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Radiation Treatment for Prostate Cancer During the COVID-19 Pandemic

A team of researchers led by PCF-funded investigator Dr. Dan Spratt has released a framework for the use of radiation oncology in prostate cancer during COVID-19. The team rapidly reviewed the available literature and issued recommendations for clinicians when considering radiation therapy for prostate cancer patients. The goal is to help doctors safely manage their patients—balancing dual concerns of prostate cancer and COVID infection risk—while conserving healthcare resources.

The framework is dubbed RADS, which is also the term used to describe the “dose” of radiation therapy. From the paper:

R = Remote Visits. Use phone or video instead of in-person visits.
A = Avoid Radiation. Do not treat with radiation therapy where evidence suggests little or no benefit.
D = Defer Radiation.  Defer the start of treatment as far out as possible to maintain safety.
S = Shorten Radiation. If radiation is used, use the shortest safe form possible.

 
The simplest way to think about the framework is:

Very low risk/low risk/favorable intermediate risk  –>  Defer radiation treatment until safe
Unfavorable intermediate risk/high risk/very high risk  –>  Delay radiation treatment with ADT as needed

The table below is adapted from the paper and includes more detailed recommendations. Note that essentially all visits and treatment can safely be delayed for weeks to months, depending on the disease state. In many cases, ADT can be used to delay RT for 4-6 months.

See the original publication for additional detail on preparation for treatment as well as considerations of brachytherapy and external-beam RT. The authors note that “brachytherapy should cautiously be used during the pandemic given high PPE requirements and resource utilization.”

Finally, the authors note that “these recommendations apply only to patients not infected with COVID-19. For patients who have symptoms concerning for COVID-19, or who have tested positive already, please follow local hospital plans and procedures.”

Radiation Treatment Recommendations