Challenges of curative treatment of prostate carcinoma during the Covid-19 pandemic
DOI: 10.22591/magyurol.2022.3.darabosn.102
Authors:
Darabos Norbert dr., Szepesváry Zsolt dr., Kullmann Tamás dr.
Petz Aladár Egyetemi Oktató Kórház, Osztályológiai, Győr (osztályvezető: Szepesváry Zsolt dr.)
Summary
Objective: The Covid-19 pandemic caused by Covid-19 in Hungary also significantly changed the algorithms used in the diagnosis and treatment of prostate cancer. It can be hypothesized that this change had a negative effect on patients’ chances of recovery.
Material and methods: Data from laparoscopic radical prostatectomies performed during the epidemic were compared with those performed during peacetime. Data from 19 patients operated on between October 2019 and January 2020 in normal healthcare were analyzed. The average time from diagnosis to surgery was 3 months.
As a control, data from 16 patients operated between October 2020 and January 2021 were processed. The average time from diagnosis to surgery was 4 months during epidemic. The prostate biopsy findings, the predictive risk of lymph node involvement calculated from the Briganti nomogram, final histological findings, and postoperative PSA values of the patients were recorded. If the patient received ADT prior to surgery for any reason, it was also recorded.
PSA values were monitored postoperatively for 6 months in both groups, and early biochemical relapse was examined. PSA laboratory tests were performed 3 and 6 months after surgery. The cut-off level was determined in 0.1 ng/ml.
Results: The data showed that during the Covid-19 pandemic, prostate tumour patients were diagnosed and treated with more severe stage of the disease meaning higher preoperative and postoperative Gleason score values, and a more advanced pathological stage. Local extent at the pT3 stage was 2.97-fold more common than those who were operated before the pandemic period.
Consequently, the rate of positive surgical margin was also higher in the pandemic group. Perineural spread was found to be 2.57-fold and lymhovascular invasion was 2.37-fold. There was also a significant difference in the rate of early biochemical relapse, which was also higher in the pandemic group.
Conclusion: The results indicate that patients have a lower chance of cancer-specific recovery during the Covid-19 pandemic. Due to the delay or omission of screening programs, patients may be diagnosed and treated later.