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Management of Prostate Cancer During COVID-19 Pandemic

Objective: To communicate interim guidelines to safely manage prostate cancer patients

Cancer patients and physicians must prudently evaluate the potential benefit of routine cancer care against the high morbidity and mortality of Coronavirus disease of 2019 (COVID-19), especially in elderly cancer patients and those with comorbidities. Redistribution of staff and judicious use of resources are required. Continuously evolving policies and guiding principles are intended to provide a better framework to manage prostate cancer patients. When compared the risk of mortality of COVID-19 with prostate cancer, minimal harm is expected with delays in care or treatment of 3–6 months.

Following are the some of the measures to be taken care of:

  1. Opt for Remote Visits- Go for telehealth (phone or video) consultations
  2. Avoid, Defer, and Shorten/ Reduce Routine Care, Staging, and Treatment When Possible:
    a. Avoid: Patients with very low, low, and favorable intermediate risk (IR) disease should avoid further staging, active surveillance, confirmatory testing/monitoring, and treatment until deemed safe. Metastatic disease patients should avoid initiating androgen deprivation therapy (ADT) for patients with a prostate-specific antigen (PSA) doubling time of >9 months. Once ADT is started or intermittent ADT is initiated, consider remote telehealth visits and PSA/testosterone and other laboratory monitoring to avoid clinic exposures.

    b. Defer: Defer further staging and radical treatment for patients with asymptomatic unfavorable intermediate risk (UIR), high risk, and very high risk (HR) prostate cancer.

    c. Shorten/Reduce: Consider using 3-, 4-, or 6-month formulations of ADT over 1-month injections. If it is considered safe for patients to receive radiation therapy (RT), the shortest safe external beam RT (EBRT) regimen should be used.
  3. Encourage Patients: Discuss and document emergency contact information and Durable Power of Attorney . Encourage patients to have an adequate supply of oral cancer medications and supportive care medications on hand (and/or have delivered by mail). Consider telehealth genetic counseling options, if available, or deferring in-person visits. For advanced disease patients, consider non-myelosuppressive regimens to minimize risk of immunosuppression and infectious complications.

Reference: Management of Prostate Cancer During the COVID-19 Pandemic. Available from: https://www.nccn.org/covid-19/pdf/NCCN_PCa_COVID_guidelines.pdf. Accessed on Apr 29, 2020.