Early in the COVID-19 pandemic, racial/ethnic minority communities disproportionately experienced poor outcomes; however, the association of the pandemic with prostate cancer (PCa) care is unknown.
To assess the association between race and PCa care delivery for Black and White patients during the first wave of the COVID-19 pandemic.
This multicenter, regional, collaborative, retrospective cohort study compared prostatectomy rates between Black and White patients with untreated nonmetastatic PCa during the COVID-19 pandemic (269 patients from March 16 to May 15, 2020) and prior (378 patients from March 11 to May 10, 2019).
Prostatectomy rates.
Of the 647 men with nonmetastatic PCa, 172 (26.6%) were non-Hispanic Black men, and 475 (73.4%) were non-Hispanic White men. Black men were significantly less likely to undergo prostatectomy during the pandemic compared with White patients (1 of 76 [1.3%] vs 50 of 193 [25.9%]; P < .001), despite similar COVID-19 risk factors, biopsy Gleason grade groups, and comparable prostatectomy rates prior to the pandemic (17 of 96 [17.7%] vs 54 of 282 [19.1%]; P = .75). Black men had higher median prostate-specific antigen levels prior to biopsy (8.8 ng/mL [interquartile range, 5.3-15.2 ng/mL] vs 7.2 ng/mL [interquartile range, 5.1-11.1 ng/mL]; P = .04). A linear combination of regression coefficients with an interaction term for year demonstrated an odds ratio for likelihood of surgery of 0.06 (95% CI, 0.01-0.35; P = .002) for Black patients and 1.41 (95% CI, 0.81-2.44; P = .23) for White patients during the pandemic compared with prior to the pandemic. Changes in surgical volume varied by site (from a 33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery caring for a greater proportion of Black patients.
In this large multi-institutional regional collaborative cohort study, the odds of PCa surgery were lower among Black patients compared with White patients during the initial wave of the COVID-19 pandemic. Although localized PCa does not require immediate treatment, the lessons from this study suggest systemic inequities within health care and are likely applicable across medical specialties. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the COVID-19 pandemic to develop balanced mitigation strategies as viral rates continue to fluctuate.
JAMA oncology. 2021 Jul 22 [Epub ahead of print]
Adrien N Bernstein, Ruchika Talwar, Elizabeth Handorf, Kaynaat Syed, John Danella, Serge Ginzburg, Laurence Belkoff, Adam C Reese, Jeffery Tomaszewski, Edouard Trabulsi, Eric A Singer, Bruce Jacobs, Alexander Kutikov, Robert Uzzo, Jay D Raman, Thomas Guzzo, Marc C Smaldone, Andres Correa
Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Division of Urology, University of Pennsylvania, Philadelphia., Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Health Care Improvement Foundation, Philadelphia, Pennsylvania., Department of Urology, Geisinger Health System, Danville, Pennsylvania., Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania., Division of Urology, MidLantic Urology/Main Line Health, Bala Cynwyd, Pennsylvania., Department of Urology, Temple University, Philadelphia, Pennsylvania., Division of Urology, Cooper University Health Care, Camden, New Jersey., Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania., Division of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick., Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania., Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.