Department of Urology, Hannover Medical School, Hannover, Germany.
Department of Urology, St. Antonius Hospital, Gronau, Germany.
PLoS One. 2022 Jun 14;17(6):e0269827. doi: 10.1371/journal.pone.0269827. eCollection 2022.
Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines.
To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses.
A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate.
While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.
自 2020 年大流行开始以来，COVID-19 改变了医疗格局。针对局限性前列腺癌（PCa）的国际建议包括延迟治疗和调整治疗方案。
为了纵向评估德国泌尿外科和放射治疗部门的 PCa 治疗策略的变化，我们向 134 个机构发送了一个调查链接，涵盖了大流行前两周和 2020 年 3 月至 2021 年 2 月的 13 周。该问卷收集了根治性前列腺切除术、前列腺活检以及常规和低分割放疗的病例数量。结果采用描述性分析进行评估。
共完成了 35%的问卷。与 2019 年相比，2020 年 PCa 治疗增加了 6%。基线时，共记录了 69 个放疗系列和 164 例根治性前列腺切除术（RP）。在 COVID-19 第一波期间，低危 PCa 的治疗下降了 60%。夏季几个月的恢复后，2020 年底再次降至 58%。2020 年 7 月之前，RP 的数量逐渐下降至 61%，在此期间，前列腺活检数量保持稳定（89%至 98%）。在第一波之后，RP 的使用波动不定，没有明显的风险组优先化。66%的患者接受常规分割，其次是中度低分割（30%）和超分割（4%）。一个局限性在于所选周的潜在选择偏倚和低响应率。
尽管在大流行的两波中，PCa 的诊断和治疗都受到了影响，但在两次高峰之间的间隔期内，2020 年接受治疗的患者总数高于 2019 年。针对优先化和分割方案的建议得到了不同程度的实施，为未来大流行的挑战留下了未开发的潜力。
