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Prostate Cancer Surgery Rates in Black vs White Men With Nonmetastatic Disease During the COVID-19 Pandemic


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In a retrospective cohort study reported in JAMA Oncology, Bernstein et al found that prostatectomy rates during the initial wave of the COVID-19 pandemic were dramatically lower among Black men vs White men with previously untreated nonmetastatic prostate cancer.

Study Details

The study involved data from the Pennsylvania Urologic Regional Collaborative, a prospective collaborative of urology practices in Pennsylvania and New Jersey. Prostatectomy rates were assessed among 269 patients receiving care during the pandemic lockdown between March 16 and May 15, 2020, and among 378 patients receiving care over the corresponding 9-week period prior to the pandemic (between March 11 and May 10, 2019). 

Key Findings

For Black patients vs White patients during the lockdown, there were no significant differences in COVID-19 risk factors for severe infection as defined by the Centers for Disease Control and Prevention (0, 1, ≥ 2; overall P = .35) or biopsy Gleason grade group (1, 2, 3, 4–5; overall P = .59). Black men had higher median prostate-specific antigen levels prior to biopsy (8.8 vs 7.2 ng/mL, P = .04). 

During the lockdown, 1 (1.3%) of 76 Black men underwent prostatectomy vs 50 (25.9%) of 193 White men (P < .001). During the prepandemic period, 17 (17.7%) of 96 Black patients vs 54 (19.1%) of 282 White patients underwent prostatectomy (P = .75).

KEY POINTS

  • During the lockdown, 1 (1.3%) of 76 Black men underwent prostatectomy vs 50 (25.9%) of 193 White men.
  • On multivariate analysis adjusting for presence of high-risk disease and age, White patients were significantly more likely to undergo prostatectomy during the lockdown, with an odds ratio of 30.48.
  • Sites with the largest reductions in cancer surgery cared for a greater proportion of Black patients.

On multivariate analysis adjusting for presence of high-risk disease and age, White patients were significantly more likely to undergo prostatectomy during the lockdown, with an odds ratio of 30.48 (P = .001). Odds ratios for likelihood of undergoing prostatectomy during vs prior to the pandemic were 0.06 (P = .002) among Black patients and 1.41 (P = .23) among White patients.

During a 9-week period after reopening began, prostatectomy was performed in 19 (25.0%) of 76 Black patients vs 54 (28.0%) of 193 White patients (P = .62).

Changes in cancer surgery volume varied across sites from 100% reduction to 33% increase during the lockdown, with sites with the largest reductions in cancer surgery caring for a greater proportion of Black patients. Black patients accounted for 49 (40.5%) of 121 patients at sites with the greatest reduction in volume; White patients accounted for 210 (81.7%) of 257 patients at sites at which volume was less affected.

The investigators concluded, “In this large multi-institutional regional collaborative cohort study, the odds of prostate cancer surgery were lower among Black patients compared with White patients during the initial wave of the COVID-19 pandemic. Although localized prostate cancer 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.”

Andres Correa, MD, of the Division of Urologic Oncology, Fox Chase Cancer Center, is the corresponding author for the JAMA Oncology article.

Disclosure: The collection and management of data for the Pennsylvania Urologic Regional Collaborative is funded by the Health Care Improvement Foundation through practice participation. For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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