When the COVID pandemic began shutting us down in March 2020, life became surreal. The lockdown imposed dramatic changes in work/social life, and curtailed movement outside the home. Likewise, delivery of medical care suffered. Hospital staff were overwhelmed by the early waves of very ill and highly infectious patients, while well people who avoided routine medical visits. Normal screening tests such as PSA tests, breast mammograms, and colonoscopies were simply dropped by those who felt safer behind their own doors than a doctor’s office or clinic.

The natural result of this was delayed detection of potentially serious diseases like prostate, breast and colon cancers. In many cases, thankfully, these were eventually caught at early stages as safe practices like masking, hand washing, and social distancing became more broadly adopted. Even before the introduction of effective COVID vaccines, the medical community began resuming normal schedules while reinforcing ongoing safety measures.

Delayed prostatectomy = worse outcomes

Sadly, the measurable impact of delayed prostate cancer treatment is now showing up, as illustrated by the September 2021 publication of a multi-institutional European study, “Has the COVID-19 Outbreak Changed the Way We Are Treating Prostate Cancer?”^[i] The collaboration included French, German, Italian and Dutch institutions. It’s an analysis of 2574 prostate cancer (PCa) patients from 8 sites starting in March 2019. All had biopsy-proven PCa, and they all ultimately underwent radical prostatectomy (surgical removal of the prostate gland).

The study group included 927 cases who were treated between March 2020 (when the World Health Organization declared the start of a pandemic) and December 2020. The remaining 1647 were treated between March 2019 and December 2019, and made up the control group.

The data revealed that “…patients who were treated during the pandemic had higher risk of extra prostatic disease and lymph node invasion.” In other words, those who had to delay surgery due to pandemic conditions were at greater risk of having tumor involvement outside the prostate capsule. This is called stage migration (the cancer moved into a worse stage) and it implies that for many patients, the surgeon was unable to remove all the cancer. Sadly, in such cases the risk for eventual recurrence and metastasis is greater.

The anxiety and fear created in the early months of the pandemic was sparked by the terrifying media images and reports of overcrowded emergency rooms and intensive care units, shortages of personal protective equipment and ventilators, and an astonishing numbers of deaths. It’s no wonder that basic doctor visits and preventive care dropped off sharply during 2020, a year that will be long remembered as one of the darkest events in modern history. Medical statisticians are now monitoring future developments for post-2020 data curves that will likely reflect increased cancer prevalence and deaths due to what the study authors call “… a delay in the administration of curative-intent therapies in patients with localized PCa.”

Keeping hope alive

Right from the start of the pandemic, all of us at the Sperling Prostate Center recognized the threat of the rapidly growing number of COVID cases, and immediately implemented protective measures for ourselves and our patients as guidance became available. Our situation as a community-based imaging center was very different from the hospitals that were inundated with severely ill people who needed immediate intervention.

Having anticipated a possible drop in our patient numbers, we took steps to keep our patients informed and reassured. As much as possible, we hoped to provide safe, continued availability of our PCa early detection and diagnostic services, knowing that this saves lives. Our Center continued to support and monitor PCa patients on Active Surveillance so they did not have to miss a beat. For men who were candidates for Focal Laser Ablation, our outpatient procedure enabled them to stay out of overcrowded hospitals and recover quickly at home. In fact, we did not experience a significant drop in cases, and our treatment services were within timely windows. We were able to keep hope alive.

Our hearts go out to all cancer patients who felt like the pandemic forced them to compromise their treatment protocols. We are grateful that much ground has been, and continues to be, regained. We may not yet be completely out of the COVID woods, but the closer we get to the edges where the trees are thinning out, the more rays of bright hope there are to light our path.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Zattoni F, Marra G, Kretschmer A, Preisser F et al. Has the COVID-19 outbreak changed the way we are treating prostate cancer? An EAU – YAU Prostate Cancer Working Group multi-institutional study. Cent European J Urol. 2021;74(3):362-365.