Lemanska Agnieszka, Andrews Colm, Fisher Louis, Bacon Seb, Mehrkar Amir, Inglesby Peter, Davy Simon, Goldacre Ben, MacKenna Brian, Walker Alex J
Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BJU Int. 2024 May;133(5):587-595. doi: 10.1111/bju.16305. Epub 2024 Feb 27.
To investigate the effect of the COVID-19 pandemic on prostate cancer incidence, prevalence, and mortality in England.
With the approval of NHS England and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models and the pre-pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals (CIs) of the predicted values were used to estimate the significance of the difference between the predicted and observed rates.
In 2020, there was a drop in recorded incidence by 4772 (31%) cases (15 550 vs 20 322; 95% CI 19 241-21 403). In 2021, the incidence started to recover, and the drop was 3148 cases (18%, 17 950 vs 21 098; 95% CI 19 740-22 456). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (95% CI 71.5-71.8) years, in 2021 it was 71.8 (95% CI 71.7-72.0) years as compared to 71.3 (95% CI 71.1-71.4) years in 2019.
Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20 000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.
调查2019冠状病毒病（COVID-19）大流行对英格兰前列腺癌发病率、患病率和死亡率的影响。
在英格兰国民保健服务体系（NHS England）批准下，我们使用了包含2400万患者的OpenSAFELY-TPP数据集，对被诊断为前列腺癌的男性进行了队列研究。我们可视化了2015年1月至2023年7月期间每10万名成年男性中前列腺癌发病率、患病率和死亡率的月度数据。为评估大流行的影响，我们使用广义线性模型和大流行前的数据来预测2020年3月起若无大流行时的预期发病率。预测值的95%置信区间（CI）用于估计预测发病率与观察到的发病率之间差异的显著性。
2020年，记录的发病率下降了4772例（3l%）（15550例对20322例；95%CI为19241 - 21403）。2021年，发病率开始回升，下降了3148例（18%，17950例对21098例；95%CI为19740 - 22456）。到2022年，发病率恢复到预期水平。在大流行期间，确诊年龄向老年男性偏移。2020年平均年龄为71.6（95%CI为71.5 - 71.8）岁，2021年为71.8（95%CI为71.7 - 72.0）岁，而2019年为71.3（95%CI为71.1 - 71.4）岁。
鉴于我们的数据集代表了40%的人口，我们估计仅在英格兰，大流行按比例导致了20000例前列腺癌漏诊。2023年记录的发病率上升不足以弥补漏诊病例。在整个大流行期间，前列腺癌的患病率一直低于预期。随着恢复工作的继续，医疗保健应专注于找到受影响的男性。研究应专注于调查老年确诊男性可能受到的危害。
