Impact of COVID-19 on the incidence of localized and metastatic prostate cancer among White and Black Veterans

Abstract

The COVID-19 pandemic disrupted prostate-specific antigen (PSA) screening and prostate biopsy procedures. We sought to determine whether delayed screening and diagnostic workup of prostate cancer (PCa) was associated with increased subsequent rates of incident PCa and advanced PCa and whether the rates differed by race. We analyzed data from the Veterans Health Administration to assess the changes in the rates of PSA screening, prostate biopsy procedure, incident PCa, PCa with high-grade Gleason score, and incident metastatic prostate cancer (mPCa) before and after January 2020. While the late pandemic mPCa rate among White Veterans was comparable to the pre-pandemic rate (5.4 pre-pandemic vs 5.2 late-pandemic, p = 0.67), we observed a significant increase in incident mPCa cases among Black Veterans in the late pandemic period (8.1 pre-pandemic vs 11.3 late-pandemic, p < 0.001). Further investigation is warranted to fully understand the impact of the COVID-19 pandemic on the diagnosis of advanced prostate cancer.

Keywords: COVID-19; cancer screening; incidence of prostate cancer; racial disparities; veterans affairs.

FIGURE 1

Monthly rates of prostate‐specific antigen testing, prostate biopsy, incident prostate cancer diagnosis, high‐grade Gleason score, and incident metastatic disease per 100,000 men by race. Denoted by a vertical dashed line in each of the five panels, January 2020 was the month in which the U.S. Department of Health and Human Services declared COVID‐19 a public health emergency in the U.S. mPCa, metastatic prostate cancer; PCa, prostate cancer; PSA, prostate‐specific antigen.