Effect of Covid on 2020 UK PCa stats.

[pjoshea13]

New studu below, [1].

"Diagnostic and treatment activity between March 23rd (start of first national lockdown in England) and December 31st 2020 was compared with same calendar period in 2019." {Just England?}

"There was a 30.8% reduction (22,419 versus 32,409) in the number of men with newly diagnosed PCa in 2020 after the start of the first lockdown, compared with the corresponding period in 2019.

"Men diagnosed in 2020 were typically at more advanced stage (21.2% versus 17.4%, stage IV ***) and slightly older (57.9% versus 55.9% ≥ 70 years, p<0.001).

"Prostate biopsies in 2020 were more often performed through using transperineal routes (64.0% versus 38.2%).

"The number of radical prostatectomies in 2020 was reduced by 26.9% (3,896 versus 5,331) ...

"... and the number treated by external beam radiotherapy (EBRT) by 14.1% (9,719 versus 11,309).

"Other changes included an increased use of EBRT with hypofractionation and reduced use of docetaxel chemotherapy in men with hormone-sensitive metastatic PCa (413 versus 1,519) with related increase in the use of enzalutamide."

*** misleading, since there was a slight reduction in actual stage IV cases if my math is correct: 5,425 cases versus 5,639.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/350...

BJU Int

. 2022 Jan 25. doi: 10.1111/bju.15699. Online ahead of print.

Impact of the Covid-19 pandemic on the diagnosis and treatment of men with prostate cancer

Julie Nossiter 1 2 , Melanie Morris 1 2 , Matthew G Parry 1 2 , Arunan Sujenthiran 2 , Paul Cathcart 3 , Jan van der Meulen 1 , Ajay Aggarwal 1 4 5 , Heather Payne 6 , Noel W Clarke 7

Affiliations collapse

Affiliations

1 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.

2 Clinical Effectiveness Unit, Royal College of Surgeons of England.

3 Department of Urology, NHS Foundation Trust, Guy's and St Thomas.

4 Department of Radiotherapy, NHS Foundation Trust, Guy's and St Thomas.

5 Department of Cancer Epidemiology, Population, and Global Health, King's College London.

6 Department of Oncology, University College London Hospitals NHS Foundation Trust, London.

7 Department of Urology, The Christie and Salford Royal NHS Foundation Trusts.

PMID: 35080142 DOI: 10.1111/bju.15699

Abstract

Objective: To determine the impact of the Covid-19 pandemic on diagnostic and treatment activity in 2020 across hospital providers of prostate cancer (PCa) care in the English National Health Service.

Methods: Diagnostic and treatment activity between March 23rd (start of first national lockdown in England) and December 31st 2020 was compared with same calendar period in 2019. Patients newly diagnosed with PCa were identified in national rapid cancer registration data linked to other electronic healthcare datasets.

Results: There was a 30.8% reduction (22,419 versus 32,409) in the number of men with newly diagnosed PCa in 2020 after the start of the first lockdown, compared with the corresponding period in 2019. Men diagnosed in 2020 were typically at more advanced stage (21.2% versus 17.4%, stage IV) and slightly older (57.9% versus 55.9% ≥ 70 years, p<0.001). Prostate biopsies in 2020 were more often performed through using transperineal routes (64.0% versus 38.2%). The number of radical prostatectomies in 2020 was reduced by 26.9% (3,896 versus 5,331) and the number treated by external beam radiotherapy (EBRT) by 14.1% (9,719 versus 11,309). Other changes included an increased use of EBRT with hypofractionation and reduced use of docetaxel chemotherapy in men with hormone-sensitive metastatic PCa (413 versus 1,519) with related increase in the use of enzalutamide.

Conclusion: We found substantial deficits in the number of diagnostic and treatment procedures for men with newly diagnosed PCa after the start of the first lockdown in 2020. The number of men diagnosed with PCa decreased by about one third and those diagnosed had more advanced disease. Treatment patterns shifted towards those that limit the risk of Covid-19 exposure including increased use of transperineal biopsy, hypofractionated radiation, and enzalutamide. Urgent concerted action is required to address the Covid-19-related deficits in PCa services to mitigate their impact on long-term outcomes.

Keywords: Covid-19; diagnosis & treatment; prostate cancer.

This article is protected by copyright. All rights reserved.

[Graham49]

Thanks PatrickI wonder how the PCa death statistics compare.

[pjoshea13 in reply to Graham49]

Well, the covid saga continues & we will no doubt find out how the 2020 diagnosis "deficit" affects future mortality stats.

[cigafred]

You would know better than I, but maybe the problems with the NHS make this study pretty much irrelevant to markets like the US for which getting timely doctor and hospital appointments was usually possible during Covid.

[pjoshea13 in reply to cigafred]

I expect that there were far fewer PSA tests in the US in 2020. i.e. with men without PCa skipping a year. The US diagnosis "deficit" might be quite high. Would no doubt please the U.S. Preventive Services Task Force.

I saw none of my docs in 2020. I spoke by phone to two of them once each. But I am not on anything given by injection or infusion.

[cigafred in reply to pjoshea13]

Yes, agreed that a lot of people here skipped or skimped on doctors, testing, etc., but those who so wanted were generally able to continue as before. In my case it helped because I was able to meet with a far-away doctor by phone due to a Covid-related relaxation of state laws on doctoring in states where not licensed to so do. At least for me, everything was still possible here, there were no six-month and longer wait lists as in the UK even before Covid.

