Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 20
Filter
1.
Sci Rep ; 11(1): 21526, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1500514

ABSTRACT

Earlier in 2020, seven Italian regions, which cover 62% of the Italian population, set up the Mimico-19 network to monitor the side effects of the restrictive measures against Covid-19 on volumes and quality of care. To this aim, we retrospectively analysed hospital discharges data, computing twelve indicators of volume and performance in three clinical areas: cardiology, oncology, and orthopaedics. Weekly indicators for the period January-July 2020 were compared with the corresponding average for 2018-2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown, and post-lockdown. The weekly trend of hospitalisations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Malignant neoplasms surgery volumes differed substantially by site, with a limited reduction for lung cancer (< 20%) and greater declines (30-40%) for breast and prostate cancers. The percentage of timely surgery for femoral neck in the elderly remained constantly higher than the previous 2 years whereas hip and knee replacements fell dramatically. Hospitalisations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. General trends did not show important differences across regions, regardless of the different burden of Covid-19. Preventive and primary care services should adopt a pro-active approach, moving towards the identification of at-risk conditions that were neglected during the pandemic and timely addressing patients to the secondary care system.


Subject(s)
COVID-19/epidemiology , Hospitalization/statistics & numerical data , Arthroplasty, Replacement, Hip/statistics & numerical data , Arthroplasty, Replacement, Knee/statistics & numerical data , Breast Neoplasms/pathology , Breast Neoplasms/surgery , COVID-19/therapy , COVID-19/virology , Female , Hospitalization/trends , Humans , Italy , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Quarantine , Retrospective Studies , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/pathology , ST Elevation Myocardial Infarction/therapy
2.
JAMA Oncol ; 7(10): 1467-1473, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1320053

ABSTRACT

Importance: Early in the COVID-19 pandemic, racial/ethnic minority communities disproportionately experienced poor outcomes; however, the association of the pandemic with prostate cancer (PCa) care is unknown. Objective: To assess the association between race and PCa care delivery for Black and White patients during the first wave of the COVID-19 pandemic. Design, Setting, and Participants: This multicenter, regional, collaborative, retrospective cohort study compared prostatectomy rates between Black and White patients with untreated nonmetastatic PCa during the COVID-19 pandemic (269 patients from March 16 to May 15, 2020) and prior (378 patients from March 11 to May 10, 2019). Main Outcomes and Measures: Prostatectomy rates. Results: Of the 647 men with nonmetastatic PCa, 172 (26.6%) were non-Hispanic Black men, and 475 (73.4%) were non-Hispanic White men. Black men were significantly less likely to undergo prostatectomy during the pandemic compared with White patients (1 of 76 [1.3%] vs 50 of 193 [25.9%]; P < .001), despite similar COVID-19 risk factors, biopsy Gleason grade groups, and comparable prostatectomy rates prior to the pandemic (17 of 96 [17.7%] vs 54 of 282 [19.1%]; P = .75). Black men had higher median prostate-specific antigen levels prior to biopsy (8.8 ng/mL [interquartile range, 5.3-15.2 ng/mL] vs 7.2 ng/mL [interquartile range, 5.1-11.1 ng/mL]; P = .04). A linear combination of regression coefficients with an interaction term for year demonstrated an odds ratio for likelihood of surgery of 0.06 (95% CI, 0.01-0.35; P = .002) for Black patients and 1.41 (95% CI, 0.81-2.44; P = .23) for White patients during the pandemic compared with prior to the pandemic. Changes in surgical volume varied by site (from a 33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery caring for a greater proportion of Black patients. Conclusions and Relevance: In this large multi-institutional regional collaborative cohort study, the odds of PCa surgery were lower among Black patients compared with White patients during the initial wave of the COVID-19 pandemic. Although localized PCa does not require immediate treatment, the lessons from this study suggest systemic inequities within health care and are likely applicable across medical specialties. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the COVID-19 pandemic to develop balanced mitigation strategies as viral rates continue to fluctuate.


