Overcoming the impact of the pandemic on prostate cancer screening

As of mid-September 2022, COVID-19 has infected 613 million people and killed 6.53 million people worldwide. The impact of her COVID-19 in the United States intensified in the spring of 2020, with its surge and flare-ups impacting every aspect of her life. Mandatory public facility closures, stay-at-home policies, and the loss of health care workers, combined with increased demand for critical care, have created unprecedented stress. We are now returning to ‘normal’, but it is clearly the ‘new normal’ and many challenges lie ahead. Healthcare is acutely aware that workflows and workforces have changed, and practices need to be adjusted to provide the quality care patients deserve. But at the height of the pandemic, it was mostly hibernating from health care, especially including screening and preventive care.

One of the still undetermined effects of the pandemic is the repercussions from reduced prostate cancer screening. The director of the National Cancer Institute has expressed concern about increased cancer mortality due to screening delays.¹ Several reports document a decline in prostate-specific antigen (PSA) screening and testing during this period. One large government database estimates that the overall lack of prostate cancer screening in the United States during this period affects her 1.6 million men.² In another central Massachusetts database, PSA testing decreased 34% in March 2020, 78% in April 2020, and 53% in May 2020.³ Additionally, there are some indications that reduced screening has disproportionately affected black men.^Four These reports (and others) are concerning and may foreshadow changes in prostate cancer symptoms in the years to come.

There is precedent for the results of decreased prostate cancer screening. In October 2011, the United States Preventive Services Task Force (USPSTF) issued draft guidelines discouraging PSA-based screening for prostate cancer (Grade D recommendation).^Five The following year, recommendations for PSA screening reduced prostate cancer diagnoses by 28%. The consequences of this reduction in screening began to become apparent. Following USPSTF recommendations, not only was PSA screening significantly reduced, but a shift in disease at diagnosis to higher grades and stages was reported in the years that followed.⁶ In fact, the incidence of metastatic prostate cancer has increased significantly in the United States. These trends were (and remain) particularly concerning for young men with high-grade disease, who are most likely to benefit from early detection and definitive prostate cancer treatment.

We hope that we can recapture the gains we made before the pandemic and recover from this temporary hiatus of our regularly scheduled healthcare programs. Urologists and primary care providers will need increased messaging and more creative approaches to PSA-based screening and prostate cancer awareness. We need to reach men (and those with influence) with a thoughtful, shared decision-making message about prostate cancer screening. But we need to work harder, work smarter, and reach this target male audience. We hope that the progress made with PSA screening behind the pandemic will continue beyond the prostate cancer awareness campaign in September. Cancers don’t take vacations or vacations, they don’t care about pandemics. Our efforts to reduce deaths from prostate cancer through screening and early detection must continue.

References

1. Sharpless NE. COVID-19 and cancer. chemistry2020;368(6497):1290. doi:10.1126/science.abd3377

2. Cheng RC, Haynes K, Du S, Baron J, Katz AJ. Lack of cancer screening in the United States and its association with the COVID-19 pandemic. JAMA Oncology2021;7(6):878-884. doi:10.1001/jamaoncol.2021.0884

3. Epstein MM, Sundaresan D, Fair M, et al. Trends in breast and prostate cancer screening and diagnostic procedures during his COVID-19 pandemic in central Massachusetts. Cancer causes control. 2022;33(10):1313-1323. doi:10.1007/s10552-022-01616-4

4. Kelkar AH, Zhao J, Wang S, Cogle CR. Impact of the COVID-19 Pandemic on Colorectal and Prostate Cancer Screening in the Large US Healthcare System. Healthcare (Basel). 2022;10(2):264.doi:10.3390/healthcare10020264

5. Impact of USPSTF Grade D recommendations for prostate cancer screening, including Barocas D, Mallin K, Graves AJ, on prostate cancer diagnosis in the United States. J Urol. 2015;194(6):1587-1593. doi:10.1016/j.juro.2015.06.075

6. Eapen RS, Herlemann A, Washington SL 3rd, Cooperberg MR. The impact of the US Preventive Services Task Force’s “D” recommendation on prostate cancer screening and staging. Curr Opin Urol. 2017;27(3):205-209. doi:10.1097/MOU.0000000000000383