A multicentre analysis of safety of focal therapy for non-metastatic prostate cancer during the COVID-19 pandemic


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Deepika Reddy, Gaelle Fiard, Mariana Bertoncelli Tanaka, Juliet McQueen, Mohamed Noureldin, Tim - University Hospital Southampton Dudderidge, Richard Hindley, Amr Emara, Clement Orczyk, Caroline Moore, Manit Arya, Mark Emberton, Hashim Ahmed

Abstract

Background

Clinicians and patients must weigh the risk of treatment of prostate cancer during a global pandemic with the risk of cancer treatment delays. With the possibility of another peak, public confidence in cancer treatments requiring general anaesthetic will be critical. We report on the safety of performing focal therapy in the UK during the initial Covid-19 peak.

Method

Consecutive patients treated in 8 centres (23/3/20-23/7/20) were contacted at least 2 weeks after receiving focal ablative therapy. Treatment modalities included high intensity focused ultrasound (HIFU, n=90), cryotherapy (n=32) or irreversible electroporation (IRE, n=6).

Results

128/129 patients treated during the study period were successfully contacted. 107/ 128 (83.5%) underwent primary focal treatment, all had D’Amico intermediate or high-risk disease. National guidelines varied throughout the period. Treating sites requested formal shielding from May 2020 and done in 48/128 (37.5%). 20/128 (15.6%) underwent pre-operative swab tests and 5/128 (3.9%) pre-operative chest imaging. Two (1.6%) had intra-operative complications secondary to catheterisation, but none required overnight admission. No COVID-19 related post-treatment admissions were reported; 2 (1.6%) had Covid-19 related symptoms but were not tested as symptoms spontaneously resolved. 3 were admitted for non-COVID-19 issues and one was directly due to treatment related clot retention resulting in the only reported Clavien-Dindo score >2 complication.

Conclusion

Focal therapy for non-metastatic prostate cancer was a safe treatment option during a COVID-19 pandemic when appropriate precautions are taken and should be discussed with eligible patients.

Impact statement

Focal therapy when performed under carefully determined precautionary measures is a safe management option for patients with localised prostate cancer during the COVID-19 pandemic.