Delay in surgical therapy for clinically localized prostate cancer and biochemical recurrence after radical prostatectomy.

BACKGROUND: In Canada, waiting times for cancer care have been increasing, particularly for patients with genitourinary malignancies. We examined whether delay from diagnosis for patients undergoing surgery for clinically localized prostate cancer affects cancer cure rates. METHODS: We conducted a historical cohort study among 645 patients who underwent radical prostatectomy between 1987 and 1997, using biochemical recurrence (PSA elevation) and metastasis as endpoints. We examined whether patients who underwent surgery >/= months (delayed surgery group) from the date of diagnosis had reduced recurrence-free survival, compared to patients who had surgery <3 months (early surgery group) from the date of diagnosis, adjusting for grade, stage and PSA level at diagnosis. RESULTS: The crude 10-year recurrence-free and metastasis-free survival rates for all patients were 71.1% (95% C.I.: 64.9% - 77.3%) and 95.3% (95% C.I.: 91.3% - 99.3%), respectively. Of the 645 patients, 189 (29.3%) had surgery >/= months after diagnosis. The median time from the date of diagnosis to surgery was 68 days (range 15 to 951 days). The 10-year recurrence-free survival was higher for patients who underwent early surgery (74.6%, 95% C.I.: 67.9% - 81.4%) compared to patients in the delayed surgery group (61.3%, 95% C.I.: 46.7% - 76.0%, p=0.05). The crude and adjusted hazard ratios for developing biochemical recurrence for patients in the delayed surgery group were 1.58 (95% C.I.: 1.0 - 2.4, p=0.04) and 1.46 (95% C.I.: 0.9 - 2.3, p=0.09), respectively, compared to patients who underwent early surgery. CONCLUSIONS: There may exist a possible relationship between delays from diagnosis for radical prostatectomy and prostate cancer cure rates. These findings may have many biases that could not be properly accounted in this retrospective analysis and larger cohort analyses will be required to confirm these findings.

Psychosocial impact of renal donation.

PURPOSE: To determine the psychosocial effects of donor nephrectomy on a sample of Canadian donors. MATERIALS AND METHODS: Patients donating one of their kidneys for transplantation at the Toronto Hospital between 1991-1996 were asked to complete a 170-item questionnaire designed to assess their psychosocial well-being and the impact of renal donation on various aspects of their lives. Of the 153 donors contacted, 104 (68.0%) have responded to date. RESULTS: Less than 5% of donors complained of renal donation severely affecting any aspect of their life. Most donors (84%) were able to perform their normal daily activities within 12 weeks of nephrectomy, and 75% had recovered their pre-donation level of work function by this time. Almost one third of donors lost wages because of their donation, and half incurred significant transportation costs. Very few donors (< 10%) complained of other costs. Almost 90% of donors felt that donating a kidney had positively impacted their relationship with the recipient, and donors felt that their relationships with the recipient were significantly more positive at follow-up (p<.003). CONCLUSIONS: Donating a kidney results in a moderate psychosocial impact on the donor and appears to strengthen the bond between donor and recipient. Recovery times to daily activities and work may be longer than anticipated in a large proportion of donors.

Living donor nephrectomy: follow-up renal function, blood pressure, and urine protein excretion.

PURPOSE: To assess the effect of donor nephrectomy on blood pressure, 24-hour urine protein excretion, and renal function. MATERIALS AND METHODS: Of the 198 individuals who donated a kidney between 1991-1996, 101 had their blood pressure, 24-hour urine protein excretion, and serum creatinine concentration levels measured. The mean duration of follow-up was 3.2 +/- 1.6 years (range: 8.5 months to 6.5 years). RESULTS: Serum creatinine concentration was significantly higher (p<.001) at follow-up (107 +/- 20 umol/L) compared to before donation (86 +/- 18 umol/L). When follow-up serum creatinine concentrations were expressed as percentages of their pre-operative values, a gradual decline was observed with time (R= -.380). Diastolic blood pressures (p<.05) and 24-hour urine protein levels (p<.001) were significantly higher at follow-up, however, neither increased with time. The prevalence of hypertension and proteinuria in our donors was no different from that of the general population. CONCLUSIONS: Donor nephrectomy does not impair renal function or result in a progressive rise in blood pressure or urine protein excretion up to 6.5 years after nephrectomy.