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Hayes J, Nayak A, Gan C, Foley C, Vasdev N, Popert R, Adshead J. A TREXIT Catalyst: an updated review of NHS England prostate biopsy data during COVID-19. BJU Int 2023; 131:304-305. [PMID: 36445113 DOI: 10.1111/bju.15939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John Hayes
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Arvind Nayak
- Department of Urology, Lister Hospital, Stevenage, UK
| | - Christine Gan
- Department of Urology, Lister Hospital, Stevenage, UK
| | | | - Nikhil Vasdev
- Department of Urology, Lister Hospital, Stevenage, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Rick Popert
- Department of Urology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Jim Adshead
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Chan VWS, Asif A, Koe JSE, Ng A, Ng CF, Teoh JYC. Implications and effects of COVID-19 on diagnosis and management of prostate cancer. Curr Opin Urol 2022; 32:311-317. [PMID: 35142745 DOI: 10.1097/mou.0000000000000973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The Coronavirus disease 2019 (COVID-19) pandemic has led to uncertainty on the optimal management for prostate cancer (PCa). This narrative review aims to shed light on the optimal diagnosis and management of patients with or suspected to have PCa. RECENT FINDINGS Faecal-oral or aerosol transmission is possible during prostate procedures; caution must be in place when performing digital rectal examinations, transrectal ultrasound-guided prostate biopsies and prostate surgeries requiring general anaesthesia. Patients must also be triaged using preoperative polymerase chain reaction tests for COVID-19. COVID-19 has accelerated the adoption of multiparametric Magnetic Resonance Imaging (MRI), reducing the need for prostate biopsy unless when absolutely indicated, and the risk of COVID-19 spread can be reduced. Combined with prostate-specific antigen (PSA) density, amongst other factors, multiparametric MRI could reduce unnecessary biopsies in patients with little chance of clinically significant PCa. Treatment of PCa should be stratified by the risk level and preferences of the patient. COVID-19 has accelerated the development of telemedicine and clinicians should utilise safe and effective teleconsultations to protect themselves and their patients. SUMMARY COVID-19 transmission during prostate procedures is possible. Patients with a Prostate Imaging-Reporting and Data System (PI-RADS) of <3 and PSA density <0.15 ng/ml/ml are deemed low-risk and are safe to undergo surveillance without MRI-targeted biopsy. Intermediate- or high-risk patients should be offered definitive treatment within four months or 30days of diagnosis to avoid compromising treatment outcomes; three-month courses of neoadjuvant androgen deprivation therapy can be considered when a delay of surgery is anticipated.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Division of Surgery and Interventional Science, University College London, London
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London
- Leicester Medical School, University of Leicester, Leicester
| | - Jasmine Sze-Ern Koe
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Alexander Ng
- UCL Medical School, University College London, London, UK
| | - Chi Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Nossiter J, Morris M, Parry MG, Sujenthiran A, Cathcart P, van der Meulen J, Aggarwal A, Payne H, Clarke NW. Impact of the Covid-19 pandemic on the diagnosis and treatment of men with prostate cancer. BJU Int 2022; 130:262-270. [PMID: 35080142 DOI: 10.1111/bju.15699] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the impact of the Covid-19 pandemic on diagnostic and treatment activity in 2020 across hospital providers of prostate cancer (PCa) care in the English National Health Service. METHODS Diagnostic and treatment activity between March 23rd (start of first national lockdown in England) and December 31st 2020 was compared with same calendar period in 2019. Patients newly diagnosed with PCa were identified in national rapid cancer registration data linked to other electronic healthcare datasets. RESULTS There was a 30.8% reduction (22,419 versus 32,409) in the number of men with newly diagnosed PCa in 2020 after the start of the first lockdown, compared with the corresponding period in 2019. Men diagnosed in 2020 were typically at more advanced stage (21.2% versus 17.4%, stage IV) and slightly older (57.9% versus 55.9% ≥ 70 years, p<0.001). Prostate biopsies in 2020 were more often performed through using transperineal routes (64.0% versus 38.2%). The number of radical prostatectomies in 2020 was reduced by 26.9% (3,896 versus 5,331) and the number treated by external beam radiotherapy (EBRT) by 14.1% (9,719 versus 11,309). Other changes included an increased use of EBRT with hypofractionation and reduced use of docetaxel chemotherapy in men with hormone-sensitive metastatic PCa (413 versus 1,519) with related increase in the use of enzalutamide. CONCLUSION We found substantial deficits in the number of diagnostic and treatment procedures for men with newly diagnosed PCa after the start of the first lockdown in 2020. The number of men diagnosed with PCa decreased by about one third and those diagnosed had more advanced disease. Treatment patterns shifted towards those that limit the risk of Covid-19 exposure including increased use of transperineal biopsy, hypofractionated radiation, and enzalutamide. Urgent concerted action is required to address the Covid-19-related deficits in PCa services to mitigate their impact on long-term outcomes.
