Impact of COVID-19 pandemic on prostate cancer outcomes at an uro-oncology referral center.

INTRODUCTION: To evaluate the possible effects of the coronavirus disease 2019 (COVID-19) pandemic on the oncologic results of patients with prostate cancer regarding clinical staging, presence of adverse pathological outcomes, and perioperative complications. MATERIALS AND METHODS: This retrospective study included patients who underwent radical prostatectomy. The time between biopsy and surgery, staging tests, final histopathological evaluation after surgery, lymphadenectomy rate, postoperative complications, and prostatic specific antigen (PSA) levels (initial and 30 days after surgery) were analyzed and compared in a group of patients before and during the pandemic period. RESULTS: We included 226 patients: 88 in the pre-pandemic period and 138 during the pandemic period. There was no statistically significant difference in mean age, body mass index, ASA, pathological locally advanced disease, the proportion of patients who underwent lymphadenectomy, and ISUP grade in the biopsy between the groups. Positive surgical margins, prostatic extracapsular extension, and PSA levels at 30 days were also similar between the groups. The mean time between medical consultation and surgery was longer in the pandemic period than in the pre-pandemic (124 vs. 107 days, p<0.001), and the mean time between biopsy and medical consultation (69.5 days vs. 114 days, p<0.001) and between biopsy and surgery (198.5 days vs. 228 days, p=0.013) was shorter during the pandemic. The incidence of severe early and late perioperative complications was similar between the periods. CONCLUSIONS: There was no delay between diagnosis and treatment at our institution during the COVID-19 pandemic period. No worsening of the prostate cancer features was observed.

Secondary Educators' Writing Practices for Students with Disabilities: Examining Distance Learning and In-Person Instruction

We report results of a national survey of secondary teachers who teach special education and/or English language arts in the United States. A total of 50 teachers from 27 different states completed the survey. In the survey, we asked teachers about their experience delivering distance and in-person instruction during the COVID-19 pandemic. We specifically focused on three broad areas: writing assignments, writing instructional practices, and adaptations used to support students with disabilities. We also collected information about teacher characteristics, technology use, and teacher attitudes and self-efficacy about writing. On average, teachers reported receiving minimal preparation to teach writing via distance or in-person instruction. When compared to in-person instruction, teachers reported using fewer writing assignments, evidence-based writing practices, and adaptations for students with disabilities during distance learning. We provide implications for teacher professional development and detail limitations related to sample size and response rate © The Author(s) 2022.

Prostatic Cancer: Analysis of the mortality rate in Chile between 2017-2021

Introduction: Prostate cancer (PC) is a hormone-dependent neoplasm of the prostate. It presents a global mortality in decline, decreasing from 39 to 19 per 100,000 people;In Chile there is no recent data. Objective: To describe the mortality rate (MR) of prostate cancer in the years between 2017-2021 in Chile. Material y methods: An ecological study on deaths from PC in the period 2017-2021 in Chile(n=10,783, according to age group and region. Using data obtained by the Departamento de Estadística e Información de Salud, to perform descriptive statistics and calculation MR. No ethics committee was required. Results: A MR of 34.84/100,000 men in the period studied was evidenced, presenting a decrease of 7.90%. The age group of 65 to 79 years old presented a greater number of deaths with 139.95%(4308). The metropolitan regon presented the largest number of functions with 32.96% (3,555). Conclusion: The decrease in MR during the covid-19 pandemic may be due to the fact that patients were possibly misclassified as covid-19 deaths. Regarding the age group with the highest number of deaths, it is consistent with the literature. The region with the highest number of deaths was the most populated region of Chile, which may have the highest number of patients with PC. In conclusion, CP presents high TM in older age groups, it is important to make diagnoses in a timely manner, since it is a detectable pathology that entails health costs. (English) [ FROM AUTHOR]

The Impact of the Ongoing COVID-19 Epidemic on the Increasing Risk of Adverse Pathology in Prostate Cancer Patients Undergoing Radical Prostatectomy.

