Principles of treatment for Prostate Cancer in COVID-19 time:
- Maintenance of social distancing – medical distancing
- Patient safety – Minimizing patient exposure to clinics and hospitals
- Occupational safety – Minimizing exposure of health care providers
- Optimal Health Resource utilization for COVID and NON-COVID areas
- A concern of the potential risk of disease (cancer) progression
- The assumption that the pandemic will last for at least several months, with multiple waves of varying lengths
- Promote the use of telemedicine consultations while also avoiding, deferring, and shortening radiotherapy and surgery whenever possible
Q: I have some urinary problem, I am afraid I might have prostate cancer, What should I do?
A: The most common cause of urinary symptoms in men over the age of 50 is an enlarged prostate, which isn’t cancer and doesn’t usually need urgent treatment. Even if it’s cancer, most prostate cancers are slow-growing tumors, so don’t panic. Wait for this pandemic to stabilize before getting evaluated for prostate cancer.
Q: I was seen by my doctor a few days back. My PSA is high, and I have an enlarged prostate, Can I go for a prostate biopsy?
A: A delay in diagnosis of up to 6 months have a minimal negative impact on the outcome for most prostate cancers. A biopsy can be safely avoided in most of the patients. However, under some circumstances, prostate biopsy should be done for diagnosis of potentially lethal prostate cancer — based on symptoms (urinary retention, spinal cord compression, severe bony pain, very high PSA levels). Doctors need to discuss with the patient and identify the unique needs of every patient.
Routine prostate cancer screening — including (PSA) and digital rectal examination (DRE) — for all asymptomatic individuals should be avoided until the pandemic subsides.
Q: I have been diagnosed with an early (localized prostate cancer), How long can I delay the treatment?
A: In most instances, there is minimal harm if there is a delay in treatment of 3–6 months compared to the risk of mortality of COVID-19.
For patients with very low, low, and favorable intermediate-risk disease, treatment can be avoided or delayed. They should not undergo any further testing or staging or treatment until the pandemic subsides.
Patients with asymptomatic unfavorable intermediate-risk (UIR), high risk, and very high risk (HR) can defer further staging and radical treatment until deemed safe. Case selection and shared decision making are very important in this group of patients. Please speak to the Uro-oncologist to make a decision.
Q: I have been diagnosed with high-risk but early prostate cancer, How can the treatment be planned?
A: Prostate cancer is a unique disease compared to other forms of cancer. Most prognoses are not aggressive, but for those that are, Androgen Deprivation Therapy (ADT) can delay the start of radiotherapy for months.
This allows for patients with prostate cancer to successfully wait for the pandemic to subside before resuming treatment. For those who are planned for Radiation Therapy (RT) + Hormone Therapy (HT), can receive Hormone therapy for 6 months before starting RT.
Patients planned for surgical treatment, delaying Radical Prostatectomy for some intermediate-risk and high-risk early prostate cancers patients for up to 6 months does not impact the outcome unfavorably.
Q: I have undergone RT (Radiation)/Surgery (Radical Prostatectomy) for prostate cancer, I can’t go for a follow-up visit now due to travel restrictions, what should I Do?
A: Individuals who have received definitive treatment for their cancer with either radiation or surgery can defer initial post-treatment monitoring (PSA-based testing and digital rectal exam [DRE]) until deemed safe.
You can avail telemedicine facility of the hospital to discuss any problem and PSA monitoring.
Q: I am on Hormone therapy and radiation therapy – NAHT + RT + HT, How my treatment protocol can be changed?
A: For those on Hormone therapy, 3 or 6-monthly formulations is preferable compared to monthly injections to decrease the number of hospital visits.
The shortest safe External Beam Radiation Therapy (EBRT) regimen should be used over the conventional regimens. This can consist of 5 to 7 fractions only.
Q: I am having bleeding in urine and difficulty in passing urine and back pain. What should I do?
A: For symptomatic patients, e.g., urinary obstruction, bleeding with urine conservative; measures should be prioritized e.g., medical therapy, hormone therapy, catheterization. If necessary, surgical intervention or RT may be considered. Avoid unwanted emergency department (ED) visits and hospitalizations.
Q: I am on Chemotherapy for prostate cancer, Can I continue?
A: For metastatic (advanced) disease: Chemotherapy regimens and protocols need some changes.
Discuss with your Oncologist. Consider drugs and regimens that are less myelosuppressive (Bone Marrow Suppression) as it may decrease immunity making you more prone to Infection.
Ask for growth factor support administration on the same day of chemotherapy to improve the bone marrow function and immunity.
Q: I’m having treatment for prostate cancer, Am I at risk of severe illness if I get Coronavirus?
A: It depends on the type of treatment you are receiving.
Chemotherapy – Men receiving chemotherapy or immunotherapy may have severe effects of Coronavirus infection. For men with advanced prostate cancer that has spread to the lungs are more prone to this infection. Stay at home for the next 12 weeks, by this time immunity recovers.
Radical Prostatectomy – If you’ve had surgery to treat prostate cancer in the past and have recovered from the operation, this won’t increase your risk of catching Coronavirus. It also won’t increase your risk of severe illness, if you do catch Coronavirus. Your risk should be the same as other people in general.
External Beam Radiotherapy – To the prostate shouldn’t affect your immune system. So, if you’ve had – or are currently having – radiotherapy to treat cancer inside your prostate, this won’t affect your risk of catching Coronavirus.
Hormone Therapy – Being on standard hormone therapy won’t increase your risk of catching Coronavirus, or of severe illness, if you do catch Coronavirus.
Abiraterone – If you’re taking abiraterone tablets, you will also be taking a steroid called prednisolone or prednisone. Steroids cause some people to have a slightly higher risk of getting infections, but this will depend on the amount you are taking.
If you’re taking a steroid with abiraterone, you’ll only be having a low-dose steroid. This means the effect on your risk of getting infections should be small.
Enzalutamide – If you’re taking Enzalutamide, this could affect the number of white blood cells in your blood. If this happens, you may be more likely to get infections, including Coronavirus. Speak to your doctor.