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,
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Maintaining social distance to prevent community spread.
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Assuring patient safety by minimizing the exposure of the patient to the clinics and hospitals.
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Minimizing exposure of primary care providers (occupational health and safety - OHS).
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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.
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The major concern is the potential risk of disease (cancer) progression.
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Healthcare utilization for COVID and non-COVID areas to make use of the services by persons to prevent and cure health problems.
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Do not come to a conclusion that the pandemic will last for several months, with multiple waves for varying lengths to avoid anxiety.
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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:
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Protein-specific antigen (PSA).
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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:
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Urinary retention.
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Spinal cord compression.
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Severe bony pain.
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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:
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Very low-risk disease.
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Low-risk disease.
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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:
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Unfavorable intermediate-risk (UIR).
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High risk.
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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:
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Patients with androgen deprivation therapy (ADT) can delay the start of radiotherapy for months.
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Patients planned for radiation therapy (RT) and hormone therapy (HT) can receive hormone therapy for six months before starting radiation therapy.
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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,
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PSA (protein-specific antigen)-based testing.
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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,
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Urinary obstruction.
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Bleeding with conservative urine.
2) The treatment measures to be prioritized are:
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Medical therapy.
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Hormone therapy.
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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:
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Immunity.
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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.
