Excessive waitlists and delays to treatment with low-dose-rate brachytherapy predict an increased risk of recurrence and metastases in intermediate-risk prostatic carcinoma

• Published in: Clinical and translational radiation oncology Vol. 30; pp. 38 - 42
• Main Authors: Khanolkar, Rutvij A., Quon, Harvey, Thind, Kundan, Sia, Michael, Roumeliotis, Michael, Husain, Siraj, McGeachy, Philip, Meyer, Tyler, Martell, Kevin
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.09.2021; Elsevier
• Subjects: Brachytherapy; Metastases; Prostate cancer; Recurrence; Wait times for treatment; Wait times for treatment; Recurrence; Brachytherapy; Prostate cancer; Metastases
• ISSN: 2405-6308; 2405-6308
• DOI: 10.1016/j.ctro.2021.06.008

•Resource constraints have led to prolonged wait-times for prostate brachytherapy.•Increased wait times predict a significant increase in recurrence and metastases.•Better resource planning is needed to reduce management delays & improve outcomes. It has previously been shown that increased wait times for prostatectomy are associated with poorer outcomes in intermediate-risk prostatic carcinoma (PCa). However, the impact of wait times on PCa outcomes following low-dose-rate brachytherapy (LDR-BT) are unknown. We retrospectively reviewed 466 intermediate-risk PCa patients that underwent LDR-BT at a single comprehensive cancer center between 2003 and 2016. Wait times were defined as the time from biopsy to LDR-BT. The association of wait times with outcomes was evaluated using Cox and Fine-Gray regression in both univariate and multivariate models. Median (interquartile range) follow-up and wait time for all patients were 8.1 (6.3–10.4) years and 5.1 (3.9–6.9) months, respectively. Among NCCN unfavourable intermediate-risk (UIR) patients (n = 170; 36%), increased wait times predicted both a greater cumulative incidence of recurrence [MHR = 1.01/month of wait time (95% CI: 1.00–1.03); P = 0.044] and metastases [MHR = 1.04/month of wait time (95% CI: 1.02–1.06); P < 0.001] in multivariate modeling. In NCCN favourable intermediate-risk (FIR) patients, there was no significant association between wait time and recurrence or metastases risk. Among all intermediate-risk patients, wait time was associated with an increase in the incidence of metastases [MHR = 1.03/month of wait time (95% CI: 1.02–1.05); P < 0.001], but not recurrence in multivariate models. There was no association between wait time and overall survival in the UIR, FIR, or all intermediate-risk cohorts. Resource constraints within this center’s public healthcare system have contributed to waitlists exceeding 5-months in length. This study finds that patients with UIR PCa experience a 1% increase in the risk of recurrence and 4% increase in the risk of metastases with each additional month of delay in definitive disease management. Preventing such extended management delays in LDR-BT may improve disease-related outcomes in patients with PCa.