Department of Urology, University College London Hospital, London, UK.
Medical School, University College London, London, UK.
BJU Int. 2021 Jun;127(6):729-741. doi: 10.1111/bju.15299. Epub 2021 Mar 10.
Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic.
We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways.
Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites.
Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.
新冠疫情导致前列腺癌患者的确定性治疗出现延误。除了直接延误之外，预计未来患者的积压量还会增加。本研究旨在制定针对选择手术治疗的非转移性前列腺癌患者的手术优先排序标准和重新配置管理路径的指南。第二个目标是确定感染预防和控制（IPC）措施，如果要在疫情爆发期间和疾病流行期间进行根治性前列腺切除术（RP），以降低发生 2019 年冠状病毒病（COVID-19）的风险。
我们通过在线会议向 34 名国际前列腺癌专家小组展示了对 COVID-19 的快速共识进程和系统评价，并回顾了前列腺癌的国际指南。这一共识进程总共进行了三轮调查。第二轮和第三轮调查的补充内容是基于前几轮的答案和意见制定的。共识意见定义为≥80%的一致意见，并以此重新配置前列腺癌路径。
关于延迟治疗前列腺癌患者的证据很少。专家小组一致认为应重新配置前列腺癌路径，并制定措施以防止医院内 COVID-19 感染，用于接受手术治疗的患者。对于接受手术的患者的优先排序标准和接受延迟治疗的患者的管理路径达成了共识。为实现医院内 COVID-19 低发生风险提出了感染预防和控制措施，称为“COVID-19 冷”站点。
如果手术管理出现明显延误（>3-6 个月），建议重新配置前列腺癌患者的管理路径。所提出的管理路径为这些患者提供了指导。所提出的 IPC 流程为在疫情爆发期间或疾病流行期间，以低 COVID-19 风险为环境下提供 RP 提供了框架。更广泛的概念可以适应前列腺癌手术以外的其他适应症。
