Management of patients who opt for radical prostatectomy during the COVID-19 pandemic: An International Accelerated Consensus Statement.
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.
Tandogdu, Zafer; Collins, Justin; Shaw, Greg; Rohn, Jenifer; Koves, Bela; Sachdeva, Ashwin; Ghazi, Ahmed; Haese, Alexander; Mottrie, Alex; Kumar, Anup; Sivaraman, Ananthakrishnan; Tewari, Ashutosh; Challacombe, Benjamin; Rocco, Bernardo; Giedelman, Camilo; Wagner, Christian; Rogers, Craig G; Murphy, Declan G; Pushkar, Dmitry; Ogaya-Pinies, Gabriel; Porter, James R; Ramesh Seetharam, Kulthe; Graefen, Markus; Orvieto, Marcelo A; Covas Moschovas, Marcio; Schatloff, Oscar; Wiklund, Peter; Coelho, Rafael; Valero, Rair; de Reijke, Theo M; Ahlering, Thomas; Rogers, Travis; van der Poel, Henk G; Patel, Vipul; Artibani, Walter; Wagenlehner, Florian; Nathan, Senthil; Erik Bjerklund Johansens, Truls; Hawkey, Peter; and Kelly, John, "Management of patients who opt for radical prostatectomy during the COVID-19 pandemic: An International Accelerated Consensus Statement." (2020). Articles, Abstracts, and Reports. 3977.