Prostate Cancer Diagnoses, Treatment Patterns Changed During COVID-19 Pandemic

Men diagnosed with prostate cancer during the COVID-19 pandemic in the United States were more likely to have higher-risk disease and less likely to receive definitive treatment compared with those diagnosed before the pandemic, according to the findings of separate studies presented at the American Urological Association’s 2023 Annual Meeting in Chicago, Illinois.

“The COVID-19 pandemic was associated with significant changes in the distribution of both stage and grade of prostate cancer,” Edoardo Beatrici, MD, of Brigham and Women’s Hospital in Boston, Massachusetts, and colleagues concluded in a poster presentation. “Possible explanations for this migration include a better selection of patients for prostate biopsy during the pandemic or changes in prostate cancer screening patterns.”¹

Using the National Cancer Database, the investigators identified 398,719 men diagnosed with prostate cancer from 2018 to 2020. They divided the men into a pre-pandemic (2018-2019) group (281,602 men) and a pandemic (2020) group (117,117 men). Compared with the pre-pandemic group, the pandemic group had significant 15% increased odds of metastasis, 3% increased odds of grade group 4 or 5 disease, and 15% increased odds of D’Amico intermediate- and high-risk disease after adjusting for multiple variables, Dr Beatrici reported on behalf of his colleagues. In addition, the pandemic group had significant 6% increased odds of having PSA levels above 20 ng/mL and 12% increased odds of cT3-4 stage disease.

In a separate study of the same patient populations, Dr Beatrici and colleagues compared the likelihood of definitive treatment between the study periods according to grade group.² Among patients with grade group 1 and 2 disease, patients in the pandemic cohort had significant 20% and 15% lower odds of treatment, respectively, compared with their counterparts in the pre-pandemic cohort in adjusted analyses. Among patients with grade group 3 disease, those in the pandemic vs pre-pandemic cohort had significant 13% lower odds of treatment. The investigators found no significant difference between the cohorts among patients with grade group 4 or 5 disease.

During the pandemic, the investigators reported in a poster presentation, patients with grade groups 1, 2, and 3 prostate cancer were more likely to receive expectant management (such as active surveillance or watchful waiting) than definitive treatment, although this was not the case for patients with more aggressive disease.

“This finding suggests a high capacity of facilities to appropriately risk stratify and prioritize higher-risk cases during a public health emergency,” they wrote.

Reference

1. Beatrici E, Labban M, Stone BV, et al. Stage and grade migration of prostate cancer during the COVID-19 pandemic. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Poster MP77-10.
2. Beatrici E, Labban M, Stone BV, et al. Trends in definitive therapy for prostate cancer during the COVID-19 pandemic: A grade-by-grade analysis. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Abstract MP77-20.