Introduction: Since early 2020, the global pandemic caused by COVID-19 has resulted in considerable healthcare related and economic impacts. To mitigate health impact to the wider population, restrictions on non-essential services were imposed. Australia performed favourably compared to other developed countries, largely due to these state-initiated transient ‘lock-downs’ to control local outbreaks. Recommendations to limit non-urgent urologic care were formulated to optimise patient safety and many of these were adopted in Australia. We aimed to extend this analysis to observe the trend in PSA tests, biopsies, and radical prostatectomies in the first 18 months of the pandemic, from January 2020 through to mid-2021, and compare these to the previous ten years.
Methods: Medicare Benefits Schedule data was extracted per state and per month from January 2010 to June 2021 for PSA tests, prostate biopsies, and radical prostatectomies. Each item was plotted as a two-year trend, with the count of tests/procedures expressed as a ratio to the first January count of that two-year period. Data on the number of covid cases per day to 30th June 2021, as a 7-day average.
Results: A sharp fall in PSA tests among all states was seen in April 2020 as the first wave of COVID-19 cases were detected and lockdown measures initiated. Test numbers rebounded quickly but remained slightly below the long-term trend (Figure 1, green line). For biopsy procedures, a decline from the expected trend began in March/April 2020 but generally remained below trend for the remainder of the year for most states within Australia. The observed deviation for radical prostatectomies commenced later than biopsies, with an apparent two- or three-month lag. In comparison to the longer-term average trend, from Jan 2020 to Jun 2021 it is estimated that there were 15% fewer PSA tests, 16% fewer biopsies and 17% fewer prostatectomies in Australia.
Conclusions: The consequence of periodic lockdowns in response to COVID19 on patterns of care on stage at presentation and oncological outcomes is unknown but should be measured. As vaccination rates rise globally, it is expected that strict COVID-19 mitigation measures will not be required, therefore limiting the consequent impact on prostate cancer management contained.
Source of Funding: Marlon Perera is sponsored by the Australian-America Fulbright Commission administered through a 2021-2022 Fulbright Future Scholarship funded by The Kinghorn Foundation