Purpose: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. Material and Methods: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. Results: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. Conclusions: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged.
Background The occurrence of postoperative urinary incontinence (UI) remains a problem for patients undergoing robot-assisted radical prostatectomy (RARP). Non-surgical interventions (NSI) in addition to intraoperative techniques and patient behavioral changes have been proposed to improve urinary continence (UC) recovery after RARP. However, to date, the real clinical impact of postoperative NSI remains not well characterized. Materials and Methods We performed a Systematic Review in April 2021, using Allied and Complementary Medicine (AMED), Embase, and MEDLINE according to the PRISMA recommendations and using the Population, Intervention, Comparator and Outcome (PICO) criteria. Primary outcome of interest was the impact of NSI on UC recovery rate and time to achieve UC after RARP. Secondary outcomes of interest were the assessment of patient adherence to NSI, risk factors associated with UI, and correlation between postoperative NSI and sexual activity recovery. Results A total of 2758 articles were screened, and 8 full texts including 1146 patients were identified (3 randomized controlled trials, 3 prospective single-arm trials, and 2 retrospective series). Postoperative NSI of interest included pelvic floor muscle training (PFMT) (n = 6 studies) and administration of oral medications (solifenacin) (n = 2 studies). PFMT appeared to increase UC rates and to accelerate time to achieve UC in the early postoperative period. Similarly, solifenacin provided higher rates of UC recovery and contributed to a certain degree of symptomatic relief. There was a great variability regarding NSI features and data reporting among studies. Major limitations were the small sample sizes and the short follow-up. Conclusion Postoperative NSI to manage UI after RARP include PFMT and solifenacin administration. Both seem to modestly improve early UC recovery. Nonetheless, evidence supporting their routinely use is still weak and lacks appropriate follow-up to evaluate possible benefits on long-term UC recovery.
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