Subject(s)
African Americans/statistics & numerical data , COVID-19/epidemiology , Prostatectomy/statistics & numerical data , Prostatic Neoplasms/surgery , /statistics & numerical data , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Neoplasm Grading , Pandemics , Prostatic Neoplasms/ethnology , Prostatic Neoplasms/pathology , Retrospective Studies , United States/ethnology
3.
Int J Clin Pract ; 75(8): e14278, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1319297

ABSTRACT

AIM: In this study, we aimed to evaluate the anxiety and depression status of prostate cancer (PCa) patients whose planned operations in the urology clinic of our hospital, which is serving as a pandemic hospital in Turkey have been postponed because of the coronavirus disease 2019 pandemic. METHODS: This survey study was conducted at urology clinic of Ankara City Hospital between March 1 and June 1, 2020, and included 24 male patients who agreed to answer the questionnaires (State-Trait Anxiety Inventory [STAI] I and II and Beck Depression Inventory [BDI]). Demographical and clinical data (age, time since diagnosis, total serum prostate-specific antigen (PSA) levels, risk groups according to the D'Amico classification system, smoking, alcohol habitus, major surgical history and comorbidities) of the patients were collected from hospital software. RESULTS: The mean STAI-I score of the patients (46.7 ± 1.4 [44-49]) was significantly higher than their STAI-II score (41.7 ± 2.4 [39-47]) (P < .001). The negative correlation between the decrease in age and STAI-I score was found to be statistically significant (r = 0.439, P < .05). The mean BDI score of the patients was 4.3 ± 3.2 (0-13), which was compatible with mild depression. There was no statistically significant difference among the time elapsed from diagnosis, PSA levels, smoking and alcohol habitus, major surgical history and comorbidity status and STAI-I, STAI-II and BDI scores (P > .05). CONCLUSION: Prostate cancer patients with postponed operations should be guided properly in order to manage their anxiety status especially young patients.


Subject(s)
COVID-19 , Prostatic Neoplasms , Anxiety/epidemiology , Anxiety/etiology , Depression/epidemiology , Depression/etiology , Humans , Male , Pandemics , Prostatic Neoplasms/complications , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/surgery , SARS-CoV-2 , Turkey
4.
Ann Surg Oncol ; 28(13): 8688-8696, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1282289

ABSTRACT

BACKGROUND: During the height of the coronavirus disease 2019 (COVID-19) pandemic, elective surgeries, including oncologic surgeries, were delayed. Little prospective data existed to guide practice, and professional surgical societies issued recommendations grounded mainly in common sense and expert consensus, such as medical therapy for early-stage breast and prostate cancer patients. To understand the patient experience of delay in cancer surgery during the pandemic, we interviewed breast and prostate cancer patients whose surgeries were delayed due to the pandemic. PATIENTS AND METHODS: Patients with early-stage breast or prostate cancer who suffered surgical postponement at Brigham and Women's Hospital (BWH) were invited to participate. Semi-structured telephone interviews were conducted with 21 breast and prostate cancer patients. Interviews were transcribed, and qualitative analysis using ground-theory approach was performed. RESULTS: Most patients reported significant distress due to cancer and COVID. Key themes that emerged included the lack of surprise and acceptance of the surgical delays but endorsed persistent cancer- and delay-related worries. Satisfaction with patient-physician communication and the availability of a delay strategy were key factors in patients' acceptance of the situation; perceived lack of communication prompted a few patients to seek care elsewhere. DISCUSSION: The clinical effect of delay in cancer surgery will take years to fully understand, but there are immediate steps that can be taken to improve the patient experience of delays in care, including elicitation of individual patient perspectives and ongoing communication. More work is needed to understand the wider experiences of patients, especially minority, socioeconomically disadvantaged, and uninsured patients, who encounter delays in oncologic care.


Subject(s)
COVID-19 , Prostatic Neoplasms , Humans , Male , Pandemics , Prospective Studies , Prostatic Neoplasms/surgery , SARS-CoV-2
5.
BJU Int ; 127(6): 729-741, 2021 06.
Article in English | MEDLINE | ID: covidwho-1138102

ABSTRACT

OBJECTIVE: Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic. METHODS: We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways. RESULTS: Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites. CONCLUSION: Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.


