Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme

Introduction: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation. Objectives: The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program. Methods: The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019). Results: During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years. Conclusions: Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.S

Influence of serum testosterone on urinary continence and sexual activity in patients undergoing radical prostatectomy for clinically localized prostate cancer

The aim of the present study was to evaluate how serum testosterone level (T) can affect urinary continence and erectile function in patients undergoing radical prostatectomy (RP). We included 257 patients with clinically localized prostate cancer, those who had filled out preoperative quality of life questionnaires (University of California, Los Angeles Prostate Cancer Index, International Index of Erectile Function (IIEF)), and those who had T and total PSA sampled the day before surgery. We calculated correlations between T and age, body mass index (BMI), PSA, urinary function or bother (UF, UB) and sexual function or bother (SF, SB) and IIEF-5 in the whole population and in sub-populations with normal (⩾10.4 nmol l−1) and low (<10.4 ng ml−1) T using Pearson's and Spearman's correlation coefficients. We evaluated differences in these parameters between patients with low and normal T using the unpaired samples t-test and Mann–Whitney test, and finally the correlation between UF and SF, UB and SB, and between PSA and T in the overall population, and separately in patients with low and normal T using the Pearson's correlation coefficient. Mean preoperative T was 13.5 nmol l−1 and 23.7% of patients presented a low T. Mean age, mean BMI and mean preoperative total PSA at RP were 64.3 years, 25.9 kg m−2 and 9.0 ng ml−1, respectively. BMI was negatively correlated with T in the overall population (r=−0.266; P=0.02); moreover, patients with normal T presented lower BMI compared with patients with low T (25.7 vs 27.6: P=0.02). We found a significant correlation between SF scores and T in patients with normal T (r=0.1777: P=0.05). SF was significantly higher in patients with normal T compared with those with low T (74.8 vs 64.8: P=0.05). Furthermore, UF and UB were significantly correlated with SF (r=0.2544: P<0.01) and SB (r=0.2512: P=0.01), respectively, in men with normal T. Serum T was significantly correlated with PSA in men with low T (r=0.3874: P=0.0029), whereas this correlation was missed in the whole population and in men with normal T. The correlation between preoperative PSA and T in men with low T is in agreement with the ‘saturation' model proposed by Morgentaler. The correlation between basal T and preoperative erectile function and urinary continence underlines the importance of assessing T before RP

Diagnostic accuracy of hTERT mRNA in comparison with a preoperative serum PSA test.

<p>PPV: Positive predictive value; NPV: Negative predictive value; CI: confidence interval; LR: Likelihood ratio.</p

hTERT mRNA diagnostic accuracy. Comparison with serum PSA.

<p>ROC curves show that plasma hTERT mRNA, but not serum PSA, discriminates between PCa patients and healthy individuals or patients with prostatitis or BPH. Plasma hTERT mRNA shows higher sensitivity (85% vs 83%), specificity (90% vs 47%), PPV (83% vs 56%), NPV (92% vs 77%) and AUC ROC (0.932 vs 0.651) than PSA with respect to PCa diagnosis. Pairwise comparison of hTERT mRNA and PSA ROC curves showed significant differences (p<0.001).</p

Differences between hTERT mRNA and preoperative serum PSA levels according to prostate biopsy characteristics and final stage (adding clinical staging).

*<p>Non-parametric Mann-Whitney U and Kruskal-Wallis tests were used for comparison of two medians and more than two medians, respectively.</p

Results of the logistic regression analysis predicting PCa diagnosis.

<p>DRE: Digital Rectal Examination; TRUS: Transrectal Ultrasonography; CI: Confidence Intervals;</p>*<p>Logistic regression analysis, p–values less than 0.05 were considered statistically significant.</p

Flow diagram showing that PSA screening results in a high percentage of unnecessary biopsies.

<p>One hundred and five consecutive patients with elevated PSA levels underwent prostate biopsy. Forty-six of the 105 patients (44%) were diagnosed with PCa, and fifty-nine patients (56%) showed no evidence of cancer. PCa: Prostate Cancer BPH: Benign Prostatic Hyperplasia.</p

Age, preoperative serum PSA and hTERT mRNA levels of controls and patients according to histopathological findings.

*<p>Mean ±SD (Range).</p>**<p>Median (Interquartile range).</p