Trends in Definitive Therapy for Prostate Cancer during the Covid-19 Pandemic: A Grade-by-Gradeanalysis

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.