Prostate cancer and coronavirus (COVID-19)

So — rather obviously — the web has been swamped with information about COVID-19 over the past 2 months or more. That information runs the gamut from very accurate, well-constructed guidance to utter garbage, and it would have been impossible for us to sort it all out for you. So we haven’t tried. The fact that there is a strong political element (in some countries) to the information being distributed is simply sad, and doesn’t help anyone.

The questions on the minds of prostate cancer patients and their family members — also rather obviously — relate to how the COVID-19 pandemic affects them and the management of their specific prostate cancer. And it is nearly impossible to answer these questions in a general way because so much depends on where you live and where your doctor sees you and treats you. For example, a patient who lives in midtown Manhattan and has been going to Memorial Sloan-Kettering Cancer Center for treatment is obviously in a very different situation to someone who lives in Abilene, KS, and has been going to see a urologist in Salina, 30 miles to the west! In the former case. one probably hasn’t wanted to (and shouldn’t have) left one’s apartment at all if one could avoid it. In the latter case, one might have had no problem keeping a regular appointment with one’s urologist.

As far as we are currently aware, the number of pieces of really sound, general advice we can offer prostate cancer patients are low:

  • Before you do anything else, call you doctor’s office and find out what they can or cannot do for you! Every patient is different and the situation of every doctor’s office may be different too!
  • If you need a PSA test and can’t get this at your doctor’s office for some reason, ask whether there is some other testing laboratory (like a Quest or a Labcorp facility) where you could go to get the PSA test done or whether it is reasonable to just “skip” a test.
  • If there is any reason for you to think that you might be at elevated risk for the consequences of COVID-19 infection (age, general health status, respiratory or cardiovascular history, treatment with chemotherapy or immunotherapy), stay home and stay “socially distant” from others if you possibly can.

If you have any other significant concerns, call your doctor’s office and seek guidance that they will be able to tailor to you and your specific situation.

The single most important thing that you need to understand is that your individual situation and your doctor’s or doctors’ individual situations are likely to be very different from those of others — even if the situations may look similar in several ways. As a consequence, it is important to get individual, personalized guidance that your doctor or doctors should be able to provide — although it may take them a little while to get back to you.

Try to be patient. Try to be relaxed. We are all in this together.

Your sitemaster is old enough to have been at a boarding school in England at the time of the 1957 influenza pandemic. He was — for a few days at least — the only student who lived at the school who was not in bed with the ‘flu. Then — as now — life was completely disrupted for a while, although not as badly.

13 Responses

  1. I wonder about how other readers on AS are coping. Skipping visits, DREs, PSAs? How are anxiety levels with COVID-19 added on?

  2. Howard:

    It would certainly be “reasonable” to think that a man on AS who had favorable intermediate-risk disease might be feeling a good deal more anxious than a man like you with very low-risk disease if he had to “skip” a PSA test and a DRE.

    On the other hand, it is probably also “reasonable” to believe that any man who is generally anxious about health issues will be more anxious than an otherwise similar man who is generally either fatalistic or realistic about risk and life.

    It has, however, never failed to amaze me how some men can express high levels of health-related anxiety and still drive cars and other vehicles around (with varying levels of skill, expertise, and alcohol-induced loss thereof) without any apparent recognition of the fact that their highest level of health-related risk is the fact that they are driving a vehicle on a public highway! I suppose this is a form of selective unconsciousness.

  3. Excellent reminder about the garbage on the Internet and that we are not all the same regarding where we are with PCa

  4. Here’s a bit of anecdotal information:

    My wife had COVID-19 and conjunctivitis in January, yet I didn’t catch it, which is amazing as we were in a hotel room the entire time.

    I’m on Firmagon ADT. The Firmagon has been as good as it gets: no side effects, no life changes.

  5. I am on active surveillance and was supposed to have a PSA test on March 24 and see my urologist that day. I was notified they wanted to push all that to June 24.

    I resisted and had the PSA test April 15. Low and behold, my PSA had jumped more than ever before, from around 6.0 to 9.4. I’m set to go in for an MRI on May 7, so my advice to anybody reading this is to not sit back. After the initial shock of the PSA spike, I really haven’t had a lot of anxiety about it. My initial anxiety concerned dealing with the situation amidst this coronavirus, i.e., when would I be able to get the necessary further tests and treatment if necessary? Once I had those questions resolved positively, my anxiety was pretty well ameliorated.

  6. For those on ADT and who may wonder if they are immunosuppressed and at higher risk, there is some evidence, according to Dr. Charles Drake, that these patients may actually have some protection against the coronavirus because they have lower levels of the protein TMPRSS, which facilitates entry of the virus into cells.

  7. Len,

    The opposite seems to be true. ADT seems to be immunoprotective. I can’t say if it helps with COVID-19 specifically, though.

  8. Allen,

    Here’s the proof, so far. My oncologist at Mt. Sinai, NYC, told me he was going to conduct his own RCT but the number of his CoVID cases suddenly dropped by 50% — a good thing!

  9. Just to follow up on Allen and Len’s comments, the Italian study funded by PCF appears to show that men on ADT fare way better.

    Amongst a population of Italians with prostate cancer, 5,000+ on ADT, and 37,000+ not, only 4 men were found to be infected with COVID-19 when on ADT vs. 114 of the control group. And there were no deaths on ADT versus 18 in the control group.

    PCF has now initiated a similar trial across the VA system here in the US. Men will be given a single 1-month shot of the LHRH antagonist degarelix (Firmagon).

    Do I see some of our long-suffering men on ADT smiling?

  10. Yes, you do, Rick! : )

  11. We all face things differently of course. Someone close to me was stoic about her knee replacement. We went to a meeting of patients about to undergo surgery at the University of Chicago. One strapping middle-aged guy was crying and in a panic.

  12. Can Covid-19 CAUSE a PSA spike?

  13. Not that I am aware of … but then there are a lot of things about COVID-19 infection that we don’t fully understand as yet.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: