Impact of delay from transperineal biopsy to radical prostatectomy upon objective measures of cancer control

Abstract Objective Treatment delays in prostate cancer have been characterised, although not explicitly in men undergoing transperineal prostate biopsies. We aimed to determine if delays to radical prostatectomy correlate with adverse outcomes using a contemporary population-based cohort of men diagnosed by transperineal biopsy. Methods This study analysed men with prostate cancer of grade group ≥2, diagnosed from transperineal prostate biopsy who underwent prostatectomy, using the prospectively enrolled Prostate Cancer Outcomes Registry-Victoria in 2014–2018. Data were analysed according to stratified demographic and disease characteristics. Time intervals from biopsy (28, 60, 90, 120 and 270 days) were compared using odds-ratios and regression analyses for proportion of upgrading, early biochemical recurrence, pT3 disease at prostatectomy and positive surgical margins. Results In total, 2008 men were analysed. There were 306 (16.7%) men with upgrading, 151 (8.4%) with biochemical recurrence, 1068 (54.1%) with pT3 disease, and 464 (23.1%) with positive surgical margins (percentages exclude patients with missing data). All adverse outcomes studied were significantly associated with higher PSA and grade at diagnosis. Delays of 120–270 days did not adversely alter the incidence of Gleason upgrading, pT3 or recurrence. Delay (most frequent 60–89 days, 28%) was associated with positive surgical margins but not monotonically. Regression modelling demonstrated no increased likelihood of most adverse outcomes for up to 270 days. Conclusion Men with grade group ≥2 prostate cancer diagnosed through transperineal biopsies may wait up to 270 days for a prostatectomy without a greater likelihood of upgrading, pT3 disease, positive surgical margins or biochemical recurrence.