Prostate Cancer and COVID-19

Creator: Dr. Madhan Kumar Madathupalayam Velusamy
Published: 2021-07-21T11:09:39-04:00

Written by

and medically reviewed by Dr. Madhan Kumar Madathupalayam Velusamy

Published on Jul 21, 2021 and last reviewed on Sep 11, 2023 - 5 min read

Abstract

COVID-19 disease has become a major health problem worldwide, and this article discusses the disease spread of COVID-19 in patients with prostate cancer.

Contents

What Are the Principles of Treatment for Prostate Cancer in COVID-19 Time?

Is the Urinary Problem a Sign of Prostate Cancer?

Can Prostate Biopsy Be Delayed If There Is an Enlarged Prostate and High PSA?

How Long Can We Delay the Treatment of Localized Prostate Cancer?

What Is the Treatment Plan For High-Risk Early Prostate Cancer?

What Happens When You Do Not Go For a Follow-up Visit After Radiation Therapy or Surgery (Radical Prostatectomy) For Prostate Cancer?

How Can the Treatment Protocol Be Changed When on Hormonal Therapy and Radiation Therapy?

What to Do When You Have Difficulty in Passing Urine and Bleeding in Urine at Times of COVID-19 Pandemic?

Can Chemotherapy for Prostate Cancer Be Continued During COVID-19?

Are Patients Under Treatment of Prostate Cancer at Severe Risk of Coronavirus Disease?

What Are the Principles of Treatment for Prostate Cancer in COVID-19 Time?

What Is the Treatment Plan For High-Risk Early Prostate Cancer Patients?

What Happens When a Person Miss a Follow-up Visit After Radiation Therapy or Surgery (Radical Prostatectomy)?

How to Change the Treatment Protocol When on Hormonal Therapy and Radiation Therapy?

What to Do When a Patient Is Has Urine Issue During COVID-19 Pandemic?

Can Chemotherapy for Prostate Cancer Be Continued During COVID-19?

Are Patients Under Prostate Cancer Treatment at Severe Risk of Coronavirus Disease?

Introduction:

Men are at high risk of developing COVID-19 disease when compared to women, and this is because of stronger immune reactions in women. Scientists say that initially, the virus starts to fasten up the infection in the human cell receptors, but it can pass through the cell only with the help of the TMPRSS2 (Transmembrane serine protease 2) protein. Testosterone controls TMPRSS2 protein, and when the testosterone levels decrease, then TMPRSS2 levels will also decrease so that the coronavirus disease is blocked at the gates.

The mechanism of coronavirus infection is multifactorial, and in some patients, testosterone levels may play a major role, and in some patients, it may not. So, it is not definitive that altering testosterone levels for COVID-19 treatment is effective.

What Are the Principles of Treatment for Prostate Cancer in COVID-19 Time?

The principles of treatment for prostate cancer in COVID-19 times are,

Maintaining social distance to prevent community spread.
Assuring patient safety by minimizing the exposure of the patient to the clinics and hospitals.
Minimizing exposure of primary care providers (occupational health and safety - OHS).
Make use of telemedicine consultations when there is no need for in-person consultations or if there is a chance to avoid or shorten radiotherapy and surgery whenever possible.
The major concern is the potential risk of disease (cancer) progression.
Healthcare utilization for COVID and non-COVID areas to make use of the services by persons to prevent and cure health problems.
Do not come to a conclusion that the pandemic will last for several months, with multiple waves for varying lengths to avoid anxiety.
Discuss with the treating doctor regarding COVID vaccination and get a double dose vaccinated.

Is the Urinary Problem a Sign of Prostate Cancer?

Enlarged prostate above 50 years of age is the most common cause of urinary symptoms in men. But it is not cancer, and it does not require urgent treatment. Even if it is cancer, there is no need to panic as prostate cancers are slow-growing, and there is no need for acute treatment. So wait for the pandemic to become steady before being evaluated for prostate cancer.

Can Prostate Biopsy Be Delayed If There Is an Enlarged Prostate and High PSA?

The prostate biopsy can be avoided in most patients, and a routine prostate screening for all asymptomatic individuals can be avoided until the pandemic subsides, such as:

Protein-specific antigen (PSA).
Digital rectal examination (DRE).

A delay in the diagnosis of prostate cancer for up to six months does not result in a negative impact. Mostly, a prostate biopsy is done for potentially lethal prostate cancers based on the symptoms of:

Urinary retention.
Spinal cord compression.
Severe bony pain.
Very high protein-specific antigen levels.

How Long Can We Delay the Treatment of Localized Prostate Cancer?

A delay in the treatment of localized prostate cancer for three to six months will create minimal harm when compared to the risk of mortality due to COVID-19. Further testing or staging, or treatment can be avoided or delayed until the pandemic subsides for patients with:

Very low-risk disease.
Low-risk disease.
Favorable intermediate-risk disease.

Further staging and radical treatment can be postponed considering the safety due to the COVID-19 pandemic for patients with asymptomatic:

Unfavorable intermediate-risk (UIR).
High risk.
Very high risk.

