Management of prostate cancer radiotherapy during the COVID-19 pandemic: A necessary paradigm change.

To adapt the management of prostate malignancy in response to the COVID-19 pandemic.

In according to the recommendations of the European Association of Urology, we have developed practical additional document on the treatment of prostate cancer.

Low-Risk Group Watchful Waiting should be offered to patients >75 years old, with a limited life expectancy and unfit for local treatment. In Active Surveillance (AS) patients re-biopsy, PSA evaluation and visits should be deferred for up to 6 months, preferring non-invasive multiparametric-MRI. The active treatment should be delayed for 6-12 months. Intermediate-Risk Group AS should be offered in favorable-risk patients. Short-course neoadjuvant androgen deprivation therapy (ADT) combined with ultra-hypo-fractionation radiotherapy should be used in unfavorable-risk patients. High-Risk Group Neoadjuvant ADT combined with moderate hypofractionation should be preferred. Whole-pelvis irradiation should be offered to patients with positive lymph nodes in locally advanced setting. ADT should be initiated if PSA doubling time is < 12 months in radio-recurrent patients, as well as in low priority/low volume of metastatic hormone sensitive prostate cancer. If radiotherapy cannot be delayed, hypo-fractionated regimens should be preferred. In high priority class metastatic disease, treatment with androgen receptor-targeted agents should be offered. When palliative radiotherapy for painful bone metastasis is required, single fraction of 8 Gy should be offered.

In Covid-19 Era, the challenge should concern a correct management of the oncologic patient, reducing the risk of spreading the virus without worsening tumor prognosis.

Cancer treatment and research communications. 2021 Feb 06 [Epub ahead of print]

Beatrice Detti, Gianluca Ingrosso, Carlotta Becherini, Andrea Lancia, Emanuela Olmetto, Emanuele Alì, Simona Marani, Maria Ausilia Teriaca, Giulio Francolini, Angela Sardaro, Cynthia Aristei, Andrea Riccardo Filippi, Giuseppe Sanguineti, Lorenzo Livi

RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: ., Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy., RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Diagnostic Imaging and Radiotherapy Section, Department of Interdisciplinary Medicine, University Aldo Moro, Bari, Italy., Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.