Table 1.
Recommendations
| Disease state | Visits |
Simulation/preparation |
If treatment is warranted during pandemic |
||||||
|---|---|---|---|---|---|---|---|---|---|
| New consults∗ | RVs∗ | Fiducials† | Rectal spacers† | Simulation scans | Preferred treatment during pandemic | Brachytherapy‡ | EBRT type | ADT | |
| Localized/locally advanced | |||||||||
| Very low/low | Delay until safe | Delay until safe | Delay until safe | Delay until safe | Delay until safe | AS | Do not use | Do not use | Do not use |
| FIR | Delay 3 mo | Delay until safe | Delay until safe | Delay until safe | Delay until safe | AS | Delay until safe | Delay until safe | Do not use |
| UIR | Delay 1-3 mo | Delay 4 mo | Consider if performing SBRT | Consider if performing SBRT | Delay up to 4-6 mo if ADT given | RT + ADT | Delay until safe | 5 fx (preferred) or 20 fx |
Can use ADT to delay RT 4-6 mo Consider 6-mo depot |
| High/very high | Delay up to 1 mo | Delay 3 mo | Consider if performing SBRT | If experienced to place, consider only if performing SBRT | Delay 4-6 mo if ADT given | RT + ADT | Delay until safe | 5 fx (preferred) Or 20 fx |
Can use ADT to delay RT 4-6 mo Consider 6-mo depot |
| N+ | Delay 2-4 wk | Delay 3 mo | Consider if performing SBRT | Not recommended | Delay 4-6 mo if ADT given | RT + ADT | Not recommended | 5 fx or 20 fx |
Can use ADT to delay RT 4-6 mo Consider 6-mo depot |
| Postprostatectomy | |||||||||
| Adjuvant | Strongly consider use of early salvage RT | Delay 4 mo | - | - | Delay allowing treatment up to 120 d after surgery | RT ± ADT | - | 20 fx | Can use ADT to delay RT 4-6 mo Consider 6-mo depot |
| Salvage | Delay up to 1 mo | Delay 3 mo | - | - | Delay depending on PSA level and doubling time | RT ± ADT | - | 20 fx | Can use ADT to delay RT 4-6 mo Consider 6-mo depot |
| Metastatic | |||||||||
| Oligometastatic | If newly diagnosed, asymptomatic, and on ADT, can delay 2-3 mo | Delay 3 mo | - | - | If symptomatic do not delay | RT ± ADT | - | 1 fx or 3 fx |
Can use ADT to delay RT 4-6 mo |
| Low-volume M1 | If newly diagnosed, asymptomatic, and starting ADT, can delay 4-6 mo | Should follow with medical oncology as needed | - | - | Can delay 4-6 mo if ADT given | Prostate directed therapy + ADT | - | 5 fx or 6 fx |
Patient should be on ADT as part of standard of care |
Abbreviations: ADT = androgen deprivation therapy; AS = Active surveillance; EBRT = external beam radiation therapy; FIR = favorable intermediate risk; fx = fractions; N+ = regional lymph node involvement; PSA = prostate-specific antigen; RT = radiation therapy; RV = return visit; SBRT = stereotactic body radiation therapy; UIR = unfavorable intermediate risk.
New consults and return visits can be delayed as necessary based on resource availability. If staff is able to conduct these visits without affecting pandemic response resources, these should continue on a regular schedule using remote visits. PSA and other laboratory testing should be deferred as deemed safe. Return visit delay listed is an additional delay beyond the current return visit interval.
Placement of fiducial markers and rectal spacers requires extra personal protective equipment use. The benefit of these procedures should be based on resource and staff availability.
Brachytherapy should cautiously be used during the pandemic given high personal protective equipment requirements and resource utilization. Avoidance of general anesthesia is preferred if possible.