Seek for an uro-oncologist to decide on case selection and decision making as it is very important in this group of patients.

What Is the Treatment Plan For High-Risk Early Prostate Cancer Patients?

The prognosis of prostate cancer is not aggressive, and it is a unique disease when compared to other cancers. Patients with intermediate-risk and high-risk early prostate cancers can successfully wait for the pandemic to subside before resuming the treatment like:

Patients with androgen deprivation therapy (ADT) can delay the start of radiotherapy for months.
Patients planned for radiation therapy (RT) and hormone therapy (HT) can receive hormone therapy for six months before starting radiation therapy.
Patients planned for surgical treatment can delay radical prostatectomy for up to six months.

What Happens When a Person Miss a Follow-up Visit After Radiation Therapy or Surgery (Radical Prostatectomy)?

Patients who have received definitive treatment for prostate cancer, either radiation therapy or surgery, can postpone their follow-up, which is initial post-treatment monitoring,

PSA (protein-specific antigen)-based testing.
Digital rectal exam (DRE) until deemed safe.

Also, telemedicine helps us during this pandemic to discuss any problem and PSA monitoring.

How to Change the Treatment Protocol When on Hormonal Therapy and Radiation Therapy?

Due to this COVID-19 pandemic, the treatment protocol for hormone therapy can be changed by three to four-month formulations when compared to monthly injections to decrease the risk of hospital visits. However, for conventional regimens, the shortest safe external beam radiation therapy (EBRT), which only consists of five to seven fractions, can be used.

What to Do When a Patient Is Has Urine Issue During COVID-19 Pandemic?

When there are unusual symptoms during the COVID pandemic, follow the below:

1) Treatment measures should be followed when there are symptoms like,

Urinary obstruction.
Bleeding with conservative urine.

2) The treatment measures to be prioritized are:

Medical therapy.
Hormone therapy.
Catheterization.

3) Surgical intervention or radiation therapy may be considered when necessary.

4) Avoid unwanted emergency department (ED) visits and hospitalizations.

Can Chemotherapy for Prostate Cancer Be Continued During COVID-19?

Chemotherapy regimens and protocols need some changes when in the advanced disease stage. The drugs and regimens that are less myelosuppressive (bone marrow suppression) are to be discussed with the oncologist as they may decrease immunity making us more prone to infections. So on the same day of chemotherapy, ask for growth factor support administration to improve:

Immunity.
Bone marrow function.

Are Patients Under Prostate Cancer Treatment at Severe Risk of Coronavirus Disease?

The severity of risk for coronavirus disease depends on the type of treatment the patients are receiving.

Chemotherapy - Patients receiving chemotherapy or immunotherapy have severe effects of COVID-19 disease. Advanced prostate cancer spreads to the lungs making the patients more prone to coronavirus disease. So these patients should stay home to avoid complications.

Radical Prostatectomy - These patients have the same risk as the general population. After complete recovery from this surgery done in the past for prostate cancer, the patient has the same risk as that of the general population of coronavirus disease.

External Beam Radiotherapy - A patient who has received or is currently receiving radiotherapy to treat prostate cancer is not at risk of catching coronavirus disease.

Hormone Therapy - Standard hormone therapy will not increase the risk of coronavirus disease.

Abiraterone - When the patients take this tablet, they will also be taking steroids like Prednisolone or Prednisone. People on steroids are at a slightly higher risk of getting infections, but it depends on the dose taken. But on taking Abiraterone, the patient will have a low dose of steroid, and hence there is decreased risk of getting infections.

Enzalutamide - This medication affects the number of white blood cells in the blood, so there is an increased risk of infections like coronavirus disease.

Conclusion:

Considering the COVID-19 disease, switch to the treatment recommendations in COVID-19 for prostate cancer and follow the COVID safety precautions in order to avoid community spread and prevent complications. Get the vaccination and the booster dose. Also, seek the nearest hospital if an individual comes across any unusual symptoms, and do not frequently visit clinics unless the treatment cannot be done through telemedicine.

Frequently Asked Questions

1. How Does COVID Influence Cancer Patients?

Due to the compromised immune systems caused by cancer therapy, Covid-19 can significantly influence cancer patients, increasing their risk of severe disease. Cancer therapies may sometimes need to be postponed or adjusted, which might impact the patient's prognosis. Cancer clinics and hospitals may also be understaffed or closed, making it difficult for patients to obtain the necessary care. Furthermore, the emotional and mental stress induced by the epidemic might impact cancer patients.

2. What Drugs Can Raise PSA Levels?

PSA (Prostate-Specific Antigen) levels can be raised by drugs such as androgens, 5-alpha-reductase inhibitors, anti-androgens, and progestins. It is essential to consult with a healthcare provider to establish the cause of a high PSA level and ensure appropriate therapy.

3. Can a Virus Have an Impact on PSA Test Results?

Certain viral infections, such as prostate cancer-related viruses and urinary tract infections, might temporarily elevate PSA levels, resulting in false-positive findings. It is essential to discuss any recent viral infections or other relevant variables that may alter PSA test results with the healthcare professional. It is also recommended to wait until an active viral illness has resolved before performing the test.

