(UroToday.com) The 2023 American Urological Association (AUA) annual meeting held in Chicago, IL, hosted a moderated poster session focusing on the epidemiology and natural history of prostate cancer. Dr. Edoardo Beatrici discussed his group’s study evaluating the stage and grade migration of prostate cancer during the COVID-19 pandemic.
The COVID-19 pandemic led to the redistribution/refunnelling of available health care resources, which led to expected decreases in the rates of screening for various malignancies. Delayed PSA screening may, as such, have led to decreased detection of earlier grade/stage cancers, and, thus, a resulting grade/stage migration. The objective of this study was to evaluate prostate cancer grade and stage migration secondary to the COVID-19 pandemic.
This was a retrospective analysis of the National Cancer Database (NCDB) for men diagnosed with prostate cancer between 2018 and 2020. Patients were divided into two cohorts based on their year of diagnosis: 2018-2019 (“Pre-Pandemic”) and 2020 (“Pandemic”) cohorts. Patients in the two cohorts were compared for:
- PSA value (>20 versus ≤20)
- Clinical stage (cT1-2 versus cT3-4)
- Clinical M stage (cM0 versus cM1)
- International Society of Uropathology (ISUP) grade group (ISUP 1-3 versus ISUP 4-5)
- D’Amico risk classification (low, intermediate, and high risk)
Differences in stage and grade distributions across the two diagnostic year cohorts were compared using Pearson’s chi-square test. Multivariable logistic regression analysis, adjusting for clinical and sociodemographic covariates, was used to estimate the effect of the “pandemic” period on the stage and grade distributions.
This analysis included a total of 398,719 men diagnosed with prostate cancer between 2018 and 2020: 71% during 2018-2019 and 29% during the pandemic year of 2020. On univariable analysis with Chi-square testing, an increase in stage and grade across the two periods was observed (p <0.001). On multivariable analysis adjusting for potential confounders, the pandemic year of 2020, compared to 2018-19, was associated with increased odds of:
- PSA > 20 levels (aOR: 1.06; 95% CI 1.03 – 1.08; p-value < 0.001)
- cT3-4 stages (aOR: 1.12; 95% CI 1.08 – 1.16; p < 0.001)
- cM1 stage (aOR: 1.15; 95% CI 1.12 – 1.18; p< 0.001)
- ISUP grade group 4 or 5 (aOR: 1.03; 95% CI 1.01 – 1.05; p = 0.003)
- D’Amico intermediate and high-risk groups (aOR: 1.15; 95% CI 1.13 – 1.18; p < 0.001)
The authors concluded that the COVID-19 pandemic was associated with significant changes in the stage and grade distributions of newly diagnosed prostate cancer. The authors hypothesized that possible explanations for this migration include a better selection of patients for prostate biopsy during the pandemic or changes in prostate cancer screening patterns.
Presented by: Edoardo Beatrici, MD, Urology Resident Physician, Humanitas University, Milan, Italy
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023