We aimed to assess whether the ongoing course of the COVID-19 epidemic has been associated with an increased risk of adverse pathology (AP) findings in prostate cancer (PC) patients treated with radical prostatectomy (RP). We performed a retrospective data analysis which included 408 consecutive, non-metastatic, previously untreated PC patients who underwent RP in our institution between March 2020 and September 2021. Patients were divided into two equally numbered groups in regard to the median surgery date (Early Epidemic [EE] and Late Epidemic [LE]) and compared. Adverse pathology was defined as either grade group (GG) ≥ 4, pT ≥ 3a or pN+ at RP. Patients in the LE group demonstrated significantly higher rates of AP than in the EE group (61 vs. 43% overall and 50 vs. 27% in preoperative non-high-risk subgroup, both p < 0.001), mainly due to higher rates of upgrading. On multivariable analysis, consecutive epidemic week (odds ratio: 1.02, 95% confidence interval: 1.00-1.03, p = 0.009) as well as biopsy GG ≥ 2 and a larger prostate volume (mL) were associated with AP in non-high-risk patients. The study serves as a warning call for increased awareness of risk underassessment in contemporarily treated PC patients.

Impact of the COVID-19 outbreak on prostate cancer care in the Netherlands.

INTRODUCTION: The COVID-19 outbreak has affected care for non-COVID diseases like cancer. We evaluated the impact of the COVID-19 outbreak on prostate cancer care in the Netherlands. METHODS: Prostate cancer diagnoses per month in 2020-2021 versus 2018-2019 were compared based on preliminary data of the Netherlands Cancer Registry (NCR) and nationwide pathology network. Detailed data was retrieved from the NCR for the cohorts diagnosed from March-May 2020 (first COVID-19 wave) and March-May 2018-2019 (reference). Changes in number of diagnoses, age, disease stage and first-line treatment were compared. RESULTS: An initial decline of 17% in prostate cancer diagnoses during the first COVID-19 wave was observed. From May onwards the number of diagnoses started to restore to approximately 95% of the expected number by the end of 2020. Stage at diagnosis remainedstable over time. In low-risk localised prostate cancer radical prostatectomy was conducted more often in week 9-12 (21% versus 12% in the reference period; OR=1.9, 95% CI; 1.2-3.1) and less active surveillance was applied (67% versus 78%; OR=0.6, 95% CI; 0.4-0.9). In the intermediate-risk group, a similar change was observed in week 13-16. Radical prostatectomy volumes in 2020 were comparable to 2018-2019. CONCLUSION: During the first COVID-19 wave the number of prostate cancer diagnoses declined. In the second half of 2020 this largely restored although the number remained lower than expected. Changes in treatment were temporary and compliant with adapted guidelines. Although delayed diagnoses could result in a less favourable stage distribution, possibly affecting survival, this seems not very likely.

Designing Supportive e-Interventions for Partners of Men With Prostate Cancer Using Female Partners' Experiences: Qualitative Exploration Study.

BACKGROUND: Partners of men living with prostate cancer (PCa) can experience a variety of unmet needs that are largely unaddressed by health care professionals. There is limited evidence to suggest which approach may be most effective in supporting partners' unmet needs and further research is required to determine how to provide support to caregivers and how technology solutions can be designed. OBJECTIVE: This study aims to explore the experience of partners of men living with PCa and their perceptions of the potential role of information technology in supporting their needs. METHODS: A qualitative descriptive methodology using focus groups and phone interviews was used. Purposive sampling was used to recruit people attending a national conference supported by a national PCa organization. Interview guides were adapted from an existing evidence-based smartphone app for caregivers of people with colorectal cancer. Sessions were audio recorded and transcribed verbatim. A coding framework was developed, and transcripts were coded line by line into the framework. Codes within the framework were grouped into descriptive categories that were then developed into analytical themes. RESULTS: A total of 17 female partners participated in the study, with an average age of 64 (SD 8.5) years. The following two main themes emerged: In the first theme, that is, How technology can be shaped to support female partners of prostate cancer survivors, the content and design of the smartphone app was discussed in addressing female partners' needs. The following four subthemes were developed: getting support from social networks and resources, the lack of relevant information, demystifying future care expectations during and following a PCa diagnosis, and delivering the smartphone app-to whom and from whom. In the second theme, that is, The benefits and barriers of technology, the suitability of smartphone apps as a supportive modality for female partners was described. This included three subthemes: the smartphone app as an appropriate modality for supporting female partners, the future anticipated benefits of using the smartphone app, and concerns for storing and accessing information on the internet. CONCLUSIONS: A smartphone app may be a suitable modality for providing information and peer support to female partners of men living with PCa. There is a need to provide peer support for female partners in future interventions to ensure that female partners' intimacy and daily practical needs are met.

