Effect of the COVID-19 pandemic on radical prostatectomy: A Brazilian retrospective study.
Authors: Marangoni Roschel Marina , Da Silva Vieira Laynara Vitória , Florez Narjust , Vilela Gomes Monique , Krug Alana Bruna , Dornelas Luana , Squisatti Camile Fernanda , Rodrigues Peixoto Maria Eduarda , Meyer de Souza Beatriz , Rutkowski Isabela , Meneses Beatriz , Alves Peterson Yasmin , Furtado de Oliveira Carolina , Cavalcanti Souza Maria Eduarda , Carvalho Luiza , de Aguiar Tavares Marcella Eduarda , Donadoni Costa Vitória , Santos Heloisa Griese Luciano , Rabeschini Joao Miguel 
Published: June 2023

e17101

Background: Prostate cancer is reported as the most common cancer in Brazilian men. Prostatectomy (RP) is fundamental for a better prognosis and outcome. The overload of health systems caused by the coronavirus pandemic has strongly affected surgical care in Brazilian public healthcare (SUS), making the diagnosis of prostate cancer more difficult due to the lack of resources and professionals available. Under these circumstances, we aimed to evaluate the impact of COVID-19 on the surgical treatment patterns for prostate cancer performed by SUS during the peak of the COVID-19 pandemic. Methods: A retrospective cross-sectional study was conducted using the STROBE checklist and secondary data from the Hospital Information System of DATASUS, a Ministry of Health agency. The study analyzes the absolute numbers of prostatectomies in oncology registered between January 2013 and October 2022, updated by December 15, 2022. Based on the PICo principle: People with prostate cancer in Brazil from 2013 to 2022 (Population); prostatectomy (Interest); Brazilian region (Context), the study compared the number of cancer diagnoses in the same period. Statistical analysis was performed by applying ANOVA one way to assess the number of procedures compared over the years. Results: In Brazil, on SUS, between January 2013 and October 2022, there were 31,716 RPs, with an annual average of 2,883 procedures. The total number of prostate cancer surgeries decreased by 27.20% in 2020, going from 3,499 procedures in 2019 to 2547 in the following year. There was a 43.02%, 38.87%, 35.77%, and 35.03% decrease in July, October, May, and August, respectively, compared to 2019. Despite vaccination in 2021, prostatectomies decreased by 22.32% compared to 2019. From 2013 to 2022, there were 293,308 prostate cancer diagnoses, with a 71% increase from 2017 to 2019, a 25% decrease from 2019 to 2020, and a 5% increase in 2021. The results show that the total of deaths in prostatectomies is 142. In 2019, 10 deaths were reported on SUS, and that number increased to 13 in 2020, 16 in 2021, and 18 in 2022, showing a progressive increase after the pandemic. Conclusions: The decrease in the number of RP is apparent and may impact the prognosis of the patients who were unable to access the health system during the COVID-19 pandemic. It is fundamental to know the amount of damming from those surgeries to propose measures to prevent adverse outcomes. For all to receive safe, cost-effective, and timely cancer surgery, it is crucial that surgical procedures are a central component of both global and national cancer control plans.