Abstract
Objectives
To investigate the effect of the COVID-19 pandemic on prostate cancer incidence, prevalence, and mortality in England.
Materials and methods
With the approval of NHS England, and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of people diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence and mortality per 100,000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models (GLM) and the pre-pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals of the predicted values were used to estimate the significance of the difference between the predicted and observed rates.
Results
In 2020, there was a drop in recorded incidence by 4,772 (31%) cases (15,550 vs 20,322 [95% CI: 19,241 to 21,403]). In 2021, the incidence started to recover, and the drop was 3,148 cases (18%, 17,950 vs 21,098 [19,740 to 22,456]). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (71.5 to 71.8), in 2021 it was 71.8 (71.7 to 72.0) as compared to 71.3 (71.1 to 71.4) in 2019.
Conclusions
Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20,000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.