[MateoBeach]

Very interesting, and troubling. Expect to see catch-up diagnosis exceeding norms as the undiagnosed are identified. How much excess PC death this will have caused must be characterized as downstream morbidity and mortality from care disruptions due to COVID. Personally I expect a transition to endemic status probably by mid year as the omicron wave burns through and there is much more natural and vaccine immunity. Craziness could also largely dissipate with the dominance of a much milder pattern, more similar to influenza. ( And please be kind in responses to this opinion!)

[Hidden in reply to MateoBeach]

Sounds good, I believe your profession opinion.

[lokibear0803 in reply to MateoBeach]

As a sidebar of interest wrt “endemic”, I stumbled across this in a Nature Briefing newsletter the other day:

——————————————————————————————

COVID: ‘endemic’ doesn’t mean harmless

Misuse of the word ‘endemic’ in relation to COVID-19 is encouraging a misplaced complacency, says evolutionary virologist Aris Katzourakis. To an epidemiologist, an endemic infection is one in which overall rates are static – not rising, not falling. But a disease can be endemic as well as both widespread and deadly. Malaria, for example, is an endemic disease that killed more than 600,000 people in 2020.

Policymakers must not invoke the word ‘endemic’ as an excuse to do little or nothing, and thinking that endemicity is both mild and inevitable sets humanity up for many more years of disease. To help us beat COVID-19, we need to set aside lazy optimism and tackle the virus head on, using every tool at our disposal, including effective vaccines, globally.

——————————————————————————————

Here’s the full article; there should not be a paywall, otw let me know:

nature.com/articles/d41586-...

[dockam]

Yikes, that's not a good sign. I've mentioned to my dental patients that men especially would use COVID-19 as an excuse to not get vital health screenings done. We men tend to be squeamish with procedures and very reluctant to get the "finger" during a DRE :-)I hope that there isn't a spike in Advanced PCa cases because screenings were missed. Dunno if there has been an uptick in new members in this HU forum

Fight On

[j-o-h-n in reply to dockam]

From my view asking for new member's bios.... it seems like more and younger newbies are joining this forum than have been in the recent past ....Now don't call me a stat rat for that.....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 01/27/2022 5:55 PM EST

[dockam in reply to j-o-h-n]

Oh yikes, maybe that could be a new topic/thread about not getting a PCa screening due to COVID and now here in the Advanced PCa forum. Being a rat puts you in great company Brother: youtu.be/lMgIrUQa59o(Not working as expected?)

[j-o-h-n in reply to dockam]

OH hack!!! I'm just one of the pack.....

youtube.com/watch?v=mQR0bXO...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 01/27/2022 6:20 PM EST

[lcfcpolo]

Thanks Patrick. I was diagnosed in May 2020 but delayed seeing my GP about a recurring DVT, turns out this is big red flag that you have PC.Unfortunately, sadly and tragically, I linked in with a guy in my city, Stuart. Stuart was diagnosed the same day as me but was having a lot more pain. He had delayed seeing his GP due to Covid and when in the end he walked into see his GP 'the GPs face turned white'. Stuart passed on New Year's Eve aged 50, 17 months after diagnosis. He had a loving partner, Sarah and was a devoted Uncle to his nephew and niece. Would things have been different, yes definitely without Covid. Rest in Peace Stuart.

In England and Wales you now go straight onto Enzalutamide at diagnosis, Docetaxel is not a first treatment option for newly diagnosed patients due to Covid. Biopsies are just not offered as standard on the NHS.

[pjoshea13 in reply to lcfcpolo]

Yes, quite a number of papers on PubMed saying that a DVT should be treated as a possible cancer symptom & that patient be screened for cancer (any type), with PSA being the most importand test for men in the relevant age group.

I have posted regularly on the subject of cancer-induced altered coagulation. On-going clotting can be monitored via D-dimer testing, and nattokinase can be used as a plasmin booster to speed up the breakdown of clots. A doctor might say that an elevated D-dimer can be due to other things, but a man with PCa & a history of DVTs should assume coagulation, IMO.

Of particular importance, IMO, is the need to dissolve microclots that might assist in metastasis.

Are you on an anticoagulant?

Poor Stuart - a tragic case.

Here in the US, the U.S. Preventive Services Task Force [USPSTF] (a group of health experts, but no urologists & no oncologist & 50% femate) have been very effective at reducing the number of men who check PSA. Their rationale: over-screening = over-treating.

In the UK, of course, over-screening has never been a "problem".

Best, -Patrick

[lcfcpolo in reply to pjoshea13]

Yes Patrick, I'm on a anticoagulant, Apixaban (Elequis). I do not get tested though anymore.

This over treatment myth for PSA is as crazy here as it is for you. There is a video of a Professor Whitty, our lead Medical Officer addressing students at Cambridge and he just brushes it aside, that those diagnosed late at an advanced stage are basically collateral.

[DesertDaisy]

My husband is being treated at Mayo AZ and has his first appointment with an MO there the end of February. We received a general email yesterday that Mayo will be canceling some appointments and procedures due to covid. I really thought we were beyond situations like this happening, but have to wonder if it is because they are shorthanded due to firing 700 unvaccinated employees.

[pjoshea13 in reply to DesertDaisy]

IMO the issue is omicron. Highly contagious, it is even infecting those who are vaccinated. While the omicron spike is steep & high, it is susiding quickly. We (& Mayo AZ) will return to the new normal soon. - imo.

{With omicron, the 700 unvaccinated employees might have become a serious burden, imo.}

-Patrick

[dhccpa]

I carried on as usual. Regular MO appts and two with RO in 2020. No chemo or radiation but regular office visits, injections, and three scans.