The Incidence of Extreme Serum Prostate Specific Antigen Levels During the COVID-19 Pandemic

Our objective was to compare PSA testing, PSA levels, and prostate cancer treatment rates before and during the COVID-19 pandemic. Among a large population-based cohort of 835,402 men, there was a 20% decrease in PSA testing during the pandemic. There was a higher proportion of extreme PSA levels and more patients required active treatment. Future studies are needed to assess the impact on the rates of advanced prostate cancer and cancer-specific mortality. Objective: The COVID-19 pandemic resulted in decreased prostate specific antigen (PSA) testing for prostate cancer screening and its impact remains uncharacterized. Our objective was to compare incident PSA testing rates, PSA levels, and prostate cancer treatment rates before and during the pandemic after the state of emergency (SoE) was declared. Materials and Methods: This was a population-based, retrospective cohort study among men 50-80 years of age in Ontario, Canada undergoing incident PSA testing from November 23, 2018 to July 9, 2021. Working backwards and forwards from the date of the province-wide SoE (March 17, 2020), 30-day time periods were constructed during which incident PSA testing rates were measured. Our primary outcome was the rate of incident PSA testing. Secondary endpoints included comparison of incident PSA levels and prostate cancer treatment rates. Results: We identified 835,402 men who underwent incident PSA testing. There was a 20% decrease in PSA testing after the SoE (RR = 0.80,95% CI: 0.800.81, P < .001). There was a higher proportion of extreme PSA levels after the SoE with a higher proportion of patients with a PSA > 20 ng/mL (rate ratio = 1.63,95% CI: 1.54-1.73, P < .0001) and > 100 ng/mL (rate ratio = 1.98,95% CI: 1.77-2.20, P < .0001). This effect was highest for those aged 50-59 years. More patients required active treatment (5,201,59.5% prior to the pandemic vs. 5,072,64.2%, P < .001 after the SoE declaration). Conclusions: The COVID-19 SoE resulted in patients experiencing a 2-fold increase in the risk of having an extreme PSA level and higher odds of treatment. Future studies are needed to assess the impact on the rates of advanced prostate cancer and cancer-specific mortality.