Introduction:

The COVID-19 pandemic starkly affected all aspects of healthcare, forcing many to divert resources towards emergent patient needs while postponing routine cancer care. The aim of these efforts was to encourage social distancing and resource utilization stewardship, as well as prioritizing patient and occupational safety during these unprecedented times. To that end, we sought to compare the experience of prostate cancer patients before and after the pandemic in a multi-institutional, regional cohort of diverse urology practices.

Methods:

Within the Pennsylvania Urologic Regional Collaborative (PURC), a prospective quality improvement collaborative of academic and community urology practices in Pennsylvania (PA) and New Jersey (NJ), we identified practices that had data captured through June 2020. Patients were stratified on the bases of care during the pandemic. March 13th was selected as the start of the pandemic, as a state of national emergency was declared, and the American College of Surgeons released recommendations for elective operations. The conclusion of the pandemic was May 15, 2020, when reopening began in Pennsylvania.  These cases were compared to those diagnosed in the preceding 9 months.

Mobility and COVID-19 data for PA was obtained from publicly available sources. Mobility data was an aggregate of information obtained from cellphone data. This was recorded as a percent change from baseline (1/3/2020–2/6/2020) and served as a general measure of travel from home.

Results:

Between June 2019 and June 2020, 1,004 patients presented for new prostate cancer evaluation, 35 during the pandemic. Compared to the non-pandemic period, there was no difference in race, comorbidity status or PSA (last PSA prior to a biopsy) for new visit patients. Biopsy Gleason Grade Group (GG), however was significantly higher amongst those presenting for evaluation during COVID-19 (GG>2: 44.2% vs 62.5%, p=0.009). During the pandemic only 38 patients underwent prostatectomy, compared to 595 in the preceding 9 months. Compared to pre-pandemic patients, they had higher GG (GG>2 44% v. 70.3%, p<0.05).  Additionally, the majority of these patients were diagnosed (92.1%) and had their care established prior to the onset of the pandemic (72.2%). New patient visits, surgical volume and mobility dropped sharply at the onset of the pandemic. However, only surgical volume recovered as mobility increased, new patient visits, on the other hand, remained stagnant (Figure 1).

Conclusion:

Surgical volume and patient evaluation for prostate cancer was significantly reduced during the peak of the COVID-19 pandemic. Patients who underwent surgery during the pandemic had higher grade disease, and were more likely to have been diagnosed at the same site of treatment. Although these results represent the impact of COVID-19 on a regional cohort, examining these patterns will allow clinicians to remain better prepared for possible second spike in COVID-19 cases and future public health crises. Follow-up studies within this cohort over time will provide important insight into oncologic implications of the initial response to the COVID-19 pandemic.

Funding: N/A