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INTRODUCTION AND OBJECTIVE: Covid-19 caused major disruptions to cancer diagnosis and treatment. We aimed to evaluate the longitudinal disruption to prostate cancer management. METHODS: We completed a prospective service evaluation from 01/09/2019 to 31/08/2021 of all referrals, investigations, and treatments for prostate cancer at a single centre. The first UK Covid-19 lockdown occurred from 23/03/20 to 04/07/2020: monthly data for the time period before, during, and after the first UK lockdown were compared using ANOVA and Tukey HSD. RESULTS: We identified 4501 patients for inclusion. There was a profound decrease in all aspects of prostate cancer management during the first lockdown period. For pre-lockdown, lockdown, and postlockdown periods respectively, the mean monthly rates were: 256 v 125 v 363 PSA tests (p=0.0003);86 v 40 v 79 two-week-wait referrals (p=0.0005);62 v 18 v 54 MRI imaging for possible cancer (p<0.0001);32 v 15 v 36 diagnoses (p=0.002);17 v 9 v 14 prostatectomies (p=0.06). In the period after the first lockdown, despite the previous drop, we did not observe an increase in the number of referrals, MRI imaging, diagnoses, or treatment required (including active monitoring, chemotherapy, radiotherapy, prostatectomy, and palliative care) in comparison to pre-lockdown levels (all p>0.05). However, interestingly, we did see an increase in the number of PSA tests performed (p=0.04), which continued through the two subsequent UK lockdowns. CONCLUSIONS: To our knowledge, this is the first study to provide an overview of the impact of COVID-19 national lockdowns on the whole prostate cancer management pathway - from initial referral to final treatment. Despite the disruption to prostate cancer management during the first UK Covid-19 lockdown leading to a decrease in referrals, diagnoses and treatment in the context of reduced PSA testing, we have not seen a subsequent increase in these numbers after lockdown despite a rise in PSA testing. The rise in the number PSA tests performed post-lockdown may suggest a degree of compensatory PSA observation in the community. (Figure Presented).
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Introduction & Objective: Prostate Biopsy remains the gold standard for histological confirmation of prostate cancer. The near exponential increase in the need for biopsies, in selected men, has ushered an evolving need for improving detection rates while reducing side effects. Diagnostic accuracy and infection complication rates remain obstacles in transrectal prostate biopsy. PrecisionPoint is a disposable, low cost device which enables transperineal biopsy in the outpatient setting under local anaesthetic. We present data from a predominantly nurse-performed LATP service using PrecisionPoint, which was newly started in July 2019. Initial indications were;repeat biopsy, anterior lesions, and active surveillance patients. Service was expanded in March 2020 to all prostate pathway patients following national COVID guidance. Methods: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD >0.15. PIRADS 3-5 lesions were targeted with ≥3 cores (sent separately). Systematic Ginsburg protocol biopsies were also performed (each zone sent separately). Tamsulosin was started for BOO patients. No antibiotics were used unless immunocompromised or previous sepsis. A prospective database at point of care was created detailing patient information, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. Results: 750 consecutive patients analysed. Detection of significant cancer (Gl ≥3 + 4) in PIRAD1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected significant cancer in 36%, systematic plus targeted achieved 63%. Of AS patients;40% with Gl3 + 3 were upgraded, and 49% with Gl3 + 4 were upgraded to Gl ≥4 + 3. 5 experienced vasovagal episodes. Only 5 patients were readmitted (0.6%): 2 UTI, 2 AUR, 1 urosepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further biopsies (89%). Conclusions: Adoption of this new technology into an integrated prostate cancer diagnostic pathway has enabled us to set up a safe, effective, antibiotic free LATP biopsy service in the outpatient setting. Data shows high cancer detection rates and low complication rates. PROMs data suggests this iswell tolerated by patients.
