Dr. Trinh on How COVID-19 Has Impacted Surgical Decisions in Prostate Cancer

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 surgical considerations for patients with in prostate cancer in light of the novel coronavirus disease (COVID-19) pandemic.

In March 2020, it was decided that elective procedures needed to be postponed, says Trinh. However, the big questions that are: What constitutes an elective surgery? Also, which cancer surgeries can be safely postponed?

In the field of prostate cancer, there was some consensus that most cases could be safely postponed by a couple of weeks. There is no controversy for low-risk patients with prostate cancer who would have been safely put on active surveillance either way, says Trinh. If for some reason it was decided that a low-risk patient should be operated on, a postponement of 1 month, 2 months, or 3 months, would not make much difference, according to Trinh. For most intermediate-risk patients with prostate cancer, postponement is also not associated with worse outcomes based on some retrospective data from different sources that have been published throughout the years. The big question is focused on what should be done for those with high-risk prostate cancer.

In some instances, some have advocated for surgery despite the potential risk. In other instances, these procedures were postponed. At Dana-Farber Cancer Institute, there has been some consideration for putting these patients on neoadjuvant androgen deprivation therapy (ADT) for several months before proceeding with surgery; this can be done either as part of a clinical trial, such as PROTEUS, or even off trial, concludes Trinh.