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ESMO Patient Guides COVID19 1000x250

Outpatient visits

High priority

Your outpatient appointment may be a high priority if:

  • You are due to have an initial appointment because you are experiencing symptoms or you have high-volume metastatic prostate cancer that is likely to progress quickly and cause symptoms and/or complications
  • You have recently been diagnosed with metastatic aggressive or small-cell prostate cancer
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    You are experiencing symptoms of prostate cancer that can’t be managed via telephone consultation
  • You are experiencing severe side effects from systemic treatment that can’t be managed via telephone consultation

Medium priority

Your outpatient appointment may be a medium priority if:

  • You have low-volume metastatic prostate cancer, are not currently experiencing any symptoms, and the purpose of your appointment is to begin systemic treatment
  • You are not currently experiencing any symptoms but an imaging test has indicated that you are, or might be, experiencing a relapse

Low priority

Your outpatient appointment may be a low priority if:

  • You are currently receiving treatment with androgen deprivation therapy (ADT) or androgen receptor targeted therapy and your prostate cancer is stable. In these cases, appointments may be conducted via telephone
  • You are currently under active surveillance. In these cases, appointments may be conducted via telephone

Imaging

High priority

Your appointment may be a high priority if:

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    You need urgent imaging because you are experiencing serious symptoms such as neurological effects, bleeding, bone fracture, thrombosis or pulmonary embolism

Medium priority

Your appointment may be a medium priority if:

  • You need imaging to help your doctor to make decisions about your treatment that may have an impact on your prognosis

Low priority

Your appointment may be a low priority if:

  • Your prostate cancer is stable and you are scheduled to have a routine imaging appointment

Surgery

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo surgery for high-risk prostate cancer and are not suitable for radiotherapy. In these cases, the decision to proceed with surgery will be based on discussions between you and your doctor, taking your individual circumstances into consideration

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to undergo surgery for high-risk prostate cancer and you are suitable for radiotherapy. In these cases, the decision to proceed with radiotherapy and delay surgery will be based on discussions between you and your doctor, taking your individual circumstances into consideration

Low priority

Your appointment may be a low priority if:

  • You are scheduled to undergo surgery for intermediate- or low-risk prostate cancer. In these cases, it is likely that surgery will be delayed

Radiotherapy

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo hypo-fractionated or extreme hypo-fractionated radiotherapy to treat metastases that are causing symptoms, such as a bone metastasis

Low priority

Your appointment may be a low priority if:

  • You are scheduled to undergo radiotherapy for intermediate- or high-risk prostate cancer. In these cases, your doctor may consider extending neoadjuvant ADT
  • You are scheduled to undergo hypo-fractionated radiotherapy. In these cases, your doctor may consider extending neoadjuvant ADT
  • You are scheduled to undergo radiotherapy of the pelvic lymphatic drainage. In these cases, radiotherapy will only proceed if your cancer has spread to your lymph nodes. Otherwise, your doctor may consider extending neoadjuvant ADT
  • You are scheduled to undergo radiotherapy as salvage treatment. In these cases, your doctor may consider extending neoadjuvant ADT

Medical management of advanced prostate cancer

High priority

Your appointment may be a high priority if:

  • You are scheduled to begin ADT for locally advanced or metastatic hormone-sensitive prostate cancer that is progressing and causing symptoms
  • You are scheduled to begin first-line treatment in addition to ADT for metastatic castration-resistant prostate cancer that is causing symptoms, and delaying treatment could have a negative effect on your prognosis
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    You are scheduled to receive chemotherapy with docetaxel or cabazitaxel for advanced prostate cancer that is progressing quickly, is causing symptoms and is not responsive to androgen receptor targeted therapies. In these cases, prophylactic growth factor support is recommended alongside chemotherapy

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to receive an androgen receptor targeted therapy in addition to ADT for metastatic hormone-sensitive prostate cancer. In these cases, initiation of treatment with the targeted therapy can be delayed
  • You are scheduled to receive first-line treatment for metastatic or recurrent castration-resistant prostate cancer that is progressing slowly
  • You are scheduled to receive androgen receptor targeted therapy for non-metastatic castration-resistant prostate cancer

Low priority

Your appointment may be a low priority if:

  • You are due to begin a new systemic treatment or undergo a treatment change in later lines of therapy for low-volume metastatic prostate cancer that is not causing symptoms and is showing minimal progression on imaging tests

Additional considerations for the medical management of advanced prostate cancer

  • ADT can be administered relatively infrequently and, compared with chemotherapy, has fewer side effects that may exacerbate symptoms of COVID-19. Therefore, ADT can continue in most patients during the COVID-19 pandemic
  • Whenever possible, androgen receptor targeted therapy will be chosen rather than chemotherapy for the treatment of metastatic hormone-sensitive and castration-resistant prostate cancer. If feasible, home-based administration will be considered to minimise hospital visits
  • In patients treated with chemotherapy, the number of treatment cycles may be reduced or the length of cycles may be prolonged to minimise hospital visits
  • Supportive treatment with steroids will be reduced, if possible, to minimise the use of immunosuppressive drugs

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