FAQs on COVID-19 and Prostate Cancer

A: A good place to start is visiting your cancer centre or healthcare professionals’ website. Be mindful of health services being possibly limited at this time, in terms of answering questions directly on the phone. If a website search is not able to provide information, then call your clinical trial research team or the contact person given to you by your healthcare provider.  Also, consider  visiting the national health agency or drug agency’s website for specific information regarding clinical trials.

A: It would be reasonable to have a further PSA test now, which your doctor or medical team could organise for you to help identify if the PSA is static, climbing or falling. The test should be repeated after 1.5-3 months to estimate the PSA course. As the number of infections falls, it is likely that you will be offered a PET scan. This should happen more quickly if the PSA is rising. Further treatment will depend upon original treatment and what the scan revealed.

A: The risk of delay is related to what sort of tumour is present in the prostate. This is described as:

1. The tumour stage

2. The size of the tumour which is related to your PSA (the higher the PSA the more likely the tumour will be bigger)

3 The Gleason score which relates to how aggressive the tumour is.

Data from Italy suggests, the procedure may be deferred by 6 months. However, if you are worried talk to your doctor, or medical team, and they may consider offering hormone therapy now with a plan for external beam radiation therapy (EBRT) when it is safe to do so.

The evidence on the protective effect of ADT is largely based upon a report of an Italian cohort in which male patients with cancer generally appeared to do worse than the general population but men with prostate cancer on ADT did much better; less admissions to hospital and no deaths. (Montopoli M et al, Annals of Oncology 2020;S0923-7534(20)39797-0.) The number of men with prostate cancer involved was relatively small and further data is being collected. However, there is a possible hypothesis about how it might work. SARS-CoV-2 uses TMPRSS2 to allow it to enter the cell it is infecting. Production of TMPRSS2 is promoted by testosterone and so lack of testosterone maybe protective.

There has also be interest in BCG vaccination as it has a general immune-boosting effect however, this doesn’t apply to intra-vesicle BCG and at this stage there is no evidence of a benefit for patients receiving that treatment.

It depends upon the sort of treatment you are receiving. There is a risk because of immunosuppression with e.g. corticosteroids, progressive cancer situation, immune-oncologic therapy and mainly applicable to metastasised patients who receive systemic therapies. The general risk of getting an infection with clinical symptoms is higher than in the healthy population. Surgery and radiotherapy probably reduce your immune system whilst you are having them and for 6-8 weeks afterwards. As a consequence, you should be careful to isolate as much as possible during this period. However, the evidence suggests hormone treatment may even be protective. Male patients with cancer generally appear to do worse than the general population but men with prostate cancer on ADT did much better; less admissions to hospital and no deaths. (Montopoli M et al, Annals of Oncology 2020;S0923-7534(20)39797-0.)

If you are on chemotherapy, this may also affect your immune system and as a consequence this may be suspended.

Another potential major risk for patients with cancer is the inability to receive necessary medical services, in terms of getting to a hospital or normal medical care.

If localised disease has been treated and is undetectable, the risk is not different from patients who did not have a prostate cancer diagnosis. Minimising outpatient visits can help to lower exposure and possible further transmission. Telemedicine may be used to support patients to minimise the number of visits and risk of exposure. Another potential major risk for patients with cancer is the inability to receive necessary medical services, in terms of getting to a hospital or normal medical care.

Your healthcare provider’s office will most likely be in touch to let you know if your biopsy will go ahead or unavoidably postponed as some facilities may be limited at this time. If you have not been contacted, either check on your healthcare provider’s website for information or call their office.

This depends on the priority category:
If benign feeling gland and PSA <10 ng/ml: Upfront pre-biopsy mpMRI if resources allow then biopsy. If not, defer biopsy until after COVID-19.
Abnormal DRE or PSA ≥10 ng/ml: Upfront pre-biopsy mpMRI if resources allow and transperineal biopsy if available.

Where possible, GP surgeries and hospitals are continuing to provide routine tests as normal. This means that depending on the number of patients with coronavirus in your local area, your PSA tests may continue as planned.

If you are on hormone therapy and it is controlling your prostate cancer well, your healthcare provider may decide to do your PSA tests every six months instead of every three months. This will only happen if your healthcare provider thinks it is safe for you to have PSA tests less often. Talk to your healthcare provider on the phone if you have any concerns.

A blood test at home or local laboratory may be possible to arrange with your healthcare provider. Contact your medical team to ask if this is an option.

Yes, it will be planned to continue as normal. Your healthcare provider may decide to change your hormone therapy so that you don’t have to visit your medical centre or hospital as often. For example, if you usually have an injection every month or every three months, you may start having one every six months instead. This won’t affect how well your treatment works – six-monthly injections release the drug slowly over time and are just as effective as monthly or three-monthly injections.

You should keep this appointment. However, there can be a certain time window of a few weeks, that the appointment may be able to be postponed without problems. A delay of a few weeks, or even months, is usually not harmful. If you or a contact person, such as a close relative, have COVID-19 symptoms , it is strongly advised not to visit the practice in person. In such a case, contact your doctor or medical team.

As circumstances and patients may vary, we advise you to contact your doctor or medical team to discuss the options. Patients with low risk disease can safely delay treatment for many months whilst those with more aggressive cancer should have treatment sooner.
Patients who have already had brachytherapy, may want to keep in contact with their oncology team, to monitor the situation and to follow-up on tests (e.g. PSA tests) and appointments.

Depending on your circumstances, men diagnosed with early-stage prostate cancer are not at an increased risk of contracting COVID-19, because early-stage prostate cancer has not been shown to significantly affect your immune system.

Your immune system may be affected by certain treatments, for example, men having chemotherapy treatments for their prostate cancer. However, patients on androgen deprivation may be at lower risk. It is important to balance the risks of the treatment and local occurrence of the COVID-19 virus.

Your hormone therapy may be planned to continue as normal. Your healthcare provider may decide to change your hormone therapy so that you don’t have to visit your medical centre or hospital as often. For example, if you usually have an injection every month or every three months, you may start having one every six months instead. This won’t affect how well your treatment works – six-monthly injections release the drug slowly over time and are just as effective as monthly or three-monthly injections.