Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 5 de 5
Filter
Add filters

Database
Language
Document Type
Year range
1.
Journal of Urology ; 209(Supplement 4):e1110, 2023.
Article in English | EMBASE | ID: covidwho-2312938

ABSTRACT

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic placed a significant burden on the US healthcare system. Moreover, many healthcare systems triaged cases based on the severity of disease. Therefore, we assessed the impact of the COVID-19 pandemic on prostate cancer management according to the International Society of Urological Pathology (ISUP) grade groups. METHOD(S): We retrospectively analyzed the National Cancer Database (NCDB) for patients with prostate cancer between 2018- 2020. We divided our cohort into "Pre-Pandemic" (2018/2019) and "Pandemic" (2020) periods. Men were classified according to their ISUP grade group at diagnosis. Hospital characteristics and patient-level clinical and sociodemographic variables were extracted. Our primary outcome was the utilization of definitive treatment (surgery or radiation) versus expectant management (active surveillance, watchful waiting, or no treatment). We performed multivariable logistic regressions to predict the type of management for each ISUP grade group across the two periods adjusting for clinical and socioeconomic covariates. RESULT(S): A total of 398,719 men with a diagnosis of prostate cancer were reported during the "Pre-Pandemic" (70.6%) and "Pandemic" (29.4%) periods. Overall, 24.5% had an ISUP 1, 30.6% an ISUP 2, 18.2% an ISUP 3, 13% ISUP 4, and 13.8% ISUP 5 disease (Table 1). Treatment was less likely during the "Pandemic" compared to the "Pre-Pandemic" period for ISUP grade group 1 (aOR 0.80;95% CI 0.77 - 0.83;p-value <0.001), for ISUP grade group 2 (aOR 0.85;95% CI 0.81 - 0.89;p-value <0.001) and for ISUP grade group 3 (aOR 0.87;95% CI 0.80 - 0.96;p-value <0.003). However, no differences in treatment trends were found for ISUP grade groups 4 and 5 across the two time periods. CONCLUSION(S): During the COVID-19 pandemic, patients with prostate cancers ISUP grade groups 1, 2, and 3 were more likely to receive expectant management than definitive treatment;however, this was not true for patients with more aggressive diseases. This finding suggests a high capacity of facilities to appropriately risk stratify and prioritize higher-risk cases during a public health emergency. A limitation of our study is the inability to assess the treatment trends of men diagnosed in the last 2020 quarter due to the lack of follow-up.

2.
Journal of Urology ; 209(Supplement 4):e1105, 2023.
Article in English | EMBASE | ID: covidwho-2312937

ABSTRACT

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic likely affected the healthcare system's ability to deliver prostate cancer care services. Herein, we sought to evaluate prostate cancer's stage and grade migration resulting from the COVID-19 pandemic. METHOD(S): We retrospectively analyzed the National Cancer Database (NCDB) for men with prostate cancer between 2018-2020. We divided our cohort into the "Pre-Pandemic" (2018/2019) and "Pandemic" (2020) periods. Stage and grade of prostate cancer were stratified according to the severity of disease: PSA value (<=20 vs. >20), clinical T stage (cT1-T2 vs. cT3-T4), clinical M stage (cM0 vs. cM1), International Society of Uropathology (ISUP) grade group (ISUP 1-2-3 vs. ISUP 4-5), and D'Amico risk classification (low risk vs. intermediate & high risk). Pearson's chi-square test was used to assess differences in the distribution of stage and grade across the two periods. We performed multivariable logistic regressions to estimate the effect of the "Pandemic" period on stage and grade distribution adjusting for clinical and socioeconomic covariates. RESULT(S): A total of 398,719 men were diagnosed with prostate cancer during the "Pre-pandemic" (70.6%) and "Pandemic" (29.4%) periods (Table 1). On univariable comparisons, an increase in stage/ grade across the two periods was demonstrated (all p<0.001). After adjusting for covariates, compared to the "Pre-pandemic", the "Pandemic" period was associated with increased odds of PSA >20 levels (aOR 1.06;95% CI 1.03 - 1.08;p-value <0.001), cT3-4 stages (aOR 1.12;95% CI 1.08 - 1.16;p<0.001), cM1 stage (aOR 1.15;95% CI 1.12 - 1.18;p<0.001), ISUP grade group 4 or 5 (aOR 1.03;95% CI 1.01 - 1.05;p=0.003) and D'Amico Intermediate & High risk groups (aOR 1.15;95% CI 1.13 - 1.18;p<0.001). CONCLUSION(S): The COVID-19 pandemic was associated with significant changes in the distribution of both stage and grade of prostate cancer. Possible explanations for this migration include a better selection of patients for prostate biopsy during the pandemic or changes in prostate cancer screening patterns.

