The Impact of Covid-19 Pandemic on The Selection of Prostate Cancer Treatment among Urologist in Indonesia: A Survey Analysis
Authors: Hamid Agus Rizal Ardy Hariandy 
Published: June 2023

Abstract
Prostate cancer (PCa) is the sixth leading cause of cancer death in men worldwide. Incidence of PCa in Indonesia placed in number 6th, the data from Globocan 2020 also showed that PCa lined up as the highest urological cancer cases in both sexes of the country. The cancer has broad spectrum treatments, the selection of which can be determined by risk classification. However, in the setting of the coronavirus disease 2019 (COVID-19) pandemic, health care, including urology services worldwide have been undergone changes particularly in terms of treatment protocol. This study seeks to determine how the COVID-19 pandemic influences the choice of treatment of PCa in Indonesia. This was a cross-sectional study through a questionnaire which was distributed via Survey Monkey (www.surveymonkey.com), a cloud-based online survey. A survey was delivered to all urologists in Indonesia who were registered in each association. A total of 174 urologists completed the questionnaire. Amongst 117 respondents who performed prostate biopsy, 39.2% and 37.5% working in public and private hospital had more than 50% reduction or no prostate biopsy procedure during COVID-19 pandemic. However, only 27.0% deferred prostate biopsy due to COVID-19. During pandemic, 73 (42%) respondents who previously chose radical prostatectomy as their priority for localized PCa, shifted their choice into active surveillance and androgen deprivation therapy (ADT) evenly that made active surveillance as primary choice of treatment in localized cases. Moreover, only 12.1% and 10.3% chose ADT combination therapy (with docetaxel, abiraterone acetate, enzalutamide/apalutamide) as their primary choice of metastatic PCa treatment before and during COVID-19 pandemic. In conclusion, the impact of COVID-19 on PCa were prominent in diagnostic procedure and management of localized or low risk PCa.

Keywords: COVID-19, prostate cancer, radical prostatectomy, active surveillance, radiation, androgen deprivation therapy, chemotherapy

Abstrak
Kanker prostat adalah kanker pada laki-laki dengan angka kematian tertinggi keenam di dunia. Di Indonesia insidens kanker prostat berada di peringkat ke-6 dan merupakan jenis kanker urologi terbanyak berdasarkan data Globocan 2020. Tersedia beragam terapi kanker prostat dan pemilihan terapi berdasarkan klasifikasi risiko tertentu. Pada situasi pandemi coronavirus disease 2019 (COVID-19), fasilitas pelayanan kesehatan di dunia, termasuk layanan urologi, mengalami perubahan terkait protokol tata laksana. Penelitian ini bertujuan untuk mengetahui pengaruh pandemi COVID-19 terhadap pilihan terapi kanker prostat di Indonesia. Penelitian ini menggunakan desain potong-lintang dan data diperoleh dari kuesioner yang didistribusikan melalui Survey Monkey (www.surveymonkey.com), sebuah survei daring berbasis cloud. Survei dikirim kepada seluruh urolog di Indonesia yang terdaftar di tiap asosiasi. Responden adalah 174 urolog yang telah melengkapi kuesioner. Di antara 117 responden yang mengerjakan biopsi prostat, 39,2% yang bekerja di rumah sakit umum dan 37,5% di rumah sakit swasta mengalami pengurangan jumlah prosedur biopsi prostat > 50% atau tidak melakukannya sama sekali. Hanya 27,0% yang menunda biopsi prostat akibat COVID-19. Sebelum pandemi, 73 responden (42%) memilih prostatektomi radikal sebagai prioritas utama untuk kanker prostat lokal, namun selama pandemi pilihan beralih ke surveilans aktif dan terapi deprivasi androgen secara merata, menjadikan surveilans aktif sebagai pilihan utama. Selain itu pada kasus kanker prostat metastasis jumlah responden yang memilih kombinasi terapi deprivasi androgen dengan dosetaksel, abirateron asetat, atau enzalutamid/apalutamid) sebagai pilihan utama hanya 12,1% sebelum dan 10,3% saat pandemi COVID-19. Disimpulkan dampak COVID-19 terlihat lebih nyata pada prosedur diagnostik dan manajemen kanker prostat lokal atau berisiko rendah.

Kata kunci: COVID-19, kanker prostat, prostatektomi radikal, surveilans aktif, radiasi, terapi deprivasi androgen, kemoterapi.