also true at the median TTT of 3.1 months. A subgroup analysis was performed in which patients were stratified into low-, intermediate- and high-risk groups based on pretreatment PSA, Gleason score and AJCC T-stage. FFBF, and DM were calculated above and below the median TTT of 3.1 months. In this analysis, there was no statistically significant difference in FFBF or DM within the risk groups.


CONCLUSIONS
Within the limits of the current study, data indicate that a treatment delay, even in high-risk patients, has little effect on clinical or biochemical outcome.
Andrews
Stephen F
SF
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Horwitz
Eric M
EM
Feigenberg
Steven J
SJ
Eisenberg
Debra F
DF
Hanlon
Alexandra L
AL
Uzzo
Robert G
RG
Pollack
Alan
A
D000230:Adenocarcinoma; D000368:Aged; D001706:Biopsy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors