ABSTRACT
Introduction: The risks of delaying cancer surgery and the best management for these patients during COVID-19 is unknown. This systematic review aims to compare outcomes of patients with localised prostate cancer (PCa) who experienced any delay of radical prostatectomy (RP) (including surgical waiting times and use of neoadjuvant hormone therapy [NHT]), compared to those who underwent immediate RP. Methods: MEDLINE and Cochrane CENTRAL were searched for studies pertaining to the review question. Outcomes included (Biochemical) Recurrence-free survival, cancer-specific survival, overall survival and positive surgical margin (PSM). Results: 4,120 studies were retrieved. 36 observational studies investigated the effects of delayed RP. A variety of PCa risks and delay periods contributed to considerable heterogeneity in the include studies. When stratifying by PCa risk groups, low risk PCa (Grade Group [GG] 1) can be delayed safely from at least 26 weeks to 2.6 years, without significant effects on all outcomes. Similarly, RP can be safely delayed for 6 to 9 months in intermediate risk patients (GG 2/3). In high-risk patients (GG 4/5), the delay of RP for 2 or more months tends to associate with worsen recurrences, hence NHT should be considered. Ten RCTs show 3-months of NHT is non-inferior for oncological outcomes and superior for PSM compared to immediate RP. The risk of biases of the included studies ranged from low to serious risk. Conclusion: RP is safe to be delayed in low-risk and intermediate-risk PCa patients. High-risk patients should be offered NHT;there is no sufficient evidence extending NHT over 3-months.