- Patients with prostate cancer need radiotherapy plans that conserve resources and allow for their safe management during the COVID-19 pandemic.
- A group of radiation oncologists from the United States and United Kingdom conducted a systematic review and agreed on a set of recommendations.
- Remote visits:
- All visits should be transitioned to telehealth visits; few patients require an in-person visit.
- Low- and favorable intermediate-risk disease:
- Treatment can be safely deferred for up to 12 months because these patients have favorable outcomes with watchful waiting, active monitoring, or active surveillance.
- Higher-risk disease:
- Androgen-deprivation therapy (ADT) can allow for further deferral of radiotherapy for 4-6 months.
- If ADT cannot be delivered, the benefits of immediate treatment during a window of potential cure must be weighed against COVID-19 exposure and subsequent morbidity and mortality in patients with rapid PSA doubling times (≤3 months).
- Significant prolongation of ADT beyond standards of care should be avoided.
- If treatment is deemed necessary and safe, the shortest fractionation schedule should be adopted.
- Ultrafractionation should be used for intermediate- and high-risk localized prostate cancer.
- For postprostatectomy patients, a moderate hypofractionated regimen is preferred.
- Stereotactic body radiotherapy or 6 Gy × 6 fractions can be delivered for low-volume M1 disease.