Prostate Cancer Management During the COVID-19 Pandemic

The COVID-19 pandemic has derailed the management of many cancers. Prostate cancer although a disease known for good response to treatment has posed unique challenges in this pandemic in view of the co-morbidities associated with these elderly patients. A pandemic specific treatment approach following the RADS (Remote, Avoid, Defer, Shorten) principle is required while dealing with these patients. Very low, low and favourable intermediate risk cancers may be kept on active surveillance rather than active treatment. Unfavourable intermediate, high and very high risk cases may follow the ‘defer’ policy by initiating hormonal therapy for 6-8 months to defer radiotherapy. When radiation is planned for these patients extreme or moderate hypo fractionation may be used to follow the ‘shorten’ policy. Metastatic hormone sensitive cancers may be initiated on hormonal therapy avoiding antiandrogens like Abiraterone and chemotherapy upfront. In the castration resistant phase the antiandrogens like Abiraterone or Enzalutamide may be given preference over chemotherapy. In the post operative settings early salvage may be preferred over adjuvant that too, using hypofractionation. Symptomatic patients require prompt attention and radiation should not be delayed for palliation of impending spinal compression or fracture or for local symptoms. Aggressive histologies like small cell types also need prompt treatment. Other general measures like universal masking, hand hygiene, physical distancing, respiratory etiquettes, etc., must also be emphasised keeping in mind the vulnerability of these patients.