Stage and Grade Migration of Prostate Cancer during the Covid-19 Pandemic

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.