Division of Urology, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Clin Genitourin Cancer. 2024 Oct;22(5):102194. doi: 10.1016/j.clgc.2024.102194. Epub 2024 Aug 13.
The COVID-19 pandemic resulted in decreased prostate specific antigen (PSA) testing for prostate cancer screening and its impact remains uncharacterized. Our objective was to compare incident PSA testing rates, PSA levels, and prostate cancer treatment rates before and during the pandemic after the state of emergency (SoE) was declared.
This was a population-based, retrospective cohort study among men 50-80 years of age in Ontario, Canada undergoing incident PSA testing from November 23, 2018 to July 9, 2021. Working backwards and forwards from the date of the province-wide SoE (March 17, 2020), 30-day time periods were constructed during which incident PSA testing rates were measured. Our primary outcome was the rate of incident PSA testing. Secondary endpoints included comparison of incident PSA levels and prostate cancer treatment rates.
We identified 835,402 men who underwent incident PSA testing. There was a 20% decrease in PSA testing after the SoE (RR = 0.80,95% CI: 0.800.81, P < .001). There was a higher proportion of extreme PSA levels after the SoE with a higher proportion of patients with a PSA >20 ng/mL (rate ratio = 1.63,95% CI: 1.54-1.73, P < .0001) and >100 ng/mL (rate ratio = 1.98,95% CI: 1.77-2.20, P < .0001). This effect was highest for those aged 50-59 years. More patients required active treatment (5,201,59.5% prior to the pandemic vs. 5,072,64.2%, P < .001 after the SoE declaration).
The COVID-19 SoE resulted in patients experiencing a 2-fold increase in the risk of having an extreme PSA level and higher odds of treatment. Future studies are needed to assess the impact on the rates of advanced prostate cancer and cancer-specific mortality.
COVID-19 大流行导致前列腺癌筛查的前列腺特异性抗原（PSA）检测减少，其影响尚不清楚。我们的目的是比较紧急状态（SoE）宣布前后的 PSA 检测率、PSA 水平和前列腺癌治疗率。
这是一项基于人群的回顾性队列研究，在加拿大安大略省 50-80 岁的男性中进行，这些男性在 2018 年 11 月 23 日至 2021 年 7 月 9 日期间进行了 PSA 检测。从全省 SoE（2020 年 3 月 17 日）的日期向前和向后，构建了 30 天的时间间隔，以测量 PSA 检测率。我们的主要结局是 PSA 检测的发生率。次要终点包括比较 PSA 水平和前列腺癌治疗率。
我们确定了 835402 名接受 PSA 检测的男性。SoE 后 PSA 检测减少了 20%（RR=0.80，95%CI：0.800.81，P<.001）。SoE 后，极端 PSA 水平的比例更高，PSA>20ng/mL 的患者比例更高（率比=1.63，95%CI：1.54-1.73，P<.0001）和>100ng/mL（率比=1.98，95%CI：1.77-2.20，P<.0001）。这一效应在 50-59 岁的患者中最高。更多患者需要积极治疗（大流行前为 5201 例，59.5%，SoE 宣布后为 5072 例，64.2%，P<.001）。
COVID-19 SoE 导致患者 PSA 水平处于极端水平的风险增加了一倍，并且更有可能接受治疗。需要进一步研究来评估其对晚期前列腺癌和癌症特异性死亡率的影响。