Subject(s)
COVID-19/epidemiology , Critical Pathways , Pandemics , Prostatectomy , Prostatic Neoplasms/surgery , Delphi Technique , Health Care Rationing , Humans , Infection Control , Male , SARS-CoV-2 , Time-to-Treatment
6.
Lancet Oncol ; 22(3): 294-296, 2021 03.
Article in English | MEDLINE | ID: covidwho-1111907
7.
Urologia ; 88(1): 3-8, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1105635

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d'Aosta, estimating its future impact. METHODS: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d'Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. RESULTS: Most centers (77%) declared to be "much"/"very much" affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. CONCLUSIONS: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d'Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.


Subject(s)
COVID-19/epidemiology , Continuity of Patient Care , Health Services Accessibility , Medical Oncology/statistics & numerical data , Pandemics , SARS-CoV-2 , Urologic Surgical Procedures/statistics & numerical data , Urology/statistics & numerical data , Appointments and Schedules , Female , Health Care Surveys , Humans , Italy/epidemiology , Kidney Neoplasms/epidemiology , Kidney Neoplasms/surgery , Male , Medical Oncology/organization & administration , Procedures and Techniques Utilization , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/surgery , Urinary Bladder Neoplasms/epidemiology , Urinary Bladder Neoplasms/surgery , Urologic Neoplasms/epidemiology , Urologic Neoplasms/surgery , Urology/organization & administration
8.
Ulus Travma Acil Cerrahi Derg ; 27(2): 180-186, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1102680

ABSTRACT

BACKGROUND: This article aims to give practical information and concrete suggestions on what should be considered in emergency, semi-urgent and elective settings for common anorectal diseases in the hectic period of the COVID-19 pandemic, based on early results of a series of anorectal interventions. METHODS: Referring to other related guidelines, general considerations specific to the diagnosis and treatment of highly prevalent anorectal diseases were developed to target the correct patients, evaluate and orientate by telemedicine, adapt the Proctology Unit to the new pandemic, and control contamination and infection. Specific considerations for common anorectal diseases were cited, and our initial results were retrospectively documented. RESULTS: From March 1 to April 10, 2020, we contacted 240 patients with anorectal diseases in two centers. We evaluated the results retrospectively on 16-17 April. At the end of this survey, 14 patients (5.8%) were lost for further contact and follow-up. Thirty-one patients (12.9%) were evaluated as nondeferrable cases and invited to the Proctology Unit. Twenty-eight patients required interventions at the same session. Adhering to the principles described here, more than 90 percent of benign anorectal disorders could be treated successfully, with 2.1 percent of suspected contamination and no confirmed cases. None of the Proctology personnel or their close contacts developed COVID-19, either. CONCLUSION: By adhering to the principles outlined in this practical guide, it was possible to treat most of the benign anorectal diseases safely in the initial, hectic period of the COVID-19 pandemic.


Subject(s)
COVID-19 , Colorectal Surgery , Guideline Adherence , Pandemics , Practice Guidelines as Topic , Practice Patterns, Physicians' , SARS-CoV-2 , Colorectal Neoplasms/surgery , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Humans , Male , Prostatic Neoplasms/surgery , Spain
10.
Actas Urol Esp (Engl Ed) ; 44(10): 659-664, 2020 Dec.
Article in English, Spanish | MEDLINE | ID: covidwho-986880

ABSTRACT

INTRODUCTION AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) has caused a pandemic of global impact that forced social-political measures to be taken, such as the declaration of the state of alarm in Spain. At the same time, the reorganization of the pediatric medical-surgical activities and infrastructures was carried out, with the consequent suspension of the non-urgent surgical activity of Pediatric Urology. We analyzed the impact of the COVID-19 pandemic on surgical activity in a Pediatric Urology division, as well as surgical complications according to the Clavien-Dindo classification. MATERIALS AND METHODS: A systematic review of epidemiological, clinical and surgical data was carried out, including complications and readmissions of all patients operated on in the division of Pediatric Urology within the duration of the state of alarm. Five time periods have been created according to the de-escalation phases. RESULTS: Forty-nine surgical procedures were carried out on 45 patients (8 prior to the implementation of the de-escalation phases). High priority pathologies were the most frequent in the first phases, being the ureteropelvic junction (UPJ) obstruction the most prevalent. Four complications were recorded (8.8%), none of them were respiratory. CONCLUSIONS: The EAU recommendations for the resumption of surgical activity have allowed a correct, safe and gradual transition to the routine surgical activity in Pediatric Urology. The Clavien-Dindo classification is useful and valid for application in this division. No respiratory complications have been reported that could be attributable to the pandemic situation.


