(UroToday.com) The 2023 American Urological Association (AUA) annual meeting held in Chicago, IL, hosted a moderated poster session focusing on the epidemiology and natural history of prostate cancer. Dr. Edoardo Beatrici presented the results of an analysis evaluating trends in definitive therapy for prostate cancer patients diagnosed during the COVID-19 pandemic.
The COVID-19 pandemic placed a significant burden on the US healthcare system, and many hospitals had to triage patients based on the severity/urgency of their oncologic condition. This led to many patients likely receiving delayed intervention with an increased adoption of conservative management strategies. The objective of this study was to assess the impact of the COVID-19 pandemic on the management of prostate cancer patients, stratified by the International Society of Urological Pathology (ISUP) Grade Group classification.
The authors identified prostate cancer patients diagnosed between 2018 and 2020 using the National Cancer Database (NCDB). Patients were divided into “Pre-Pandemic” (2018/2019) and “Pandemic” (2020) cohorts. Men were stratified by their ISUP Grade Group at diagnosis. Hospital characteristics and patient-level clinical and sociodemographic variables were extracted. The primary outcome was utilization of definitive treatment (i.e., surgery or radiation) versus expectant management (i.e., active surveillance, watchful waiting, or no treatment). The association between year of diagnosis (2018-2019 versus 2020) and odds of receiving definitive treatment were analyzed using multivariable logistic regression analysis, adjusted for clinical and sociodemographic characteristics.
This analysis included a total of 398,719 men diagnosed between 2018 and 2020: 71% and 29% during the “pre-pandemic” and “pandemic” periods, respectively. The Grade Group breakdown was as follows:
- Grade Group 1: 25%
- Grade Group 2: 31%
- Grade Group 3: 18%
- Grade Group 4: 13%
- Grade Group 5: 14%
Compared to the “pre-pandemic” period, decreased odds of definitive treatment in the pandemic year of 2020 were observed for patients with:
- Grade Group 1 (aOR: 0.80; 95% CI 0.77 - 0.83; p-value <0.001)
- Grade Group 2 (aOR: 0.85; 95% CI 0.81 - 0.89; p-value <0.001)
- Grade Group 3 (aOR: 0.87; 95% CI 0.80 - 0.96; p-value < 0.003)
Conversely, no significant differences in the odds of receiving definitive treatment were observed for patients with Grade Group 4 or 5 disease.
Dr. Beatrici concluded that during the COVID-19 pandemic year of 2020, patients diagnosed with ISUP Grade Group 1 – 3 prostate cancers had decreased odds of definitive treatment when compared to expectant management. This however was not observed for patients with Grade Group 4 or 5 disease. This study was limited by the lack of time-to-event data, whereby delays in time to intervention could not be assessed. Furthermore, the authors were unable to assess the treatment trends of men diagnosed in the last quarter of 2020 due to the lack of such follow-up.
Presented by: Edoardo Beatrici, MD, Urology Resident Physician, Humanitas University, Milan, Italy
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023