A new study led by urologists at the Wayne State University School of Medicine and Karmanos Cancer Institute has shown that men with intermediate- and high-risk prostate cancer could delay treatment in the era of COVID-19, similar to the “active surveillance” program men with slow-growing tumors follow.
The pandemic has forced many health care organizations to divert efforts and resources to emergent patient care, delaying many elective oncological surgeries. The researchers investigated the association between delay in radical prostatectomy and oncological outcome.
“Delayed Radical Prostatectomy is Not Associated with Adverse Oncological Outcomes: Implications for Men Experiencing Surgical Delay Due to the COVID-19 Pandemic,” published in the Journal of Urology, focused on more than 128,000 men from the National Cancer Database with “intermediate risk” and “high-risk” prostate cancer based on biopsies showing high grade cancers who underwent radical prostatectomy from 2010 to 2016.
“We wondered if these men, too, could avoid treatment, albeit for a shorter period of time. If so, this would have enormous implication during the pandemic, where hospital resources are stretched and patients and providers are put at risk of being exposed to the virus that causes COVID-19 just by showing up to the hospital,” said Professor and Chair of Urology Michael Cher, M.D., the study’s senior author.
“In men who had radical prostatectomies for intermediate and high-risk disease, we found that a delay of up to 12 months did not result in any worse outcomes compared to immediate surgery within three months of diagnosis. The men who had delay had equivalent final pathology reports, and they did not undergo additional secondary treatments at a higher rate compared with men who had immediate surgery,” he said.
The physicians weren’t sure what to expect, but based on the generally accepted view of offering radical prostatectomy or radiation to newly diagnosed men with intermediate or high-risk prostate cancer -- instead of active surveillance – they were concerned that delay in treatment would lead to worse outcomes.
The other half of men newly diagnosed with prostate cancer have slow-growing tumors, and can be followed for years with blood tests, biopsies and imaging without ever undergoing radical prostatectomy or radiation. Active surveillance helps the men avoid the side effects of treatment, including erectile dysfunction and urinary issues.
The study was initiated by Assistant Professor of Urology Kevin Ginsburg, M.D., who recently started a fellowship in urologic oncology at Fox Chase Cancer Center in Philadelphia. In addition to Dr. Cher, team members included urology resident and Class of 2016 alumnus Gannon Curtis, M.D.; medical student Ryan Timar; and University of Michigan urologist Arvin George, M.D.
The team is now working on a similar study in men with intermediate-large renal cancers.
“In contrast to the situation with prostate cancer, it appears that men who delay radical nephrectomy may have worse outcomes compared with men who have immediate radical nephrectomy,” Dr. Cher said.