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INTRODUCTION AND OBJECTIVE: A LATP service using PrecisionPoint™ was newly started in July 2019, with procedures performed by both surgeon and nurse practitioners. Initial indications were: repeat biopsy, anterior prostate lesions, and Active Surveillance patients. Service was expanded in March 2020 to all prostate pathway patients according to British Association of Urology COVID guidance. METHODS: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD>0.15. Systematic Ginsburg protocol biopsies were performed for all patients (each zone sent separately), and PIRADS 3-5 lesions were targeted with ≥3 cores (also sent separately). Alpha-blockers were started for patients with Bladder Outlet Obstruction. No antibiotics were used unless patients were immunocompromised or had a previous history of urinary sepsis. A prospective database at point of care was created detailing patient demographics, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. RESULTS: 750 consecutive patients are analysed. Detection of clinically significant prostate cancer (Gl≥3+4) in PIRADS 1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected clinically significant cancer in 36%, whereas systematic plus targeted biopsy achieved 63%. Of Active Surveillance patients;40% with Gl 3+3 were upgraded, and 49% with Gl3+4 were upgraded to Gl≥4+3. n=5 (0.6%) experienced vasovagal episodes causing delayed discharge. Only n=5 patients were readmitted (0.6%): 2 urinary tract infection, 2 acute urinary retention, 1 urinary sepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further repeat biopsies (89%). CONCLUSIONS: We have set up a safe, effective, antibiotic free LATP biopsy service, with high cancer detection rates and low complication rates. PROMs data suggests this is well tolerated by patients.
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Introduction: A predominantly nurse-performed LATP service using PrecisionPoint was newly started in July 2019. Initial indications were repeat biopsy, anterior lesions, and AS patients. Service was expanded in March 2020 to all prostate pathway patients according to BAUS COVID guidance. Methods: All patients underwent prebiopsy MRI and dedicated image-review meetings. Biopsies were performed in PIRADS 3-5, or PSAD >0.15. PIRADS 3-5 lesions were targeted with 3 cores (sent separately). Systematic Ginsburg protocol biopsies were also performed (each zone sent separately). Tamsulosin was started for BOO patients. No antibiotics were used unless immunocompromised or previous sepsis. A prospective database at point of care was created detailing patient information, MRI and biopsy characteristics. Patient Reported Outcome Measures (PROMs) are collected. Histology and complications are also reported. Results: 750 consecutive patients analysed. Detection of significant cancer (Gl3+4) in PIRAD1-2, 3, 4, 5 groups was 25%, 40%, 59%, 92% respectively. Systematic biopsy alone detected significant cancer in 36%, systematic plus targeted achieved 63%. Of AS patients;40% with Gl3+3 were upgraded, and 49% with Gl3+4 were upgraded to Gl4+3. 5 experienced vasovagal episodes. Only 5 patients were readmitted (0.6%): 2 UTI, 2 AUR, 1 urosepsis. PROMs demonstrated majority favourable results regarding pain (98%), discomfort (97%), embarrassment (96%) and further repeat biopsies (89%). Conclusion: We have set up a safe, effective, antibiotic free LATP biopsy service, with high cancer detection rates and low complication rates. PROMs data suggests this is well tolerated by patients.
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With the coronavirus outbreak, new and strengthened norms of plastic dependency emerged in the Middle East and North Africa region through the desperate demand for products like face masks and other personal protective equipment (PPE), highlighting the tradeoffs between health and the environment. While the rise in demand has been considered as temporary, behavioral barriers and misperceptions might make these norms particularly sticky and hinder society’s ability to transition to a circular economy. Fortunately, behavioral science offers valuable insights about why the current pandemic can actually be a catalyst to create new eco-conscious behaviors. As some behaviors are often strenuous to change and require enforcement through traditional policy solutions (e.g. regulations), behavioral science offers complementary tools that will make policies more effective. We have an opportunity to start thinking about ways to leverage behavioral insights to create new norms that promote a circular economy while ultimately ensuring proper adherence to hygiene practices to curb the spread of the virus. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.