Abstract and Introduction
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has affected care for diseases like cancer. The aim was to evaluate the impact of COVID-19 on waiting times for diagnosis and treatment of prostate cancer (PC), as well as the possible effect on the treatment results in PC patients undergoing radical prostatectomy.
Methods: We compared the results of 497 patients who underwent biopsy prior to the COVID-19 pandemic (1 January–31 December 2019) with those of 290 patients biopsied during the COVID-19 pandemic (1 January–31 December 2020). Demographic data, tumour characteristics, type of treatment and diagnosis times were comparable. Prostate specific antigen (PSA) levels were recorded at consultation prior to biopsy and after treatment. Mann-Whitney and chi-square tests were used to compare continuous variables and percentages, respectively.
Results: In 2020, there were fewer urology consultations (35,160 vs. 40,225 in 2019). The median PSA in 2020 was significantly higher (14.3 vs. 9.9 ng/dL in 2019). In 2019, 53.1% (N=264) of the biopsies were positive for cancer vs. 47.2% (N=137) in 2020 (P=0.104). In 2020, more patients presented with metastatic disease (7.3% vs. 1.9%, P=0.009). Also, in 2020 there was a longer waiting time for prostate biopsy (42.1 vs. 35.3 days in 2019, P=0.019). A total of 132 patients underwent laparoscopic radical prostatectomy (LARP). The median time until surgery was similar in both years (71.9 vs. 58.29 days). During 2020, a higher percentage of patients had ISUP grade 4 in the surgical specimen (34.3% vs. 17.5%, P=0.07). Furthermore, a higher percentage of aggressive (pT3) tumours were diagnosed (37.2% vs. 27.2%, P=0.08), and the percentage of patients with involvement of surgical margins was also higher (48.6% vs. 29.3%, P=0.027). There were no differences between the groups in terms of biochemical recurrence or persistent PSA at one year (P=0.711).
Conclusions: Delayed biopsy during the COVID-19 period did not appear to adversely impact biopsy results. Patients biopsied in 2020 had higher PSA, possibly due to proper triaging. A higher rate of adverse pathology outcomes was observed in patients undergoing radical prostatectomy during the pandemic, probably due to understaging of the biopsy. This study serves to raise awareness of the risk of deterioration of care of PC patients due to possible underdiagnosis.
Introduction
The global pandemic of the novel beta coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is generating severe effects on individuals and health care systems.[1] The heavy demand for resources, exacerbated by limited excess health system capacity, means that health care systems have quickly become overwhelmed.[2]
To provide sufficient intensive care unit capacity, medical specializations have had to develop new routines and risk-strategy protocols. The impact has also been felt by the urology community, and several organisations have developed specific information hubs and resource centres on how to manage urology and the care of patients with urological neoplasms during the pandemic.[3,4]
Prostate cancer (PC) is the commonest non-cutaneous male malignancy in the Western world. According to estimates, there were 1,276,000 new cases of PC and 359,000 deaths worldwide in 2018.[5] PC is a heterogeneous neoplasm that encompasses both non-clinically significant or slowly progressive disease and high-risk, clinically significant and life-threatening cancers.
In the context of the current pandemic, it is relevant that PC is more common in men at risk of adverse outcomes from coronavirus disease 2019 (COVID-19). For example, the incidence of PC increases with age and in black men[6] and >50% of affected men have one or more comorbidities.[7]
Studies reported in the literature have yielded conflicting conclusions on whether delayed diagnosis and treatment of PC worsens the long-term prognosis,[4] with some studies affirming that delays in diagnosis and performance of radical prostatectomy have no impact on oncological results. Even if this is the case, patients with high-risk PC could potentially be at greater risk of biochemical recurrence or distant spread due to delayed surgery.[8,9]
The main objective of this study was to evaluate the impact of COVID-19 on waiting times for the diagnosis (prostate biopsy) and treatment [laparoscopic radical prostatectomy (LARP), external beam radiotherapy (EBRT), active surveillance and hormonal treatment] of PC in a hospital with a high volume of patients during the COVID-19 phase and to compare the results with those during a period of identical length prior to the pandemic. As secondary objectives we analysed the positive biopsies for PC in each group and evaluated the pathological findings in patients undergoing radical prostatectomy. We also assessed the results after the application of radiotherapy. Finally, the presence of biochemical recurrence and persistent prostate specific antigen (PSA) at one year of follow-up was analysed. We present the following article in accordance with the STROBE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-22-360/rc).
Transl Androl Urol. 2022;11(12):1637-1644. © 2022 AME Publishing Company