Impact of COVID-19 on Initial Management and Evaluation of Prostate Cancer.

INTRODUCTION: The COVID-19 pandemic starkly affected all aspects of health care, forcing many to divert resources towards emergent patient needs while decreasing emphasis on routine cancer care. We compared prostate cancer care before and during the pandemic in a multi-institutional cohort. METHODS: A prospective regional collaborative was queried to assess practice pattern variations relative to the initial COVID-19 lockdown (March 16 to May 15, 2020). The preceding 10 months were selected for comparison. The impact of the lockdown was evaluated on the basis of 1) weekly trends in biopsy and radical prostatectomy volumes, 2) comparisons between those undergoing prostate biopsy, and 3) clinicopathological characteristics within radical prostatectomy patients. Categorical variables were compared using Fisher's exact and Pearson's chi-square tests, and Wilcoxon rank sum test to evaluate continuous covariates. RESULTS: Overall, there was a 55% and 39% decline in biopsy and prostatectomy volumes, respectively. During the pandemic, biopsy patients were younger with fewer COVID-19 severity risk factors (17.0% vs 9.7% no risk factors, p=0.023) and prostatectomy patients had higher grade group (GG; 45.6% >GG 4 vs 28%, p=0.01). Large variation in the change in procedural volume was noted across practice sites. CONCLUSION: In a multi-institutional assessment of surgical and diagnostic delay for prostate cancer, we found a non-uniform decline in procedural volume across sites. Future analyses within this cohort are needed to further discern the effects of care delays related to COVID-19.

Influence of androgen deprivation therapy on the severity of COVID-19 in prostate cancer patients.

BACKGROUND: The TMPRSS2 protein has been involved in severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). The production is regulated by the androgen receptor (AR). It is speculated that androgen deprivation therapy (ADT) may protect patients affected by prostate cancer (PC) from SARS-CoV-2 infection. METHODS: This is a retrospective study of patients treated for COVID-19 in our institution who had a previous diagnosis of PC. We analyzed the influence of exposure of ADT on the presence of severe course of COVID-19. RESULTS: A total of 2280 patients were treated in our center for COVID-19 with a worse course of disease in males (higher rates of hospitalization, intense care unit [ICU] admission, and death). Out of 1349 subjects registered in our PC database, 156 were on ADT and 1193 were not. Out of those, 61 (4.52%) PC patients suffered from COVID-19, 11 (18.0%) belonged to the ADT group, and 50 (82.0%) to the non-ADT group. Regarding the influence of ADT on the course of the disease, statistically significant differences were found neither in the death rate (27.3% vs. 34%; p = 0.481), nor in the presence of severe COVID-19: need for intubation or ICU admission (0% vs. 6.3%; p = 0.561) and need for corticoid treatment, interferon beta, or tocilizumab (60% vs. 34.7%; p = 0.128). Multivariate analysis adjusted for clinically relevant comorbidities did not find that ADT was a protective factor for worse clinical evolution (risk ratio [RR] 1.08; 95% confidence interval [CI], 0.64-1.83; p = 0.77) or death (RR, 0.67; 95% CI, 0.26-1.74; p = 0.41). CONCLUSIONS: Our study confirms that COVID-19 is more severe in men. However, the use of ADT in patients with PC was not shown to prevent the risk of severe COVID-19.

Androgen Deprivation Therapy in Men with Prostate Cancer Does Not Affect Risk of Infection with SARS-CoV-2.

PURPOSE: TMPRSS2 is a host co-receptor for cell entry of SARS-CoV-2. A prior report suggested that use of androgen deprivation therapy, which downregulates TMPRSS2, may protect men with prostate cancer from infection. MATERIALS AND METHODS: This is a cohort study of a prospective registry of all patients tested for SARS-CoV-2 between March 12 and June 10, 2020 with complete followup until disease recovery or death. The main exposure examined was the use of androgen deprivation therapy, and the outcome measures were the rate of SARS-CoV-2 positivity and disease severity as a function of androgen deprivation therapy use. RESULTS: The study cohort consisted of 1,779 men with prostate cancer from a total tested population of 74,787, of whom 4,885 (6.5%) were positive for SARS-CoV-2. Of those with prostate cancer 102 (5.7%) were SARS-CoV-2 positive and 304 (17.1%) were on androgen deprivation therapy. Among those on androgen deprivation therapy 5.6% were positive as compared to 5.8% not on androgen deprivation therapy. Men on androgen deprivation therapy were slightly older (75.5 vs 73.8 years, p=0.009), more likely to have smoked (68.1% vs 59.3%, p=0.005) and more likely to report taking steroids (43.8% vs 23.3%, p <0.001). Other factors known to increase risk of infection and disease severity were equally distributed (asthma, diabetes mellitus, hypertension, coronary artery disease, heart failure and immune suppressive disease). Multivariable analysis did not indicate a difference in infection risk for those with prostate cancer on androgen deprivation therapy (OR 0.93, 95% CI 0.54-1.61, p=0.8). CONCLUSIONS: Androgen deprivation therapy does not appear to be protective against SARS-CoV-2 infection.

