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. 2021 Jun;127(6):729-741.
doi: 10.1111/bju.15299. Epub 2021 Mar 10.

Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement

Zafer Tandogdu  1   2 , Justin Collins  1 , Greg Shaw  1 , Jennifer Rohn  2 , Bela Koves  3 , Ashwin Sachdeva  4 , Ahmed Ghazi  5 , Alexander Haese  6 , Alex Mottrie  7 , Anup Kumar  8 , Ananthakrishnan Sivaraman  9 , Ashutosh Tewari  10 , Benjamin Challacombe  11 , Bernardo Rocco  12 , Camilo Giedelman  13 , Christian Wagner  14 , Craig G Rogers  15 , Declan G Murphy  16 , Dmitry Pushkar  17 , Gabriel Ogaya-Pinies  18 , James Porter  19 , Kulthe Ramesh Seetharam  20 , Markus Graefen  21 , Marcelo A Orvieto  22 , Marcio Covas Moschovas  20 , Oscar Schatloff  23 , Peter Wiklund  10 , Rafael Coelho  24 , Rair Valero  25 , Theo M de Reijke  26 , Thomas Ahlering  27 , Travis Rogers  20 , Henk G van der Poel  28 , Vipul Patel  20 , Walter Artibani  29 , Florian Wagenlehner  30 , Kris Maes  31 , Koon H Rha  32 , Senthil Nathan  1 , Truls Erik Bjerklund Johansen  33 , Peter Hawkey  34   35 , John Kelly  1   2
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Free article

Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement

Zafer Tandogdu et al. BJU Int. 2021 Jun.
Free article

Abstract

Objective: 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. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic.

Methods: We conducted an accelerated consensus process and 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. The Consensus opinion was defined as ≥80% agreement and this was 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 measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation 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: Reconfiguring management pathways for patients with prostate cancer 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 RP 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.

Keywords: #COVID19; #Coronavirus; #PCSM; #ProstateCancer; #uroonc; consensus; coronavirus; nosocomial; pandemic; surgery.

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