Subject(s)
COVID-19/epidemiology , Pandemics , Postoperative Complications/epidemiology , SARS-CoV-2 , Urologic Surgical Procedures/adverse effects , Child , Child, Preschool , Female , Humans , Infant , Male , Patient Readmission/statistics & numerical data , Postoperative Complications/classification , Prostatic Neoplasms/surgery , Prune Belly Syndrome/surgery , Retrospective Studies , Rhabdomyosarcoma, Embryonal/surgery , Urinary Bladder Neoplasms/surgery , Urologic Surgical Procedures/statistics & numerical data , Urology Department, Hospital
11.
JAMA Netw Open ; 3(12): e2028320, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-970845

ABSTRACT

Importance: There is a lack of data evaluating the association of surgical delay time (SDT) with outcomes in patients with localized, high-risk prostate cancer. Objective: To investigate the association of SDT of radical prostatectomy and final pathological and survival outcomes. Design, Setting, and Participants: This cohort study used data from the US National Cancer Database (NCDB) and identified all patients with clinically localized (cT1-2cN0cM0) high-risk prostate adenocarcinoma diagnosed between 2006 and 2016 who underwent radical prostatectomy. Data analyses were performed from April 1 to April 12, 2020. Exposures: SDT was defined as the number of days between the initial cancer diagnosis and radical prostatectomy. SDT was categorized into 5 groups: 31 to 60, 61 to 90, 91 to 120, 121 to 150, and 151 to 180 days. Main Outcomes and Measures: The primary outcomes were predetermined as adverse pathological outcomes after radical prostatectomy, including pT3-T4 disease, pN-positive disease, and positive surgical margin. The adverse pathological score (APS) was defined as an accumulated score of the 3 outcomes (0-3). An APS of 2 or higher was considered a separate outcome to capture cases with more aggressive pathological features. The secondary outcome was overall survival. Results: Of the 32 184 patients included in the study, the median (interquartile range) age was 64 (59-68) years, and 25 548 (79.4%) were non-Hispanic White. Compared with an SDT of 31 to 60 days, longer SDTs were not associated with higher risks of having any adverse pathological outcomes (odds ratio [OR], 0.95; 95% CI, 0.80-1.12; P = .53), pT3-T4 disease (OR, 0.99; 95% CI, 0.83-1.17; P = .87), pN-positive disease (OR, 0.79; 95% CI, 0.59-1.06; P = .12), positive surgical margin (OR, 0.88; 95% CI, 0.74-1.05; P = .17), or APS greater than or equal to 2 (OR, 0.90; 95% CI, 0.74-1.05; P = .17). Longer SDT was also not associated with worse overall survival (for SDT of 151-180 days, hazard ratio, 1.12; 95% CI, 0.79-1.59, P = .53). Subgroup analyses performed for patients with very high-risk disease (primary Gleason score 5) and sensitivity analyses with SDT considered as a continuous variable yielded similar results. Conclusions and Relevance: In this cohort study of patients who underwent radical prostatectomy within 180 days of diagnosis for high-risk prostate cancer, radical prostatectomy for high-risk prostate cancer could be safely delayed up to 6 months after diagnosis.


Subject(s)
Adenocarcinoma , Prostate/pathology , Prostatectomy , Prostatic Neoplasms , Time-to-Treatment/statistics & numerical data , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Cohort Studies , Humans , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Prostatectomy/adverse effects , Prostatectomy/methods , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , United States/epidemiology
13.
Oncology (Williston Park) ; 34(9): 344-345, 2020 09 15.
Article in English | MEDLINE | ID: covidwho-790269

ABSTRACT

The results of 2 studies showed no association between delayed radical prostatectomy(RP) and adverse oncological outcomes, supporting current recommendations of urologic societies for surgical treatment of patients with intermediate- and high-risk prostate cancer during the coronavirus disease 2019 (COVID-19)pandemic.


