A cohort analysis of patients receiving neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy during the Covid-19 pandemic.

Sahan S Bennett,Hing Y Leung,Imran Ahmad

doi:10.1177/20514158211022216

Abstract

The purpose of this study was to investigate localised prostate cancer treated with or without neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy, and the impact of Covid-19 treatment disruption, on clinico-pathologic outcomes. Data was retrospectively collected from 124 consecutive patients treated with robot-assisted laparoscopic prostatectomy between November 2019-September 2020. Sixty-two patients were treated before 13 March 2020 (historic cohort) and 62 afterwards (covid cohort). Thirty-seven patients in the covid cohort additionally received neoadjuvant androgen deprivation therapy (mean duration of 3 months) consisting of bicalutamide 150 mg once a day for 4 weeks, with leuprolide 3.75 mg monthly injections commencing after week 1, up until the date of surgery. Statistical analysis found no difference in peri-operative measures and length of stay for patients treated with or without neoadjuvant androgen deprivation therapy. Patients with delayed surgical treatment offered neoadjuvant androgen deprivation therapy showed a trend towards a reduction in positive surgical margins (p=0.134), N1 disease (p=0.424) and pathological down-staging (50% patients with pT2 disease). Patients within the covid cohort experienced significantly increased detectable prostate-specific antigen levels (p<0.007). Our study demonstrated that a three-month duration of neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy may improve pathological outcomes but this time-frame is inadequate to influence detectable prostate-specific antigen levels. Covid-19-related treatment delays led to significantly increased detectable prostate-specific antigen levels. 2b.

Highlights

Amidst the current Covid-19 pandemic, prostate cancer (PCa) patients have experienced postponements to their curative surgical treatments on a global scale.[1]
Some institutions have trialled neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy (RALP).[4,5] whilst others have opted for watchful waiting.[3]
Appropriate ethical approval was obtained as part of the National Health Service (NHS) Greater Glasgow and Clyde (GG&C) Audit programme and patient-related data were securely kept in accordance with the Data Protection Act 1998 and local NHS Trust policy

Summary

Introduction

Amidst the current Covid-19 pandemic, prostate cancer (PCa) patients have experienced postponements to their curative surgical treatments on a global scale.[1] One of the most significant effects due to delay in surgery is psychological morbidity.[2,3] Little is known about the oncological outcomes, in a contemporary cohort of highrisk locally-advanced prostate cancers. Some institutions have trialled neoadjuvant androgen deprivation therapy (neoADT) prior to robot-assisted laparoscopic prostatectomy (RALP).[4,5] whilst others have opted for watchful waiting.[3] Trialling neoADT is not surprising as the treatment modality of choice, given that previous studies assessing neoADT have shown promise through reduction of post-surgical margins, but without any benefit on long-term patient and surgical outcomes.[6,7]

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