4. What Is the Prostate Cancer Survival Rate?

The survival rate for prostate cancer varies depending on the cancer stage when it is found. According to the American Cancer Society, the five-year survival rate for males with localized prostate cancer that has not spread outside the prostate is approximately 100%. The five-year survival percentage for males with regional prostate cancer (cancer that has spread to surrounding tissues or lymph nodes is around 96%. The five-year survival rate for males with distant prostate cancer that has spread to distant organs or bones is approximately 30%.

5. Are Cancer Survivors More Likely to Get COVID?

It is unclear if cancer survivors are more prone to get COVID-19. Cancer survivors could be at higher risk of serious illness if they contract the virus due to their weakened immune systems due to cancer treatment. To avoid infection, cancer survivors must take measures.

6. Is the Immune System Weakened as a Result of Cancer?

Cancer can, indeed, damage the immune system. Immunosuppression can develop as a result of cancer, cancer therapies such as chemotherapy (a medication that employs strong chemicals to destroy rapidly growing cells in the body), and radiation therapy (a cancer therapy in which substantial doses of radiation are used to kill cancer cells and reduce tumors), or a combination of the two.

7. What Should Not Be Done Before a PSA Test?

One should not ejaculate or have prostate stimulation, such as a digital rectal exam, for at least 48 hours before a PSA test since it can temporarily raise PSA levels. Furthermore, some drugs may affect PSA results and should be discussed with a healthcare physician before the test.

8. Which Supplements Can Help With PSA?

No scientific evidence supports using any specific supplements to help with PSA levels. Although several accessories, such as Saw palmetto, Beta-sitosterol, and Pygeum africanum, are used for prostate health, scientific evidence does not support their usage for PSA levels. Before using any supplements, please speak with a healthcare practitioner.

9. What Is a High PSA Level?

A high PSA level is usually defined as a number more than the upper limit of normal for the assay employed. The laboratory's normal range for PSA levels varies; however, a 4 ng/mL reading or less is considered normal. Some laboratories may use a slightly higher cut-off, such as 4.5 ng/mL or five ng/mL. Various variables, including age, race, and prostate size, can impact PSA levels, and they can change over time. As a result, a single high PSA level only sometimes signals a problem. When interpreting the findings, assessing the patient's whole clinical picture, including symptoms and risk factors, is essential.

10. What Might Infections Result in an Increase in PSA Levels?

PSA levels can rise due to prostatitis (prostate inflammation) and urinary tract infections. These infections can raise PSA levels because they promote inflammation in the prostate, which increases PSA levels. Other illnesses that might increase PSA values include benign prostatic hyperplasia (BPH) and prostate cancer. It should be noted that a raised PSA level does not always indicate prostate cancer and more testing is typically required to make a diagnosis.

11. What Exactly Is a Dangerously High PSA?

A dangerously high PSA level is defined as one that is considerably over the usual range. The laboratory's normal range for PSA levels varies; however, a 4 ng/mL reading or less is considered normal. Some laboratories may employ a slightly higher cut-off, such as 4.5 ng/mL or five ng/mL. Some clinicians may consider a PSA level exceeding ten ng/mL possibly diagnostic of prostate cancer; however, when interpreting the results, taking the patient's entire clinical picture and other risk factors is essential.

12. Can Stress Induce an Increase in PSA?

It is not known if stress causes a rise in PSA levels. PSA (Prostate-Specific Antigen) is a protein the prostate gland generates that can be increased in situations such as prostate cancer, BPH, and prostatitis (prostate inflammation). These disorders can result in a rise in PSA values owing to inflammation or an increase in prostate size. Stress, however, is not a direct cause of these illnesses, and there is no evidence that stress may induce a rise in PSA levels. Some studies have shown that psychological stress might influence the immune system, which may affect the prostate indirectly, but further study is needed to understand this link completely.

13. When Should a PSA Test Be Performed?

Keep track of how the condition is progressing. The American Cancer Society suggests that men begin discussing the benefits and drawbacks of prostate cancer screening with their doctor around 50. Men at a greater risk of prostate cancer, such as African Americans or those with a family history of the illness, should begin these conversations at 45.

14. What Happens Next if PSA Levels Are Elevated?

If a PSA test reveals elevated levels, seeing a doctor for additional testing, such as a repeat PSA test, a digital rectal exam (DRE), and a prostate biopsy to establish if cancer is present, is critical. If the PSA test and other tests reveal the existence of prostate cancer, treatment options will be addressed. If the results show that the problems are not malignant, therapeutic alternatives will be addressed.

15. How to Stop PSA From Increasing?

- Eat a balanced diet, exercise frequently, and avoid smoking to maintain a healthy lifestyle.
- Maintain a healthy weight.
- Limit alcohol consumption.
- Discuss any drugs taken with the doctor and their potential influence on PSA levels.
- Consider 5-alpha-reductase inhibitors (5-ARIs), which can limit the development of prostate cancer cells and reduce PSA levels.
- Discuss with the doctor the benefits of frequent PSA screenings and prostate examinations.