Safety First: Evidence for Delay of Radical Prostatectomy without Use of Androgen Deprivation Therapy During COVID-19

Ong, Sean; Condon, Benjamin; Bagguley, Dominic; Lawrentschuk, Nathan; Azad, Arun; Murphy, Declan

doi:10.2217/fon-2020-0388

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…Recent studies have evaluated the effect of COVID-19 pandemic healthcare delays on the diagnosis and treatment of a wide range of health problems, including cardiovascular disease [14][15][16][17][18][19][20][21] and cancer , with several studies focused on Emergency Department (ED), obstetrics, gynecology and pediatric patients [37,[46][47][48][49][50][51][52][53] and a limited number of studies focused on surgical procedures [20,29,41,[54][55][56][57][58][59][60][61][62][63][64]. To date, few studies have attempted to examine predictors of delayed surgical or non-surgical healthcare services in the general population [65,66].…”

Section: Introductionmentioning

confidence: 99%

Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006–2020 Health and Retirement Study

Beydoun

Alemu

et al. 2022

IJERPH

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Background: The coronavirus disease 19 (COVID-19) was declared a global pandemic on March 11, 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, ≥50 years of age. Methods: Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006–2018) linked to the 2020 HRS COVID-19 Project (57% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services (“Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?” and “What type of care did you delay”) using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data. Results: Nearly 32.7% delayed healthcare services, 5.8% delayed surgical services and 31.4% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60–70% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays. Conclusion: Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions.

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Section: Introductionmentioning

confidence: 99%

Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006–2020 Health and Retirement Study

Beydoun

Alemu

et al. 2022

IJERPH

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“…4,5 whilst others have opted for watchful waiting. 3 Trialling neoADT is not surprising as the treatment modality of choice, given that previous studies assessing neoADT have shown promise through reduction of post-surgical margins, but without any benefit on long-term patient and surgical outcomes. 6,7 At the present, there is a lack of a strong evidence base for management of PCa patients during Covid-19 as informed by the analysis of patient outcomes during the initial months of the pandemic itself.…”

Section: Introductionmentioning

confidence: 99%

“…1 One of the most significant effects due to delay in surgery is psychological morbidity. 2 , 3 Little is known about the oncological outcomes, particularly in a contemporary cohort of high-risk locally-advanced prostate cancers. The current management strategies of PCa patients are mostly driven by findings from studies conducted prior to the Covid-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

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A cohort analysis of patients receiving neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy during the Covid-19 pandemic

Bennett

Leung

Ahmad

2021

Journal of Clinical Urology

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Objectives: The purpose of this study was to investigate localised prostate cancer treated with or without neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy, and the impact of Covid-19 treatment disruption, on clinico-pathologic outcomes. Patients and methods: Data was retrospectively collected from 124 consecutive patients treated with robot-assisted laparoscopic prostatectomy between November 2019–September 2020. Sixty-two patients were treated before 13 March 2020 (historic cohort) and 62 afterwards (covid cohort). Thirty-seven patients in the covid cohort additionally received neoadjuvant androgen deprivation therapy (mean duration of 3 months) consisting of bicalutamide 150 mg once a day for 4 weeks, with leuprolide 3.75 mg monthly injections commencing after week 1, up until the date of surgery. Results: Statistical analysis found no difference in peri-operative measures and length of stay for patients treated with or without neoadjuvant androgen deprivation therapy. Patients with delayed surgical treatment offered neoadjuvant androgen deprivation therapy showed a trend towards a reduction in positive surgical margins ( p=0.134), N1 disease ( p=0.424) and pathological down-staging (50% patients with pT2 disease). Patients within the covid cohort experienced significantly increased detectable prostate-specific antigen levels ( p<0.007). Conclusion: Our study demonstrated that a three-month duration of neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy may improve pathological outcomes but this time-frame is inadequate to influence detectable prostate-specific antigen levels. Covid-19-related treatment delays led to significantly increased detectable prostate-specific antigen levels. Level of evidence: 2b

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Implications of COVID-19 on urological laparoscopic surgery

et al. 2020

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At present the most significant concern for urologists during this pandemic is to safely mitigate the risk of SARS-CoV-2 infection of both patient and the surgical team by considering the immediate need of a particular procedure, the approach and indeed even ports used to access the abdomen along with managing the surgical plume and having appropriate PPE and adjusting their planning accordingly. "

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Safety First: Evidence for Delay of Radical Prostatectomy without Use of Androgen Deprivation Therapy During COVID-19

Cited by 5 publications

References 18 publications

Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006–2020 Health and Retirement Study

Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006–2020 Health and Retirement Study

A cohort analysis of patients receiving neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy during the Covid-19 pandemic

Implications of COVID-19 on urological laparoscopic surgery

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