Clinical and surgical assistance in prostate cancer during the COVID-19 Pandemic: implementation of assistance protocols

Abstract

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.

Cancer management during the COVID-19 pandemic: Choosing between the devil and the deep blue sea

“…Several articles have provided insight into how practitioners should approach this difficult dilemma accordingly to each cancer histology. Suggestions and guidelines are available for head and neck, sino-nasal, spinal, breast, upper tract urothelial, cervical, penile, testicular, pancreatic, kidney, gastric, colorectal, skin, adrenal, liver, prostate, ovarian, endometrial, bladder and endocrine cancer ( Cohen et al, 2020 ; Baumann et al, 2020 ; Werner et al, 2020 ; Tarantola et al, 2013 ; Catanese et al, 2020 ; Vecchione et al, 2020 ; Turri-Zanoni et al, 2020 ; de C. Zequi and Abreu, 2020 ; Gravas et al, 2020 ; O’Leary et al, 2020 ; Casco et al, 2020 ; Katims et al, 2020 ; Berjano et al, 2020 ; Kapuria et al, 2020 ; P. March 25 and 2020, 2021 ; Tachibana et al, 2020 ; Loveday et al, 2020 ; Jones et al, 2020 ; Villani et al, 2020 ; Fligor et al, 2020 ; Sanchez et al, 2020 ; Wallis et al, 2020 ; Topf et al, 2020 ; Matsuo et al, 2020 ; Colombo et al, 2020 ; Campi et al, 2020 ; Raghavan et al, 2020 ).…”

Management Recommendations for Prostate Cancer during the COVID-19 pandemic: A Systematic Review

“…They concluded that prostate biopsies should be performed in men with suspected high-risk, locally advanced, or symptomatic PCa and this should be done without preceding MRI [19]. The remaining publications related to prostate biopsy are expert consensus recommendations [20][21][22][23][24][25][26][27][28]; most authors recommend that new PSA screening and continuation of diagnostic workup should not be performed until the pandemic is contained and suggest delaying prostate biopsy except in symptomatic patients [21][22][23], PSA > 10ng/mL [31,34,39], suspicion of cT3 disease, PSA doubling time (PSADT) < 6 months [24,27], or in case of medullary compression or obstructive renal failure secondary to PCa suspicion [22,27]. A summary of recommendations for screening and diagnosis is provided in Table 2.…”

“…Six papers (all of them being either narrative reviews or consensus-based recommendations) addressed the role of active surveillance (AS) in PCa patients and concluded that in very low risk (VLR), low risk (LR), and favorable intermediate risk (FIR) PCa patients, AS is an adequate management strategy [20,24,27,29,30]. For LR and FIR patients, Rodriguez-Sanchez et al and Caicedo-Martinez et al suggest implementation of AS while delaying RP and RT until the pandemic is controlled [27,30], and Kokorovic et al suggest either AS or delaying RP up to 12 months [20]. Detti et al recommend multi-parametric MRI (mpMRI) of the prostate instead of re-biopsy in patients on AS [28].…”

“…If there is a delay of more than 3 months because of the pandemic, or if there is suspicion of lymph node involvement, ADT with or without RT can be initiated [34]. Most expert consensus-based published recommendations conclude that RP for high-risk patients can be safely delayed for between 2 and 6 months [21][22][23][24][25][26][27][28]35,39,40]. If further delay is expected, ADT should be considered until surgical management can be undertaken [21][22][23][24][25][26]40].…”

The Effect of Covid-19 Pandemic on Urology Practice: A Two- Center Study

“…Yine lokal invazif, 10 cm'den büyük, vena cavada trombüsü olan ve semptomatik hastalarda tedavinin geciktirilmeden 6 hafta içerinde yapılması gerektiğinin üzerinde durmuştur (6). Literatürde yayınların çoğunda prostat kanserli (PCa) hastalarda cerrahinin pandemi süresince ertelenebileceğini önemle vurgulanmıştır (11)(12)(13). EAU, makroskopik hematürisi ve/veya hematoglobu, görüntüleme yöntemleriyle mesane içerinde kitlesi olan hastalarda sistoskopi ve TUR-MT'nin hemen yapılmasını önerirken ilk TUR-MT patolojisinde kas dokusu izlenmeyen hastaların re-TUR-MT için hazırlanmasını belirtmiştir (14).…”