Management of prostate cancer patients during COVID-19 pandemic

Prostate cancer patients’ management demands prioritization, adjustments, and a tailored approach during the unprecedented SARS-CoV-2 pandemic. Benefit of care from treatment must be carefully weighed against the potential of infection and morbidity from COVID-19. Furthermore, urologists need to be cognizant of their obligation for wise consumption of restricted healthcare resources and protection of the safety of their coworkers. Nonurgent in-person clinic visits should be postponed or conducted remotely via phone or teleconference. Prostate cancer screening, imaging, and biopsies may be suspended in general. Treatment may be safely deferred in low and intermediate risk patients. Surgery may be delayed in most high-risk patients and neoadjuvant ADT is generally not advocated prior to surgery. Initiation of long-term ADT coupled with EBRT subsequent to the pandemic may be favored as a feasible alternative in high-risk and very high-risk disease. In patients with cN1 disease, treatment within 6 weeks is advocated. Presurgery assessment should include testing for COVID-19 and preferably a chest imaging. In the presence of SARS-CoV-2 infection, surgery should be postponed whenever possible. All protective measurements suggested by national/international authorities must to be diligently followed during perioperative period. Strict precautions specific to laparoscopic/robotic surgery are required, considering the unproven but potential risk of aerosolization of SARS-CoV-2 virus and spillage with pneumoperitoneum. Regarding radiotherapy, shortest safe EBRT regimen should be favored and prophylactic whole pelvic RT and brachytherapy avoided. Chemotherapy should be avoided whenever possible.