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Affiliation(s)
- Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Clinical Effectiveness Unit, Royal College of Surgeons of England
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Clinical Effectiveness Unit, Royal College of Surgeons of England
| | - Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Clinical Effectiveness Unit, Royal College of Surgeons of England
| | | | - Paul Cathcart
- Department of Urology, NHS Foundation Trust, Guy's and St Thomas
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Department of Radiotherapy, NHS Foundation Trust, Guy's and St Thomas.,Department of Cancer Epidemiology, Population, and Global Health, King's College London
| | - Heather Payne
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts
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Devetzis K, Kum F, Popert R. Recent Advances in Systematic and Targeted Prostate Biopsies. Res Rep Urol 2021; 13:799-809. [PMID: 34805013 PMCID: PMC8598205 DOI: 10.2147/rru.s291963] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.
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Affiliation(s)
| | - Francesca Kum
- King's College School of Medicine, London, UK.,Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Richard Popert
- Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
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Bersanelli M, Porta C. Impact of SARS-CoV-2 Pandemic on Kidney Cancer Management. KIDNEY CANCER 2021. [DOI: 10.3233/kca-210112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The SARS-CoV-2 pandemic still has a huge impact on the management of many chronic diseases such as cancer. Few data are presently available reagarding how the management of renal cell carcinoma (RCC) has changed due to this unprecedented situation. OBJECTIVE: To discuss the challenges and issues of the diagnosis and treatment of RCC in the COVID-19 era, and to provide recommendations based on the collected literature and our personal experience. METHODS: Systematic review of the available Literature regarding the management of RCC during the SARS-CoV-2 pandemic. RESULTS: Our review showed a prevalence of narrative publications, raising the issue of the real relevance of the evidence retrieved. Indeed, the only original data about RCC and COVID-19 found were a small retrospective case series and two surveys, providing either patients’ or physicians’ viewpoints. CONCLUSIONS: The expected delayed diagnosis of RCC could lead to an increase of advanced/metastatic cases; thus, proper therapeutic choices for patients with small renal masses should be carefully evaluated case by case, in order to avoid negative effects on long-term survival rates. The controversial interaction between immune checkpoint blockade and COVID-19 pathogenesis is more hypothetical than evidence-based, and thus immunotherapy should not be denied, whenever appropriate. To avoid treatments which won’t have an impact on patients’ survival, a honest and accurate evaluation of the cost/benefit ratio of each treatment option should be always performed. Finally, SARS-CoV-2 swab positivity should not prevent the continuation of ongoing active treatments in asymptomatic cases, or or after symptoms’ resolution.
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Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro’ and Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
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Coma E, Guiriguet C, Mora N, Marzo-Castillejo M, Benítez M, Méndez-Boo L, Fina F, Fàbregas M, Mercadé A, Medina M. Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people. BMJ Open 2021; 11:e047567. [PMID: 34006554 PMCID: PMC8130761 DOI: 10.1136/bmjopen-2020-047567] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The objective of our study is to evaluate the impact of the pandemic on the incidence of cancer diagnoses in primary care. DESIGN Time-series study of malignant neoplasms and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020. SETTING Primary care, Catalonia, Spain. PARTICIPANTS People older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm. MAIN OUTCOME MEASURES We obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms was defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer and socioeconomic status. RESULTS Between March and September 2020 we observed 8766 (95% CI 4135 to 13 397) fewer malignant neoplasm diagnoses, representing a reduction of 34% (95% CI 19.5% to 44.1%) compared with the expected. This underdiagnosis was greater in individuals aged older than 64 years, men and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that). CONCLUSIONS Reduction in cancer incidence has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Carolina Guiriguet
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Catala De La Salut, Barcelona, Spain
| | - Nuria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Mercè Marzo-Castillejo
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Direcció d'Atenció Primària Costa de Ponent, ICS, Barcelona, Spain
| | - Mencia Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Catala De La Salut, Barcelona, Spain
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Albert Mercadé
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
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