One of the common solutions for men with prostate cancer during this COVID-19 pandemic is to more liberal use hormone therapy (ADT) before surgery. Surgery requires a stay in the hospital as well as the use of a surgical suite for the procedure.
However, many hospitals, especially in profoundly impacted areas, have converted their surgical suites into COVID ICUs. The shortage created by this shift of use of surgical suites, as well as the surgical staff, has forced many urologists to start men on to hormone therapy while they wait for a time when prostatectomies can again be performed.
This practice of putting men on ADT to start some treatment while they wait for surgery can have some serious negative consequences. Hormone therapy can obscure the Gleason score, and it can also obscure the surgical margin status.
The pathology reports after the use of hormone therapy are not as reliable. Usual clinical practice relies on pathology reports, and the postoperative PSA sores to guide future treatment. Also, postoperative prostate-specific antigens (PSAs) are changed by the use of hormone therapy, clouding our understanding of the effectiveness of the surgery.
Medicine is a constant weighing of risks and rewards. Deciding whether you might be able to wait for surgery or move forward and start hormone therapy until you can have surgery is one example of this risk vs. reward question that you will need to discuss carefully with your medical team in the time of COVID-19.
The COVID virus has pushed us into a situation where the standard of care and best practices might not be able to be implemented.
