Here are the highlights from #ARRSProstateChat, a tweetchat discussion on how COVID-19 has affected breast imaging.
How did the initial wave (Spring 2020) of COVID-19 impact prostate MRI, targeted biopsy and prostate cancer diagnosis at your institution?
With the initial wave in Spring of 2020, we had to stop doing MRIs and targeted biopsies #ARRSProstateChat— Baris Turkbey MD (@radiolobt) November 20, 2020
I will share our experience – we (in hindsight) reacted perhaps too cautiously and stopped non-urgent prostate #mri and biopsy in March due to fears of #COVID19— NickSchieda (@NickSchiedaMD) November 20, 2020
Now we are still trying to catch up with the backlog this created! https://t.co/qwL8gqHpZB
A1: We are encouraging referrers to consider abbreviated bi-parametric prostate MRI, but have gotten little (~10%) buy-in. #ARRSProstateChat https://t.co/yzZte3VtLs— Daniel Margolis (@DoctorMargolis) November 20, 2020
Biopsies and even prostatectomies were stopped for 2 to 3 months. #ARRSProstateChat https://t.co/veDApQ2Z7C— Sandeep Arora (@LetDdiceFlyHigh) November 20, 2020
MRI kept going whole time, but We had bad timing for bx – shutdown in March for Covid then moved OP centre May/June and didn’t get prostate Bx going again until late July – backlog going to take a while!— Adam Tunis (@adamtunis) November 20, 2020
We kept the same imaging protocol, but reinforced in safety measures and health screening. Also reached out to urologists to ask that they only refer urgent or particularly concerning cases.— Leonardo Kayat Bit.. (@lkayat) November 20, 2020
Which strategies, initially, were used to maintain clinical care while reducing risk of exposure to patients and staff?
We stopped using endorectal coils, keep the appointments as far as possible from each other to avoid crowds in waiting areas and applied deep cleaning in scanner and changing rooms after each case and PPE for our technologists #ARRSProstateChat https://t.co/oYhkRMIVMz— Baris Turkbey MD (@radiolobt) November 20, 2020
One of the advantages of #bpMRI for #ProstateMRI is no nurse contact. We are also building in spacing between scans – planned down-time. Therefore, we have extended hours and are keeping open older scanners we had planned to decommission. #ARRSProstateChat https://t.co/xiq8bSmrdd— Daniel Margolis (@DoctorMargolis) November 20, 2020
At my current institution, all pts coming to hospital get a COVID test prior. #ARRSProstateChat https://t.co/uyFf5yvIfg— Sandeep Arora (@LetDdiceFlyHigh) November 20, 2020
We at first stopped doing prostate MRI on all patients except those with very high PSA at risk for aggressive disease who may be harmed by no treatment. Once we had processes in place to do MRI more safely with adequate PPE we resumed and dealt with the backlog.— Ben Spilseth, MD (@benspilseth) November 20, 2020
What was the short term impact on prostate MRI, targeted biopsy and prostate cancer diagnosis at your institution after the initial wave of COVID-19?
A3: we got a big backlog and some patients who could not wait us to reopen started to get imaging in other centers and they shipped their imaging studies for us to read. We tried to help them but without biopsies it was incomplete help #arrsprostatechat— Baris Turkbey MD (@radiolobt) November 20, 2020
A3: Short term impact has been profound! MRI has caught up but biopsy is WAY BEHIND, and we are fighting a losing battle. We do 75% of the biopsied we did before so will need blitzes to catch up / but #COVID19 cases are higher now than before. 🤨#ARRSProstateChat https://t.co/kSZiAhMYJj— NickSchieda (@NickSchiedaMD) November 20, 2020
A3 #prostateMRI volume had increased 3x in as many years but dropped to nearly zero as we deferred all non-urgent scans. It made sense – they couldn’t get biopsies much less surgery (because they were being used as ICU’s). We wanted scans soon before treatment. #ARRSProstateChat https://t.co/7FV5rfECem— Daniel Margolis (@DoctorMargolis) November 20, 2020
With a resurgence of COVID-19 cases (Fall 2020), which strategies employed during the initial wave are still being used and which have been modified at your institution?
At my current institution we’re keeping the same health and safety measures that were in effect since march. We’re getting daily updates on use of PPEs and visitation policy. Other interesting measures such as virtual waiting room are being implemented.— Leonardo Kayat Bit.. (@lkayat) November 20, 2020
We now have returned to 80-85% of pre-covid volumes for MRI and targeted biopsies. It takes more time to finish all day since we work with few team members to avoid crowds and do more detailed cleaning. We keep same deep cleaning and always wearing PPE rules #arrsprostatechat— Baris Turkbey MD (@radiolobt) November 20, 2020
We definitely did not stop MRI or biopsy in the second wave – patient and staff wear PPE, cleaning +++, verbal consent, volumes are 80-90% normal – seems to be going well for now. We are still struggling to catch up from the Spring. #ARRSProstateChat https://t.co/RcPWhsVtiY— NickSchieda (@NickSchiedaMD) November 20, 2020
A4 Good question! So far we haven’t changed anything. I imagine we will follow the institution’s guidance regarding elective procedures. We are still trying to catch up mammograms, though, so who knows for #ProstateMRI? It depends if the OR’s become ICU’s again. #ARRSProstateChat https://t.co/m0Fw05oDk9— Daniel Margolis (@DoctorMargolis) November 20, 2020
A4: With resurgence of COVID, PPE and deep scrubbing after every MRI still remains. However there is a hesitancy to cut down prostate MRIs due to already huge backlogs. https://t.co/1GjjQuy9Qp— Satheesh Krishna (@Dr_RadioLogic) November 20, 2020
What will be the long term impact on prostate cancer diagnosis, treatment and outcomes for men with prostate cancer due to the COVID-19 pandemic?
There is no doubt there will be delayed #ProstateCancer diagnosis and treatment / what the long term implications are for morbidity and mortality are unknown— NickSchieda (@NickSchiedaMD) November 20, 2020
So far have not seen any terrible cases due to delays, thankfully #ARRSProstateChat https://t.co/6RKwunXoyY
A5: There has definitely been delay in treatment. At least anecdotally, initiation of chemotherapy was delayed due to delay in biopsy in a patient with strong clinical suspicion of metastatic pCa with patient having to live with the pain. Long term morbidity/mortality unknown! https://t.co/3K6CrwvLWu— Satheesh Krishna (@Dr_RadioLogic) November 20, 2020
A5 I hope, #ProstateCancer being more indolent than #BreastCancer, there will be little long-term impact. However, the effects of the brief #USPSTF recommendations against #PSA screening are already evident. Worry is warranted. #ARRSProstateChat https://t.co/FhgbhOC1TR— Daniel Margolis (@DoctorMargolis) November 20, 2020