# Change in Clinical Management of Localized Prostate Cancer Patients at a Tertiary Medical Center as a Result of SARS‐CoV‐2 (COVID‐19)

## TL;DR

This study shows how the management of prostate cancer changed during the early stages of the COVID-19 pandemic at a major hospital, including longer treatment delays and shifts in treatment approaches.

## Contribution

The study provides real-world data on how prostate cancer treatment was affected during the pandemic compared to before.

## Key findings

- Time-to-treatment increased significantly during the pandemic compared to pre-COVID periods.
- More patients received ADT before surgery during the pandemic than before.
- Higher-risk prostate cancer patients were more likely to be treated during the pandemic.

## Abstract

At the height of the COVID‐19 pandemic, healthcare utilization among cancer patients, including those with prostate cancer, was limited due to inadequate healthcare resources and concern for disease transmission among patients and medical personnel. While publications with treatment recommendations during the pandemic exist, there is limited real‐life data comparing prostate cancer management pre‐COVID to during the pandemic.

The primary aim of this study is to determine the effect of the COVID‐19 pandemic on prostate cancer management at a tertiary medical center by comparing patients receiving treatment preceding the pandemic to those receiving treatment during the height of the pandemic.

Prostate cancer patients treated with definitive intent (surgery, definitive radiation (RT), or salvage RT) in 2019–2020 were retrospectively reviewed. Analysis was performed with the following timeframes: pre‐COVID as 1/3/19 to 2/28/20 and COVID as 3/1/20 to 9/30/20. Time‐to‐treatment (TT) for surgery and definitive RT was defined from the date of diagnosis (biopsy or decision to treat if active surveillance) to the date of surgery or RT start, respectively. TT for salvage RT was defined as the date of PSA failure to RT start. Descriptive statistics such as medians and interquartile ranges (IQRs) were reported for continuous variables, while frequency counts and percents were reported for categorical variables. Chi‐squared tests (Fisher’s exact when appropriate) along with Wilcoxon rank sum tests were used to compare two timeframes. Two adjusted binary logistic regressions assessed the associations of NCCN risk groups, as well as grade group (GG), on the outcome of receipt of treatment during COVID compared to those in pre‐COVID timeframes.

This study sample included 565 prostate cancer patients treated with surgery (n = 303), definitive RT (n = 151), or salvage RT (n = 111). There was a statistically significant difference in TT by timeframe for all patients (median 111 days pre‐COVID v 126.5 days COVID, p = 0.007). For patients who received definitive or salvage RT with ADT, there were significant differences in time from ADT initiation to treatment start between pre‐COVID vs. COVID (definitive RT: median 78 days v 147 days, p = 0.001; salvage RT: median 67 days v 84 days, p = 0.004). A significantly higher proportion of patients received ADT prior to surgery in the COVID cohort compared to those in pre‐COVID (9.8% v 0.5%, p < 0.001). Patients with clinically more aggressive prostate cancer had higher odds of being treated in the COVID timeframe (HR or VHR, adjusted OR [aOR] 1.62, 95% CI: 1.02–2.55).

The COVID‐19 pandemic changed prostate cancer management in various ways including longer TT, prolonged time from ADT initiation to RT, increased utilization of ADT for patients planned for surgery, and prioritizing treatment for higher‐risk disease. Analysis of treatment outcomes for these patients may direct action in future global pandemics.