(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Christopher Koller discussing the impact of COVID-19 on adhering patients to an active surveillance protocol for prostate cancer. Active surveillance is a protocol widely accepted for low risk prostate cancer to prevent over-treatment while monitoring for progression with strict surveillance protocols including repeat biopsies. The COVID-19 pandemic reached the United States on January 20, 2020 and spread rapidly. Urologists at the Southeast Louisiana Veterans Health Care System (VA) were unable to perform biopsies between March 14, 2020 and June 20, 2020. The purpose of this study was to describe the effects of the COVID-19 pandemic on patients on an active surveillance protocol at the VA.
For this study, all patients on active surveillance at the VA were retrospectively reviewed. The inclusion criteria was a biopsy due date between February 1, 2020 and January 31, 2021, defined as less than one year after initial diagnostic biopsy or 21-27 months after a repeat biopsy. Patients who received biopsy on time (on time group), were compared to patients who did not receive biopsy on time (missed group). A Mann-Whitney u test was used to compare demographic variables. As follow is a timeline of pandemic events specific to the Southeast Louisiana VA:
Overall, there were 79 individuals that met inclusion criteria, of which 32 (40%) received a biopsy on time, while 47 (60%) missed their biopsy. Of those who missed their biopsy, only 4 patients were able to make up their biopsy as of January 31, 2021. Compared to the on time group, the missed group had significantly higher PSA density (p = 0.002) and lower prostate volume on TRUS (p = 0.03). There was no significant difference between groups for race, age, BMI, PSA, number of positive cores, or NCCN risk stratification at diagnosis:
Overall, 7 patients passed from COVID-related death, all from the missed group. Within the on-time group, 41% of patients were upgraded on their 2020 biopsies.
Dr. Koller concluded his presentation discussing the impact of COVID-19 on adhering patients to an active surveillance protocol for prostate cancer with the following take-home messages:
- COVID-19 delayed the biopsies of 60% of this active surveillance cohort and 7 patients died from COVID-related illness, demonstrating the profound impact of the pandemic
- Long term follow-up is needed to identify the true impact of the pandemic for these patients
Presented By: Christopher Koller, MD, Department of Urology, Tulane University School of Medicine, New Orleans, LA
Co-Authors: Joshua Pincus, Caleb Natale, Jacob W. Greenberg, L. Spencer Krane
Affiliations: Department of Urology, Tulane University School of Medicine, New Orleans, LA
Written By: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 86th Annual Meeting of the Southeastern Section of the American Urological Association, San Juan, PR, Mar 16 – 19, 2022