Delayed Radical Prostatectomy is Not Associated with Adverse Oncologic Outcomes: Implications for Men Experiencing Surgical Delay Due to the COVID-19 Pandemic.

PURPOSE: The 2019 novel Coronavirus (COVID-19) pandemic has forced many health care organizations to divert efforts and resources to emergent patient care, delaying many elective oncologic surgeries. We investigated an association between delay in radical prostatectomy and oncologic outcomes. MATERIALS AND METHODS: This is a retrospective review of men with intermediate and high risk prostate cancer in the National Cancer Database undergoing radical prostatectomy from 2010 to 2016. Immediate radical prostatectomy was defined as radical prostatectomy within 3 months of diagnosis, while delayed radical prostatectomy was analyzed in 3-month intervals up to 12 months. Multivariable logistic regression models were fit to test for associations between levels of delayed radical prostatectomy and outcomes of interest (adverse pathology, upgrading on radical prostatectomy, node positive disease and post-radical prostatectomy secondary treatments) compared with men undergoing immediate radical prostatectomy. RESULTS: We identified 128,062 men with intermediate and high risk prostate cancer treated with radical prostatectomy. After adjustment, we did not appreciate a significant difference in odds of adverse pathology, upgrading, node positive disease or post-radical prostatectomy secondary treatments between men treated with immediate radical prostatectomy and any level of delay up to 12 months. Subgroup analysis of men with Grade Group 4 and 5 prostate cancer did not demonstrate an association between delayed radical prostatectomy and worse oncologic outcomes. CONCLUSIONS: In the National Cancer Database delayed radical prostatectomy was not associated with early adverse oncologic outcomes at radical prostatectomy. These results may provide reassurance to patients and urologists balancing care in the current pandemic.

Clinical activity of pembrolizumab in metastatic prostate cancer with microsatellite instability high (MSI-H) detected by circulating tumor DNA.

To report a multi-institutional case series of patients with advanced microsatellite instability high (MSI-H) prostate adenocarcinoma identified with clinical cell-free DNA (cfDNA) next-generation sequencing (NGS) testing and treated with immune checkpoint inhibitors. Retrospective analysis of patients with metastatic castration-resistant prostate cancer (mCRPC) and MSI-H tumor detected by a commercially available cfDNA NGS assay Guardant360 (G360, Guardant Health) at eight different Academic Institutions in the USA, from September 2018 to April 2020. From a total of 14 MSI-H metastatic prostate cancer patients at participating centers, nine patients with mCRPC with 56% bone, 33% nodal, 11% liver and 11% soft-tissue metastases and a median PSA of 29.3 ng/dL, were treated with pembrolizumab after 2 lines of therapy for CRPC. The estimated median time on pembrolizumab was 9.9 (95% CI 1.0 to 18.8) months. Four patients (44%) achieved PSA50 after a median of 4 (3-12) weeks after treatment initiation including three patients with >99% PSA decline. Among the patients evaluable for radiographic response (n=5), the response rate was 60% with one complete response and two partial responses. Best response was observed after a median of 3.3 (1.4-7.6) months. At time of cut-off, four patients were still on pembrolizumab while four patients discontinued therapy due to progressive disease and one due to COVID-19 infection. Half of the patients with PSA50 had both MSI-H and pathogenic alterations in BRCA1 and BRCA2 in their G360 assays. The use of liquid biopsy to identify metastatic prostate cancer patients with MSI-H is feasible in clinical practice and may overcome some of the obstacles associated with prostate cancer tumor tissue testing. The robust activity of pembrolizumab in selected patients supports the generalized testing for MSI-H.