The Impact of the COVID-19 Pandemic on Adverse Pathological Outcomes After Radical Prostatectomy: Pre- and Post-Pandemic Comparison in a Brazilian Public Healthcare Setting

Abstract Background The COVID-19 pandemic severely disrupted healthcare systems, delaying essential oncological treatments. We evaluated how pandemic-related surgical delays affected pathological outcomes—such as staging and grading—in patients undergoing radical prostatectomy (RP) for localized prostate cancer within a Brazilian public university hospital. Methods This retrospective, single-center study analyzed 382 patients undergoing RP between 2016 and 2025, divided into pre-pandemic (2016–2019; n = 155) and pandemic/post-pandemic (2020–2025; n = 227) cohorts. We compared clinicopathological variables, including pathological staging, ISUP grade groups, and biopsy-to-surgery intervals, using Mann-Whitney U, Student's t, and Chi-square tests. Results The median biopsy-to-surgery interval rose from 245 to 340 days (mean: 245 to 383 days; p < 0.01). While baseline PSA remained stable (p = 0.7), we observed significant migration toward locally advanced disease (pT2 decreased from 63.2% to 42.3%; pT3a/b increased from 36.8% to 57.7%; p < 0.01). ISUP grade 5 tumors nearly doubled (14.2% to 27.7%), and histological upgrading rose from 32.9% to 55.9% (p < 0.01). Limitations include the retrospective, single-center design, and lack of long-term biochemical recurrence or survival data. Conclusions and Clinical Implications: Pandemic-related disruptions were associated with prolonged surgical delays and significantly worse pathological outcomes, strongly supporting the hypothesis of true tumor progression during the waiting period. These findings emphasize the critical need for robust contingency strategies to preserve timely cancer surgery and mitigate long-term oncological harm during future public health crises.