Management of mCRPC During COVID-19

Daniel Petrylak, MD: The interesting observations that have been made about COVID-19 and prostate cancer actually stem from the observation and may be involved in viral entry into normal cells. When one looks at the Italian data, where they do a multivariate analysis, and they look at those patients who have a per 300,000 serious events or deaths that were recorded, that were related to COVID-19, patients with prostate cancer on hormone therapy have a much lower rate of those events than those patients with prostate cancer who aren’t on hormone therapy. How do we explain that? It could be that simple observation that the antiandrogens or the lack of testosterone is having that effect. We do know that the disease is more severe and more prevalent in men. It also could be that those patients who are on hormone therapy are more debilitated, they tend to more socially isolated, and they may not be exposed to the virus in the same fashion. There’s a lot of hypotheses that can be generated. I wouldn’t make the immediate assumption that because you’re on hormone therapy that you’re going to be immune to the COVID infection, I’m not saying that at all. But this is something that people are now investigating, and there are a variety of different clinical trials that are being designed in different states of COVID infection, whether this be in patients who are asymptomatic versus patients who are hospitalized, trying to determine whether viral load changes with various different antiandrogens, or whether hospitalization or the respiratory parameters change. The VA just opened up a trial that’s looking at degarelix in men who are in the ICU, to see if they can shorten their stay. These are very important hypotheses that need to be borne out. As far as my practice is concerned, there has been a huge effect on patients, staff, and physicians. On patients of course, some are afraid to come into the office because they’re afraid of infection, all of our patients are wearing gloves, we prescreen all of our patients. In terms of symptoms the night before, we are not requiring, as some institutions do, that the patient have a negative COVID test before coming. I am face-to-face seeing patients who are going to be treated, I have not changed my algorithm in treating patients based upon this particular pandemic. Actually, in fact, I have not missed seeing patients, although I may see more video visits. My video visits were 60%, I think, at one time. Now they’re about 50%. I am seeing all of my patients face-to-face who need treatment with chemotherapy. And that’s still ongoing for both patients with prostate cancer as well as bladder cancer.

I think that the NCCN guidelines are helpful in understanding how we should deal with our patients, but you have look at the individual patient. The risk of COVID versus the risk of what’s going on with their cancer. What concerns me the most is data that’s come out suggesting that the rate of new cancer diagnoses is down by 20%. I also have known from personal experience, just seeing patients and family members, that being isolated in the house for 2 months, your conditioning goes down, and your ability to tolerate things go down. Especially men with prostate cancer on hormone therapy, where we’re trying to maintain their muscle mass by exercise and weightlifting, and other ways of doing so. That’s something that I think may be overlooked. You’ve still got to exercise; you’ve still got to be active. Whether that be in your house, whether that be somewhere else, you still have to do it.

Transcript Edited for Clarity