3.
Journal of Urology ; 209(Supplement 4):e1157, 2023.
Article in English | EMBASE | ID: covidwho-2312738

ABSTRACT

INTRODUCTION AND OBJECTIVE: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program in these patients. METHOD(S): A two arm, retrospective study on patients who underwent a RARP at a single institution in two pre-specified time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT;period from prostate biopsy to surgery), biochemical recurrence (BCR) and/or imaging evidence of progression. RESULT(S): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p<0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were continent and 30 (22.1%) patients had recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p<0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p<0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or imaging disease progression (8.1% vs 2.7%, p>=0.05). CONCLUSION(S): Our rehabilitation program is an valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies are still needed to confirm our results.

4.
European Urology ; 83(Supplement 1):S705, 2023.
Article in English | EMBASE | ID: covidwho-2250599

ABSTRACT

Introduction & Objectives: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program among patient with intermediate, high-risk PCa underwent RARP. Material(s) and Method(s): A two arm, retrospective study on patients who underwent a RARP at a single institution in two time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT), defined as period from prostate biopsy to surgery and oncological outcomes, defined as biochemical recurrence (BCR) and/or imaging evidence of progression. Result(s): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. No significant differences in baseline characteristics, clinical and pathological features were observed between the two groups. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p <0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were fully continent and 30 (22.1%) patients had full recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p <0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p <0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or disease progression between the two groups (8.1% vs 2.7%, p>=0.05). Conclusion(s): Our rehabilitation program appears to be a valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies on larger populations are still needed to confirm our results.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

5.
European Urology Open Science ; 44(Supplement 1):S112, 2022.
Article in English | EMBASE | ID: covidwho-2132862

ABSTRACT

Author of the study: The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of several urological malignancies. To determine the impact of COVID-19 pandemic on the outcomes of patients with prostate cancer (PCa) treated with robotassisted radical prostatectomy (RARP) at a single tertiary-care center. Material(s) and Method(s): A retrospective study on patients who underwent a RARP at a single institution in two pre-specified time intervals, namely March-July 2019 (pre-COVID) and March-July 2020 (during-COVID), was conducted. Surgical waiting time (SWT) was defined as the period from prostate biopsy to surgery. All patients in the pre-COVID era underwent a specific pre- rehabilitation program, consisting of preoperative pelvic floor muscle exercises starting at least 1-month before RARP, as well as counselling with a prostate casemanager. After surgery, all patients underwent a structured follow-up both with physiotherapists and andrologists. During the COVID period, this specific program was not guaranteed. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as an erection sufficient for intercourse. Oncological outcomes were defined as biochemical recurrence and/or imaging evidence of progression. Result(s): A total of 249 patientswere eligible for analysis,136 (54.6%) in the pre-COVID and 113 (45.4%) in the COVID time-span. No significant differences in baseline characteristics, clinical and pathological features were observed between the two groups. Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020. Median (IQR) follow-up was 25 (15-27) months. At 45 days, 6 months and 1 year follow-up no significant differences were observed in biochemical recurrence and progression- free survival rates. Biochemical recurrence at last followup was observed in 11 (8.1%) patients of pre-COVID and 3 (2.7%) patients during COVID. At the first follow-up visit 45 days after RARP, 49 (36.0%) patientswere continent and 6 (4.4%) patients had preserved EF in the pre-COVID group period, as compared to 8 (7.08%) and 0 (0%) in the COVID group (p < 0.001 and p = 0.072 respectively). At 6 months, 131 (96.3%) patients `were continent and 30 (22.1%) patients had EF recovery in pre-COVID group, as compared to 77 (68.14%) and 9 (8.0%) in the COVID group (p < 0.001). Finally, at 1 year 134 (98.5%) patients were continent and 50 (36.8%) patients were fully potent in the pre- COVID period, compared with 96 (85.0%) and 19 (16.8%) during COVID (p < 0.001). Conclusion(s): The use of a pre-rehabilitation program, which was routinely used in the pre-COVID era, appears to significantly improve the functional outcomes of patients subjected to RARP. On the other side, surgical delay does not appear to significantlyworsen oncological outcomes, even though these findings are limited by the short followup time. Copyright © 2022 European Association of Urology. Published by Elsevier B.V.

SELECTION OF CITATIONS
SEARCH DETAIL