Management of patients who opt for radical prostatectomy during the COVID-19 pandemic: An International Accelerated Consensus Statement
Tandogdu Z, Collins J, Shaw G, Rohn J, Koves B, Sachdeva A, Ghazi A, Haese A, Mottrie A, Kumar A, Sivaraman A, Tewari A, Challacombe B, Rocco B, Giedelman C, Wagner C, Rogers CG, Murphy DG, Pushkar D, Ogaya-Pinies G, Porter J, Ramesh Seetharam K, Graefen M, Orvieto MA, Covas Moschovas M, Schatloff O, Wiklund P, Coelho R, Valero R, de Reijke TM, Ahlering T, Rogers T, van der Poel HG, Patel V, Artibani W, Wagenlehner F, Nathan S, Erik Bjerklund Johansens T, Hawkey P, and Kelly J. Management of patients who opt for radical prostatectomy during the COVID-19 pandemic: An International Accelerated Consensus Statement. BJU Int 2020.
BACKGROUND: Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. Such delays can lead to disease progression.
OBJECTIVE: We aimed to develop guidance on criteria for prioritization for surgery and reconfiguring management pathways for non-metastatic stage of prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve low likelihood of COVID-19 hazard if radical prostatectomy was to be carried out during the outbreak and whilst the disease is endemic.
DESIGN, SETTING AND PARTICIPANTS: An accelerated consensus process and systematic review. We conducted a systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n=34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds.
OUTCOME MEASURES: Consensus opinion was defined as ≥80% agreement, which were used to reconfigure the prostate cancer pathways.
RESULTS: Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and develop measures to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritization criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as "COVID-19 cold sites".
CONCLUSION: Re-configuring management pathways for prostate cancer patients is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing radical prostatectomy within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.
ePub ahead of print