Earlier this week, the BBC asked the question “Is it time to return to normal”, citing the current level of deaths from Covid19 at 10 per day and comparing this to the current level of deaths from prostate and breast cancers at 30 per day. “Neither of these figures is read out nightly on the TV news, unlike the statistics for cases and coronavirus deaths” said Fergus Walsh, the BBC Medical Editor.
Whenever and whatever the new normal is, 30 deaths each day from prostate cancer is not something anyone wants to return to, and the renewed focus brought by the BBC piece should make providers, policymakers and patients alike take action.
At present, for men with prostate cancer, things are far from normal within the NHS. We are seeing considerable delays to diagnostic tests and treatments, and in many cases optimal treatments are being compromised.
In a recent OnFocus interview, TFTC Consultant Urologist Raj Nigam pointed out that this has led to a large increase in men with early-stage, localised prostate cancer being treated with hormones.
“This is an unfortunate negative outcome of the Coronavirus era, if you like, that traditional treatments have all had to be halted for at least three or four months, in particular radical prostatectomy and radiotherapy. And as a result of this, men have inadvertently been advised to go onto hormonal therapy without, I hate to say, you know, proper and adequate discussion,” says Raj. “Now, this is not the fault of any individual surgeon or doctor. It’s just the position that they have been placed in in terms of trying to control the condition, at least so we think with limited time and often in telephone consultation to say we’re having to put you on hormones until and unless we start just services up and running again.”
In some cases, patients have responded to the changed circumstances by making faster decisions. TFTC patient Mark Stubbs had just had a TRUS biopsy when Covid19 hit. Based on his biopsy results, he was recommended a radical prostatectomy, which he was then told would only be available in 4-5 months time. He then began to research other options, and learned about focal therapy, which required a template biopsy. This, too, was only available in 4-5 months time on the NHS, and so he came to the Focal Therapy Clinic to seek advice and treatment.
Delays in the early stages of the diagnostic pathway are more worrying, and it is difficult to get accurate estimates of how many men with suspected or confirmed prostate cancer are on NHS wait lists and at what stage of the diagnostic process they are. Various media have reported figures up to 35,000 of excess deaths due to cancer because of Covid19 delays. Prof Karol Sikora, an oncologist and former advisor to the Department of Health and World Health Organisation, has been vocal about the impact of cancer delays, stating, ‘I’ve criticised stark predictions in the past. But I think it could easily be worse than that.’
Further information can be found in this Daily Mail article.
Have you been impacted by Covid19 in your diagnosis and/or treatment for prostate cancer? If so, we’d like to hear from you.