After the start of the first COVID-19 pandemic lockdown in England in 2020, the number of men with newly diagnosed prostate cancer dropped sharply, a finding echoing similar experiences elsewhere.
Investigators examined diagnostic and treatment activity in 2020 across hospital providers of prostate cancer care in the English National Health Service (NHS). They compared diagnostic and treatment activity during the first lockdown (March 23 to July 4, 2020) with the corresponding period in 2019.
Between those periods, the number of men newly diagnosed with prostate cancer plunged 48.3%, Julie Nossiter, PhD, of the Department of Health Services Research and Policy at the London School of Hygiene and Tropic Medicine in London, UK, and colleagues reported in BJU International.
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The monthly number of diagnoses increased after lockdown restrictions were lifted in July 2020, but there was an overall 30.8% reduction in diagnoses from March 23 (the start of the first lockdown) to December 31, 2020 compared with same period in 2019. During the first lockdown period (March 23 to July 4, 2020), the number of radical prostatectomies (RPs) declined by 46.3% compared with the same calendar period in 2019. By June 2020, the number of RPs increased to 2019 levels. Investigators, however, observed a further decline in surgical activity from August 2020 onward. Overall, the number of RPs during March 23 to December 31, 2020 fell by 26.9% compared with the corresponding period in 2019.
During the first lockdown period, the number of men treated with external beam radiation therapy (EBRT) decreased 45.4% from the same calendar period in 2019. EBRT use increased substantially from July to September 2020, but decreased below 2019 levels from October 2020 onward. From March 23 to December 31, 2020, EBRT use decreased 14.1% compared with same period in 2019.
In addition, the study revealed a shift in treatment patterns, including increased use of EBRT with hypofractionation and reduced use of docetaxel chemotherapy in men with hormone-sensitive metastatic prostate cancer, with a related increase in the use of enzalutamide.
Men diagnosed during the first lockdown were more likely to be diagnosed with a more advanced cancer than those diagnosed during the corresponding period in 2019 (stage IV: 21.2% vs 17.4%).
England is among other countries in which investigators identified a link between the COVID-19 pandemic and a decrease in prostate cancer diagnoses. For example, in Sweden from March 18 to June 2, 2020, 36% fewer prostate cancer cases were reported to the country’s National Prostate Cancer Registry compared with the corresponding periods in 2017-2019, investigators reported in the Scandinavian Journal of Urology.
References
Nossiter J, Morris M, Parry MG, et al. Impact of the COVID-19 pandemic on the diagnosis and treatment of men with prostate cancer. BJU Int. Published online January 25, 2022.
doi:10.1111/bju.15699
Fallara G, Sandin F, Styrke J, et al. Prostate cancer diagnosis, staging, and treatment in Sweden during the first phase of the COVID-19 pandemic. Scand J Urol. 2021;55:184-191. doi:10.1080/21681805.2021.1910341
