Management Recommendations for Prostate Cancer During the COVID-19 Pandemic: A Systematic Review
Introduction The COVID-19 pandemic has delayed screening, diagnostic workup, and treatment in prostate
cancer (PCa) patients. Our purpose was to review PCa screening, diagnostic workup, active surveillance (AS), radical
prostatectomy (RP), radiotherapy (RT), androgen deprivation therapy (ADT) and systemic therapy during the
Materials and Methods We performed a systematic literature search of MEDLINE, EMBASE, Scopus, LILACS,
and Web of Science, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols
(PRISMA-P) statement for relevant material published from December 2019 to February 2021.
Results Prostate biopsy can be delayed, except when high-risk PCa is suspected or the patient is symptomatic.
Active surveillance is appropriate for patients with very low risk, low risk (LR) and favorable intermediate risk (FIR).
RP and RT for high risk and very high risk can be safely postponed up to 3 months. Hypofractionated external beam
RT (EBRT) is recommended when RT is employed. ADT should be used according to standard PCa-based indications.
Chemotherapy should be postponed until the pandemic is contained.
Conclusions The international urological community was not prepared for such an acute and severe pandemic.
PCa patients can be adequately managed according to risk stratification. During the COVID-19 pandemic, LR and
FIR patients can be followed with active surveillance. Delaying RP and RT in high risk and locally advanced disease
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