Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta.
Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta.
JAMA Oncol. 2022 Jun 1;8(6):914-918. doi: 10.1001/jamaoncol.2022.0467.
Several studies have assessed the negative effect of the COVID-19 pandemic on cancer screening and diagnosis rates. However, this has not been evaluated for prostate biopsy and prostate cancer (PC) diagnosis in an equal-access health care system.
To determine the association of the pandemic with prostate biopsy and PC diagnosis rates among Black vs White patients in the Veterans Affairs Health Care System (VAHCS).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included a retrospective analysis of all prostate biopsies performed on patients in the VAHCS without a preexisting PC diagnosis between January 2018 and March 2021. The base population included all living male patients who had at least 1 visit to the VAHCS during the 3 years prior to each month of the study.
The COVID-19 pandemic.
The main outcomes were the number of prostate biopsies and PC diagnoses by month. The influence of the pandemic on prostate biopsy volume and the incidence of PC diagnoses was modeled using an interrupted time-series analysis. Poisson generalized linear models were fitted to project the expected number of prostate biopsies and PC diagnoses had there been no pandemic interruption. Additional models were used to test for differences by race.
Prior to the pandemic (January 2018 through February 2020), monthly biopsy numbers among 51 606 included men ranged between 1230 and 1695, of which 56% to 60% of results were positive for PC. The estimated number of missed PC diagnoses from March 2020 through March 2021 ranged from 97 cases (October 2020: 752 cases expected, 655 cases observed) to 573 cases (April 2020: 794 cases expected, 221 cases observed). Prior to the pandemic, biopsy rates were statistically significantly higher among Black vs White men (incidence rate ratio, 2.25; 95% CI, 2.06-2.46; P < .001). There was no change in biopsy rates associated with race at the onset of the pandemic nor during the recovery period from March 2020 to March 2021. Similar trends were observed for PC diagnosis rates.
Results of this cohort study demonstrate that during the COVID-19 pandemic, prostate biopsy and PC diagnosis rates decreased, particularly during the peak of the pandemic. However, there were no statistically significant changes in rates by race.
多项研究评估了 COVID-19 大流行对癌症筛查和诊断率的负面影响。然而，在公平获得医疗保健的系统中，尚未评估前列腺活检和前列腺癌 (PC) 诊断的情况。
确定在退伍军人事务医疗保健系统 (VAHCS) 中，与黑人相比，大流行与白人患者前列腺活检和 PC 诊断率之间的关联。
设计、设置和参与者：这项队列研究回顾性分析了 2018 年 1 月至 2021 年 3 月期间在 VAHCS 中进行的所有无前列腺癌既往诊断的男性患者的前列腺活检。基础人群包括在研究期间每个月之前的 3 年内至少有一次 VAHCS 就诊的所有存活男性患者。
COVID-19 大流行。
主要结果是每月前列腺活检和 PC 诊断的数量。使用中断时间序列分析来模拟大流行对前列腺活检数量和 PC 诊断发生率的影响。使用泊松广义线性模型来预测如果没有大流行干扰，预计进行的前列腺活检和 PC 诊断数量。使用其他模型来测试种族差异。
在大流行之前（2018 年 1 月至 2020 年 2 月），纳入的 51606 名男性每月的活检数量在 1230 至 1695 之间，其中 56%至 60%的结果为 PC 阳性。从 2020 年 3 月至 2021 年 3 月期间估计的错过的 PC 诊断数量从 97 例（2020 年 10 月：预计 752 例，实际 655 例）到 573 例（2020 年 4 月：预计 794 例，实际 221 例）。在大流行之前，黑人男性与白人男性相比，活检率具有统计学意义上的显著升高（发病率比，2.25；95%CI，2.06-2.46；P < .001）。在大流行开始时以及从 2020 年 3 月至 2021 年 3 月的恢复期，种族与活检率之间均无关联变化。PC 诊断率也出现了类似的趋势。
这项队列研究的结果表明，在 COVID-19 大流行期间，前列腺活检和 PC 诊断率下降，尤其是在大流行高峰期。然而，种族之间的比率没有统计学意义上的显著变化。
