CUA CS 2020 Prostate Ca and COVID-19

Question 1

What is recommended regarding PSA screening in asymptomatic men during the pandemic?

Answer 1

the public health benefit from PSA screening is derived from long-term implementation and has no role in an acute setting. Therefore, we recommend cessation of routine prostate-specific antigen (PSA) screening in asymptomatic men until resolution of this pandemic.

Question 2

True or False: In men with a suspicion of asymptomatic localized prostate cancer (based on PSA testing or clinical exam) we recommend delay of further investigations. This includes digital rectal examination (DRE), cross-sectional or prostate imaging, and transrectal ultrasound (TRUS)-guided or perineal biopsies.

Answer 2

True

Question 3

Should ADT be used in patients with low risk or FIR to bridge them past the pandemic?

Answer 3

No, not for them. Also stop AS protocols, also if they want surgery, 6-12 months wait is ok per retrospective series. same thing with RT.

Question 4

What should you do if you get a consult for UIR or high risk or very high risk?

Answer 4

see it if you can. Work them up.

Question 5

how do you treat UIR, HR, VHR prostate ca during COVID?

Answer 5

For UIR: 6 months of ADT( for RT), hypo fractionated protocol to minimize visits

Question 6

How long of a delay in UIR, HR, VHR is thought to be ok during covid for RP?

Answer 6

3 months( some articles say 6 is ok too)

Question 7

What is the role ADt in UIR, HR VHR patients?

Answer 7

you can give it but after a thorough discussion with patient about this not being standard( in studies it has shown to help with BCR, margins and RFS)

Question 8

What is the FU for UIR, HR, VHR?

Answer 8

after treatment esp 2-3 years out you can space things out

Question 9

what is recommended for men with new advanced PC/ mpc?

Answer 9

in person visit, full work up

Question 10

What to do if you have BCR/high risk features post RP?

Answer 10

early salvage(hypo fractionated) and not adjuvant

Question 11

what if someone is diagnosed with node positive disease?

Answer 11

can put them on ADT, can also get RT, keep in mind that you can give abi but wait 6 months as abi would require closer fu

Question 12

What do you do for men with newly diagnosed mHSPC?

Answer 12

avoid chemo, put them on ADT+ARAT, chemo makes them at higher risk of covid complications and more resource intensive

Question 13

What about oligometastatic HSPC?

Answer 13

withhold or delay RT, if gonna give RT hypofractionated course please

Question 14

What do you do for nmCRPC high risk?

Answer 14

apa, enza, daro. ( DT<10 months), space out imaging

Question 15

what about mCRPC?

Answer 15

ARAT+ADT. Rad-223, weight benefits against risk of pancytopenia, A MO, RO discussion may be helpful

Question 16

what if men with painful bone lesions?

Answer 16

Refer to rad onc for short course of palliative RT

Question 17

what should you do for bone therapy( denosumab)?

Answer 17

Get them to do the injection themselves. if patients dont WANT TO come to have their Calcium checked maybe space them out q3 months instead of monthly( patient population mCRPC)

Question 18

what if someone progresses on abi?

Answer 18

consider switching from pred to dexa. might work, but worldwide shortage of dexamethasone. goal is to delay chemo