Delay from biopsy to radical prostatectomy influences the rate of adverse pathologic outcomes.

Recently published paper on delay between biopsy and surgery.

Outcome: Significant increases in the proportion of adverse pathological outcomes were found beyond 75 days in the overall cohort (P = 0.03), 150 days for patients with Gleason <=6, and PSA 0-10 (P = 0.038), 60 days for patients with Gleason 7 and PSA >20 (P = 0.032), and 30 days for patients with Gleason 8-10 and PSA 11-20 (0.041).

http://www.ncbi.nlm.nih.gov/pubmed/25809289

CONCLUSION:

In low-risk disease, there is a considerable but not unlimited surgical delay which will not adversely impact the rate of adverse pathologic features found. In higher risk disease, this time period is considerably shorter. Prostate 9999: XX-XX, 2015. © 2015 Wiley Periodicals, Inc.

This says, in conclusion, that delays between biopsy and treatment will NOT adversely impact the rate of increase, within reason. Which we pretty much already knew. If you're G6 at biopsy, you have time. If you're G8 or G9, you need to move promptly.

I was 77 days from biopsy to surgery, and went from 3/12 cores G6 (all one side), to G7, 15-20% total involvement in all 4 quadrants.

I tend to agree with Michael__T

I think my signature reflects the fact that the biopsy showed six positive cores all on the left side, while the post-operative pathology, just two months later, showed additional cancer on the right side that had not been detected by the biopsy.

That's why I never tell a newcomer that they're "only" G-6, or that they have "plenty of time" to make a decision. That certainly may be true, but it's unknowable to me.

It's sort of like drilling for oil in 12 locations on your ranch and finding nothing much, while a huge deposit of it lies in an area where no wells were sunk.

I think Halbert's post in this thread is a good example of the lack of definitive knowledge afforded by the typical 12-core biopsy.

lapilot said...
This was fairly common knowledge, but I finally see it quantified.

Oh great, that is probably my positive margin right there! What with a 2 month delay for my G9 self! Although, my PSA did drop 26%(from 10.9 to 8.1) during that decision time, FWIW!

My proof was needing 3 biopsies in less than 18 months to find the mother lode that was there all along. My uro begged me to have the 3rd one, I was determined not to, for at least another full year or more after the second. Glad he was able to talk me into it, would have been much tougher had I had my way.

Misleading to say a gleason 6 went to a gleason 7 from biopsy to surgery. One was a biopsy {sample} the other was a sliced and diced prostate{ full pathology}. Unless of course the biopsy was redone or second opinioned. If a gleason six went to a 7 in 77 days there would be zero controversy on whether gleason grades migrate higher. You may have just scared every new gl 6 on the forum to think maybe they don't have that much time to consider treatment. That may in fact be true, but that statement, is not part of the equation, in my opinion and that of many in the professional field of PCA. As they say…just saying!

It was certainly my experience! MRI showed 2 x tumours 1cm & 2.5cms both well contained. Biopsy showed Gleason of 4+3, Surgery was 11 weeks from MRI during which time the tumours had doubled in size and were just starting to breach the capsule, a third tumour had also materialised. So much for all the heavy re-assurances I had been given that there was no rush to get to treatment as prostate cancer was invariably slow growing!!!!! Had I had surgery within a few weeks of the MRI my future might well have been better secured, now it's a case of waiting to see if anything did go walk about before the op. Clear margins offer some hope it didn't