Subject(s)
Coronavirus Infections , Coronavirus , Pandemics , Pneumonia, Viral , Prostatic Neoplasms/surgery , Betacoronavirus , COVID-19 , Humans , Male , Prostatectomy , Retrospective Studies , SARS-CoV-2
14.
J Endourol ; 35(3): 305-311, 2021 03.
Article in English | MEDLINE | ID: covidwho-772743

ABSTRACT

Objectives: To report our experience and lessons learned as high-volume center of robotic surgery managing patients with prostate cancer since the beginning of the COVID-19 pandemic in our center. Materials and Methods: We described some critical changes in our routine to minimize the COVID infection among patients and health care workers. From March 1 to May 25, 2020, we described our actions and surgical outcomes of patients treated in our center during the pandemic. Results: Preventing hospital visits, we implemented some modifications in our office routine in terms of patient appointment, follow-up, and management of nonsurgical candidates. In this period, 147 patients underwent robot-assisted radical prostatectomy (RARP) without intraoperative complications. The median operative time and blood loss were 91 minutes (interquartile range [IQR] = 25) and 50 mL (IQR = 50), respectively. The median hospitalization time was 15.8 hours (IQR = 2.5). None of the patients of our study had COVID in the postoperative follow-up, and only two patients were rescheduled due to a positive rapid COVID test 1 day before surgery. The final pathology described 10 patients (6.8%) Grade Group (GrGp) 1, 34 (23.1%) GrGp 2, 31 (21%) GrGp 3, 16 (10.8%) GrGp 4, 37 (25.3%) GrGp 5, and 19 (13%) with deferred Gleason. Two patients, COVID negative, were readmitted due to infected lymphocele managed with antibiotic and Interventional Radiology drainage. Conclusion: Our experience managing patients with prostate cancer during the COVID-19 pandemic showed that changing the office routine, stratifying the patients according to the National Comprehensive Cancer Network (NCCN) risk, and adopting COVID-based criteria to select patients for surgery are necessary actions to maintain the best quality of treatment and minimize the viral infection among our oncological patients. In our routine, the RARP during the COVID pandemic is safe and feasible for patients and health care workers if the necessary precautions described in this article are taken.


Subject(s)
Prostatectomy , Prostatic Neoplasms , Robotic Surgical Procedures , COVID-19 , Hospitals, High-Volume , Humans , Male , Pandemics , Prostatic Neoplasms/surgery , Treatment Outcome
15.
J Robot Surg ; 14(6): 913-915, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-617358

ABSTRACT

Robotic-assisted laparoscopic prostatectomy (RALP) is the gold standard for the surgical management of localized prostate cancer (PCa). Multi-institutional series have demonstrated complications and readmissions in less than 5% of patients and most are now discharged within 24 h of surgery. Recently, several high-volume surgeons demonstrated the safety of same-day discharge (SDD) after RALP. The main benefits include lower costs and reduced exposure to nosocomial infections and hospital errors. The leading arguments for criticism include potential suboptimal postoperative care and the risk of missing a catastrophic event. In recent years, important advances have further strengthened the argument for SDD including more structured perioperative care, integration of single-port robotic systems, and new challenges presented by the coronavirus 2019 (COVID-19) pandemic. Here, we provide further evidence demonstrating the safety of SDD in a multi-institutional cohort of patients and review the main arguments supporting the expanded use of this approach.


Subject(s)
Ambulatory Care , Laparoscopy , Patient Admission , Perioperative Care/methods , Prostatectomy , Prostatic Neoplasms/surgery , Robotic Surgical Procedures , Databases, Factual , Humans , Male , Matched-Pair Analysis , Patient Safety , Prostatectomy/methods , Retrospective Studies
16.
J Urol ; 204(4): 720-725, 2020 10.
Article in English | MEDLINE | ID: covidwho-766913

ABSTRACT

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.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Prostatectomy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Time-to-Treatment , Aged , COVID-19 , Humans , Logistic Models , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Pandemics , Retrospective Studies , Risk Assessment , SARS-CoV-2
18.
World J Urol ; 39(6): 1789-1796, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-705039

