Impact of the Covid-19 pandemic on the diagnosis and treatment of men with prostate cancer.

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.

Diagnostic and treatment activity between March 23rd (start of first national lockdown in England) and December 31st 2020 was compared with same calendar period in 2019. Patients newly diagnosed with PCa were identified in national rapid cancer registration data linked to other electronic healthcare datasets.

There was a 30.8% reduction (22,419 versus 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 more advanced stage (21.2% versus 17.4%, stage IV) and slightly older (57.9% versus 55.9% ≥ 70 years, p<0.001). Prostate biopsies in 2020 were more often performed through using transperineal routes (64.0% versus 38.2%). The number of radical prostatectomies in 2020 was reduced by 26.9% (3,896 versus 5,331) and the number treated by external beam radiotherapy (EBRT) by 14.1% (9,719 versus 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 versus 1,519) with related increase in the use of enzalutamide.

We 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 transperineal 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.

BJU international. 2022 Jan 25 [Epub ahead of print]

Julie Nossiter, Melanie Morris, Matthew G Parry, Arunan Sujenthiran, Paul Cathcart, Jan van der Meulen, Ajay Aggarwal, Heather Payne, Noel W Clarke

Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine., Clinical Effectiveness Unit, Royal College of Surgeons of England., Department of Urology, NHS Foundation Trust, Guy's and St Thomas., Department of Oncology, University College London Hospitals NHS Foundation Trust, London., Department of Urology, The Christie and Salford Royal NHS Foundation Trusts.