Quoc-Dien Trinh, MD, discusses current strategies on the treatment of patients with high-risk prostate cancer during the COVID-19 crisis.
Quoc-Dien Trinh, MD, an associate professor of surgery at Harvard Medical School; co-director of the Dana-Farber/Brigham and Women's Prostate Cancer Center; and director the of Ambulatory Clinical Operations in the Division of Urological Surgery at Brigham and Women’s Hospital, discusses current strategies on postponing treatment for patients with high-risk prostate cancer during the COVID-19 crisis.
A lot of literature and some internal or external guidance have been published regarding the postponement of surgery in prostate cancer, says Trinh. However, no clear guidelines inform on how to manage 1 patient versus another. The National Comprehensive Cancer Network guidelines said that patients with low- or intermediate-risk prostate cancers can have their surgeries postponed; however, high-risk patients should receive treatment sooner. Regardless, the recommendations should not be considered clear guidance supported by level 1 evidence, Trinh cautions.
Internally, at the Brigham and Women’s Hospital and Dana-Farber, guidance was crafted to help manage patients with prostate cancer while achieving some consistency among providers. Most physicians could agree that the majority of low- and intermediate-risk patients with prostate cancer can be safely postponed by 4 weeks, 8 weeks, or 12 weeks; that is what was done with the majority of cases at these institutions.
The trickier question is determining what to do for high-risk patients. In some instances, treatment can be immediately administrated as it would normally, despite the risk of COVID-19. However, this should only happen after patients are carefully counseled about the benefits and risks of doing so, says Trinh.
Alternative plans include giving patients neoadjuvant androgen deprivation therapy, either as part of a clinical trial, such as PROTEUS, or off trial. This will minimize the potential for disease spread, while holding off on treatment because of the crisis has been considered, concludes Trinh.