ABSTRACT

PURPOSE: The current COVID-19 pandemic is transforming our urologic practice and most urologic societies recommend to defer any surgical treatment for prostate cancer (PCa) patients. It is unclear whether a delay between diagnosis and surgical management (i.e., surgical delay) may have a detrimental effect on oncologic outcomes of PCa patients. The aim of the study was to assess the impact of surgical delay on oncologic outcomes. METHODS: Data of 926 men undergoing radical prostatectomy across Europe for intermediate and high-risk PCa according to EAU classification were identified. Multivariable analysis using binary logistic regression and Cox proportional hazard model tested association between surgical delay and upgrading on final pathology, lymph-node invasion (LNI), pathological locally advanced disease (pT3-4 and/or pN1), need for adjuvant therapy, and biochemical recurrence. Kaplan-Meier analysis was used to estimate BCR-free survival after surgery as a function of surgical delay using a 3 month cut-off. RESULTS: Median follow-up and surgical delay were 26 months (IQR 10-40) and 3 months (IQR 2-5), respectively. We did not find any significant association between surgical delay and oncologic outcomes when adjusted to pre- and post-operative variables. The lack of such association was observed across EAU risk categories. CONCLUSION: Delay of several months did not appear to adversely impact oncologic results for intermediate and high-risk PCa, and support an attitude of deferring surgery in line with the current recommendation of urologic societies.


Subject(s)
COVID-19 , Oncology Service, Hospital , Prostatectomy , Prostatic Neoplasms , Time-to-Treatment , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Europe/epidemiology , Humans , Infection Control/methods , Kaplan-Meier Estimate , Male , Neoplasm Grading , Neoplasm Staging , Oncology Service, Hospital/statistics & numerical data , Oncology Service, Hospital/trends , Organizational Innovation , Outcome Assessment, Health Care , Prostatectomy/methods , Prostatectomy/statistics & numerical data , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Risk Assessment/methods , Risk Assessment/statistics & numerical data , SARS-CoV-2 , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data
19.
Urol Oncol ; 39(1): 73.e1-73.e8, 2021 01.
Article in English | MEDLINE | ID: covidwho-696635

ABSTRACT

OBJECTIVE: Image guided biopsies are an integral part of prostate cancer evaluation. The effect of delaying biopsies of suspicious prostate mpMRI lesions is uncertain and clinically relevant during the COVID-19 crisis. We evaluated the association between biopsy delay time and pathologic findings on subsequent prostate biopsy. MATERIALS AND METHODS: After obtaining IRB approval we reviewed the medical records of 214 patients who underwent image-guided transperineal fusion biopsy of the prostate biopsy between 2017 and 2019. Study outcomes included clinically significant (ISUP grade group ≥2) and any prostate cancer on biopsy. Logistic regression was used to evaluate the association between biopsy delay time and outcomes while adjusting for known predictors of cancer on biopsy. RESULTS: The study cohort included 195 men with a median age of 68. Median delay between mpMRI and biopsy was 5 months, and 90% of patients had a ≤8 months delay. A significant association was found between PI-RADS 5 lesions and no previous biopsies and shorter delay time. Delay time was not associated with clinically significant or any cancer on biopsy. A higher risk of significant cancer was associated with older age (P = 0.008), higher PSA (0.003), smaller prostate volume (<0.001), no previous biopsy (0.012) and PI-RADS 5 lesions (0.015). CONCLUSIONS: Our findings suggest that under current practice, where men with PI-RADS 5 lesions and no previous biopsies undergo earlier evaluation, a delay of up to 8 months between imaging and biopsy does not affect biopsy findings. In the current COVID-19 crisis, selectively delaying image-guided prostate biopsies is unlikely to result in a higher rate of significant cancer.


Subject(s)
COVID-19/epidemiology , Prostate/pathology , Time-to-Treatment , Aged , Humans , Image-Guided Biopsy , Logistic Models , Magnetic Resonance Imaging , Male , Middle Aged , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Retrospective Studies , Risk Factors , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data
20.
Int Braz J Urol ; 46(suppl.1): 50-61, 2020 07.
Article in English | MEDLINE | ID: covidwho-601969

ABSTRACT

PURPOSE: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. MATERIAL AND METHODS: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. RESULTS: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. CONCLUSIONS: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Prostatic Neoplasms/surgery , Prostatic Neoplasms/therapy , Urology/methods , Androgen Antagonists/therapeutic use , Betacoronavirus , COVID-19 , Humans , Male , Pandemics , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL
...