Assessment of Prostate Cancer Treatment Among Black and White Patients During the COVID-19 Pandemic

Question  Was the association of the COVID-19 pandemic with cancer surgery similar for Black and White patients with prostate cancer?

Findings  In this multi-institutional cohort study of patients with untreated nonmetastatic prostate cancer during the initial COVID-19 lockdown, only 1% of Black men underwent prostatectomy, while 26% of White patients did. Prior to the pandemic, there was no difference in the rate of prostatectomy between the 2 races (18% of Black men and 19% of White men).

Meaning  This study suggests that during the initial phase of the COVID-19 pandemic, hospital restrictions were unbalanced, and Black patients experienced a disproportionate lower rate of prostatectomies.

Importance  Early in the COVID-19 pandemic, racial/ethnic minority communities disproportionately experienced poor outcomes; however, the association of the pandemic with prostate cancer (PCa) care is unknown.

Objective  To assess the association between race and PCa care delivery for Black and White patients during the first wave of the COVID-19 pandemic.

Design, Setting, and Participants  This multicenter, regional, collaborative, retrospective cohort study compared prostatectomy rates between Black and White patients with untreated nonmetastatic PCa during the COVID-19 pandemic (269 patients from March 16 to May 15, 2020) and prior (378 patients from March 11 to May 10, 2019).

Main Outcomes and Measures  Prostatectomy rates.

Results  Of the 647 men with nonmetastatic PCa, 172 (26.6%) were non-Hispanic Black men, and 475 (73.4%) were non-Hispanic White men. Black men were significantly less likely to undergo prostatectomy during the pandemic compared with White patients (1 of 76 [1.3%] vs 50 of 193 [25.9%]; P < .001), despite similar COVID-19 risk factors, biopsy Gleason grade groups, and comparable prostatectomy rates prior to the pandemic (17 of 96 [17.7%] vs 54 of 282 [19.1%]; P = .75). Black men had higher median prostate-specific antigen levels prior to biopsy (8.8 ng/mL [interquartile range, 5.3-15.2 ng/mL] vs 7.2 ng/mL [interquartile range, 5.1-11.1 ng/mL]; P = .04). A linear combination of regression coefficients with an interaction term for year demonstrated an odds ratio for likelihood of surgery of 0.06 (95% CI, 0.01-0.35; P = .002) for Black patients and 1.41 (95% CI, 0.81-2.44; P = .23) for White patients during the pandemic compared with prior to the pandemic. Changes in surgical volume varied by site (from a 33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery caring for a greater proportion of Black patients.

Conclusions and Relevance  In this large multi-institutional regional collaborative cohort study, the odds of PCa surgery were lower among Black patients compared with White patients during the initial wave of the COVID-19 pandemic. Although localized PCa does not require immediate treatment, the lessons from this study suggest systemic inequities within health care and are likely applicable across medical specialties. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the COVID-19 pandemic to develop balanced mitigation strategies as viral rates continue to fluctuate.