A cross‐section of UK prostate cancer diagnostics during the coronavirus disease 2019 (COVID‐19) era – a shifting paradigm?

Stroman, Luke; Cathcart, P.; Lamb, Alastair; Challacombe, Benjamin; Popert, Rick

doi:10.1111/bju.15259

Cited by 11 publications

(6 citation statements)

References 4 publications

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“…Our results are in line with the findings of a survey of 268 urologists in the United Kingdom in April and May 2020, just after the start of the first lockdown period in England, which reported that prostate biopsies were restricted to patients who were suspected to have high-risk disease and that a TP biopsy with a local anaesthetic was typically the preferred method [16].…”

Section: Discussionsupporting

confidence: 90%

Impact of the COVID‐19 pandemic on the diagnosis and treatment of men with prostate cancer

et al. 2022

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To determine the impact of the COVID-19 pandemic on diagnostic and treatment activity in 2020 across hospital providers of prostate cancer (PCa) care in the English National Health Service. MethodsDiagnostic and treatment activity between 23 March (start of first national lockdown in England) and 31 December 2020 was compared with the same calendar period in 2019. Patients newly diagnosed with PCa were identified from national rapid cancer registration data linked to other electronic healthcare datasets. ResultsThere was a 30.8% reduction (22 419 vs 32 409) in the number of men with newly diagnosed PCa in 2020 after the start of the first lockdown, compared with the corresponding period in 2019. Men diagnosed in 2020 were typically at a more advanced stage (Stage IV: 21.2% vs 17.4%) and slightly older (57.9% vs 55.9% ≥ 70 years; P < 0.001). Prostate biopsies in 2020 were more often performed using transperineal (TP) routes (64.0% vs 38.2%). The number of radical prostatectomies in 2020 was reduced by 26.9% (3896 vs 5331) and the number treated by external beam radiotherapy (EBRT) by 14.1% (9719 vs 11 309). Other changes included an increased use of EBRT with hypofractionation and reduced use of docetaxel chemotherapy in men with hormone-sensitive metastatic PCa (413 vs 1519) with related increase in the use of enzalutamide. ConclusionWe found substantial deficits in the number of diagnostic and treatment procedures for men with newly diagnosed PCa after the start of the first lockdown in 2020. The number of men diagnosed with PCa decreased by about one-third and those diagnosed had more advanced disease. Treatment patterns shifted towards those that limit the risk of COVID-19 exposure including increased use of TP biopsy, hypofractionated radiation, and enzalutamide. Urgent concerted action is required to address the COVID-19-related deficits in PCa services to mitigate their impact on long-term outcomes.

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Section: Discussionsupporting

confidence: 90%

Impact of the COVID‐19 pandemic on the diagnosis and treatment of men with prostate cancer

et al. 2022

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“…[17][18][19] Some examples are limitations of access to screening programmes, to medical care cancer-related visits (both in primary care and in hospitals), to cancer diagnostic tests, reduction in scheduled cancer surgeries due to limited access to postsurgical critical care units and occupation of hospital beds by patients with COVID-19, reduction of treatments that could pose a high risk to the patient in the circumstances of the pandemic, and modifications of therapeutic guidelines, among others. [18][19][20][21] In some countries, a reduction in cancer diagnostics and cancer encounters was observed. [22][23][24] This led to a reduction in new cancer diagnoses and a delay in cancer treatment.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

et al. 2021

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ObjectiveCancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The objective of our study is to evaluate the impact of the pandemic on the incidence of cancer diagnoses in primary care.DesignTime-series study of malignant neoplasms and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020.SettingPrimary care, Catalonia, Spain.ParticipantsPeople older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm.Main outcome measuresWe obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms was defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer and socioeconomic status.ResultsBetween March and September 2020 we observed 8766 (95% CI 4135 to 13 397) fewer malignant neoplasm diagnoses, representing a reduction of 34% (95% CI 19.5% to 44.1%) compared with the expected. This underdiagnosis was greater in individuals aged older than 64 years, men and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that).ConclusionsReduction in cancer incidence has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer.

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“…The peak of COVID-19 disruption on the diagnostic pathway of PCa caused a 59.7% drop in prostatespecific antigen (PSA) testing and a decline in the number of centres offering biopsies [6]. A 26% decline for local anaesthetic transperineal (LATP), 59% decline for general anaesthetic transperineal (GATP), and 58% decline for local anaesthetic transrectal (LATRUS) biopsies were seen respectively in the UK [7,8]. The extant literature suggests that both LATP and GATP biopsies lead to fewer complications due to infection or urosepsis, without requiring additional protective measuressuch as the use of prophylactic antibiotics.…”

Section: Adaptations Of Prostate Cancer Diagnostic Pathway During Cov...mentioning

confidence: 99%

Implications and effects of COVID-19 on diagnosis and management of prostate cancer

Chan

Asif

Koe

et al. 2022

Current Opinion in Urology

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Purpose of reviewThe Coronavirus disease 2019 pandemic has led to uncertainty on the optimal management for prostate cancer (PCa). This narrative review aims to shed light on the optimal diagnosis and management of patients with or suspected to have PCa. Recent findingsFaecal-oral or aerosol transmission is possible during prostate procedures; caution must be in place when performing digital rectal examinations, transrectal ultrasound-guided prostate biopsies and prostate surgeries requiring general anaesthesia. Patients must also be triaged using preoperative polymerase chain reaction tests for COVID-19. COVID-19 has accelerated the adoption of multiparametric Magnetic Resonance Imaging (MRI), reducing the need for prostate biopsy unless when absolutely indicated, and the risk of COVID-19 spread can be reduced. Combined with prostate-specific antigen (PSA) density, amongst other factors, multiparametric MRI could reduce unnecessary biopsies in patients with little chance of clinically significant PCa. Treatment of PCa should be stratified by the risk level and preferences of the patient. COVID-19 has accelerated the development of telemedicine and clinicians should utilise safe and effective teleconsultations to protect themselves and their patients. SummaryCOVID-19 transmission during prostate procedures is possible. Patients with a Prostate Imaging-Reporting and Data System (PI-RADS) of <3 and PSA density <0.15 ng/ml/ml are deemed low-risk and are safe to undergo surveillance without MRI-targeted biopsy. Intermediate-or high-risk patients should be offered definitive treatment within four months or 30days of diagnosis to avoid compromising treatment outcomes; three-month courses of neoadjuvant androgen deprivation therapy can be considered when a delay of surgery is anticipated.

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A cross‐section of UK prostate cancer diagnostics during the coronavirus disease 2019 (COVID‐19) era – a shifting paradigm?

Cited by 11 publications

References 4 publications

Impact of the COVID‐19 pandemic on the diagnosis and treatment of men with prostate cancer

Impact of the COVID‐19 pandemic on the diagnosis and treatment of men with prostate cancer

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

Implications and effects of COVID-19 on diagnosis and management of prostate cancer

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