Time from diagnosis to initiation of primary radiation therapy: does it effect outcomes?

Patients are often concerned about delaying initiation of treatment. Will it give the cancer a chance to metastasize? What if the random biopsy didn’t detect existing higher grade cancer? This is particularly of concern to patients considering active surveillance.

Dong et al. reported on the cancer control outcomes of 4,064 patients treated with external beam radiation therapy at Fox Chase Cancer Center. The patient records included 1,549 low-risk patients, 1,612 intermediate risk patients, and 903 high-risk patients. The average (median) time from diagnosis to initiation of treatment was 3.3 months.

After a median follow-up of 64 months:

  • There were no differences in 5-year biochemical failure, distant metastases, or overall survival depending on whether patients started treatment sooner or later than the median time to treatment.
  • This was true for every risk group.
  • This was even true for high-risk patients who did not receive any ADT in addition to their radiation.

This reflects the very slow natural history of prostate cancer progression, even with a high-risk diagnosis.

Patients who are considering which kind of therapy is right for them should take comfort from this. They have sufficient time to meet with a variety of specialists and to gather the information they need to make a well-considered decision.

Patients who are considering active surveillance should also take comfort from this. Delay in seeking therapy is not likely to adversely impact cancer control, even if they harbor a riskier form of the disease, at least in the short term. I suspect that was true even in the longer term for low-risk patients, but that was not reported in the abstract. Of course, a confirmatory follow-up biopsy, especially one that is targeted using multiparametric MRI, will provide a much higher degree of assurance.

Editorial note: This commentary was written for The “New” Prostate Cancer InfoLink by Allen Edel.

2 Responses

  1. I should probably have mentioned that the same holds true whether the final decision is surgery or radiation (or, of course, active surveillance). Prostate cancer patients have enough time to meet with a variety of specialists and make a well-considered decision, irrespective of their risk level at the time of diagnosis. Here’s a similar study among men who chose surgery.

  2. My understanding is one must in any event wait 6 to 8 weeks following biopsy for any sort of treatment to minimize side effects.

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