Over the nearly two years of navigating the COVID pandemic, urology practices were forced to increase their efficiency by focusing on streamlining patient visits without sacrificing care quality. However, postponed checkups were unavoidable as the public was encouraged to stay home. According to the Centers for Disease Control and Prevention (CDC), 40% of Americans in 2020 delayed or avoided medical care due to pandemic-related concerns. Although necessary, we are now facing the severe consequences of delayed diagnosis and prostate cancer seems to be leading the way.
Because of the pandemic, rate of advanced prostate cancer has increased significantly. The American Cancer Society (ACS) estimates prostate cancer cases will rise from 191,930 to 248,530 from 2020 to 2021. The implication is that urologists are now combatting not just more positive prostate biopsies, but a higher volume of more aggressive cancer diagnoses as well.
Prior to the pandemic, the urology field was already experiencing a higher trend in positive and aggressive prostate cancer diagnoses, perhaps due to the change in screening guidelines caused by the United States Preventive Services Task Force (USPSTF). I’d estimate that the positive biopsy rate has increased 10 to 15% since the start of the pandemic.
The increase of prostate cancer cases makes physicians wary of overtreatment because the vast majority of men who have prostate cancer will not die of it. Because prostate cancer is highly survivable if detected early, urologists should focus on utilizing early detection tools that will better stratify patients into groups of high risk or low risk.
The rising number of positive prostate biopsies should serve as a catalyst for implementing biomarker tools into a patient’s clinical pathway, especially with the uncertainty surrounding the new COVID-19 Omicron variant. Prostate cancer biomarkers should be utilized to help determine patients at low vs. high risk for clinically significant prostate cancer, so patients may be prioritized accurately for detection and treatment and not be subjected to unnecessary visits.
Biomarker tests are no longer a novelty. Several biomarker tests are included in the NCCN Guidelines for the Early Detection of Prostate Cancer and many don’t require an additional in-person office visit. These tools can detect “hidden” or “missed” prostate cancer and prevent overtreatment. These tests, in combination with the standard of care screening tests, will improve patient outcomes.
I encourage all physicians to explore biomarker tests to understand how they can benefit your patients. At my practice, I still see patients who are appropriately hesitant to participate in in-person checkups. It’s our duty to provide the best care for men at risk for prostate cancer, and that includes incorporating biomarker tests into our clinical pathways, so that we can reduce prostate cancer mortalities.
Written by: David Crawford, MD, E. David Crawford, MD, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer. He is currently a Professor of Urology at the University of California, San Diego, and emeritus distinguished endowed Professor of Surgery, Urology, and Radiation Oncology, and Head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. Dr. Crawford received his medical degree from the University of Cincinnati and his postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship at the University of California Medical Center in Los Angeles.