Biopsy-to-treatment delay in prostate cancer: Postpandemic impact in a swiss national, multicenter, prospective registry

BACKGROUND: Surgical delays increased during the COVID-19 pandemic. The effect of treatment delay in intermediate- and high-risk prostate cancer remains uncertain. We evaluated whether biopsy-to-surgery delay influences early oncological outcomes in a large contemporary cohort. METHODS: We analyzed 6,448 intermediate- or high-risk patients from the prospective Swiss national prostatectomy registry (2020-2025). Outcomes were: PSA persistence; adverse pathology (lymph-node invasion [LNI], extracapsular extension [ECE], seminal vesicle invasion [SVI], or ISUP ≥ 4); advanced stage (LNI, ECE, or SVI). Delay was categorized as <6 weeks, 6 weeks to 3 months, 3 to 6 months, or >6 months. Multivariable logistic regression adjusted for clinical and pathological covariates was performed. RESULTS: Median time from biopsy to surgery was 2.56 months (IQR 1.87-3.55). Overall, 547 patients (8.5%) experienced PSA persistence, 2,668 (41%) had adverse pathology, and 2,376 (37%) had advanced stage disease. In multivariable analyses, biopsy-to-surgery delay was not significantly associated with PSA persistence (6 weeks-3 months: OR 0.91, P = 0.5; 3-6 months: OR 0.97, P = 0.8; >6 months: OR 1.29, P = 0.2), adverse pathology (respectively, OR 0.98, P = 0.8; OR 0.97, P = 0.7; OR 1.03, P = 0.8), or advanced stage disease (respectively, OR 0.94, P = 0.6; OR 1.02, P = 0.9; OR 1.06, P = 0.8). Subgroup analyses stratified by D'Amico risk group confirmed these findings. CONCLUSION: In this large nationwide prospective cohort, biopsy-to-surgery delay did not adversely affect pathological or early oncological outcomes. Surgical deferral of up to 6 months appears acceptable and clinically safe, with particular relevance in settings of restricted operative capacity.