University of Hertfordshire

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  • Vinson Wai-Shun Chan
  • Wei Shen Tan
  • Aqua Asif
  • Alexander Ng
  • Olayinka Gbolahan
  • Eion Dinneen
  • Wilson To
  • Hassan Kadhim
  • Melissa Premchand
  • Oliver Burton
  • Jasmine Sze-Ern Koe
  • Nicole Wang
  • Jeffrey Leow
  • Gianluca Giannarini
  • Nikhil Vasdev
  • Shahrokh F Shariat
  • Dmitry Enikeev
  • Chi Fai Ng
  • Jeremy Yeun-Chun Teoh
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Original languageEnglish
Article number3274
Number of pages15
JournalCancers
Volume13
Issue13
DOIs
Publication statusPublished - 30 Jun 2021

Abstract

External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle–Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited

Notes

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)

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