The NHS has continued to provide essential and urgent cancer treatments during the coronavirus outbreak, and is now working hard to get all services back to normal. For example, hospitals have made changes to ensure that people with cancer can be treated in places that are likely to be free from coronavirus.
But some men and their doctors may still have to decide whether to delay or change their prostate cancer treatment. Your safety will always be a priority in these decisions, which could be for the following reasons.
- Some prostate cancer treatments increase your risk of getting infections, which could put you at risk of catching coronavirus. In this case, other treatments may be safer for you at this time.
- Some prostate cancer treatments involve regular hospital appointments or time on a hospital ward. In parts of the country with higher levels of coronavirus, this could put you at risk of catching the virus. In this case, other treatments that don’t involve spending time at the hospital may be safer for you until the risk has reduced.
Prostate cancer often grows slowly, so for many men a delay or change to their treatment shouldn’t affect how well their treatment works in the long term. If tests show your cancer is more likely to grow quickly or spread, your doctor should make your treatment a priority so that you get the treatment you need without unnecessary delays.
If your doctor does need to delay or change your treatment at all, they will talk to you first to make sure you understand your options and why this is happening. Speak to your doctor if you have any concerns.
Your appointments and check-ups may happen over the phone so that you don’t have to go into the hospital or GP surgery. If you’re not sure whether to go to any planned appointments, contact your doctor or nurse to check.
Calls from your GP surgery or hospital may come from a withheld number, or you may not recognise the number. It may be worth answering any calls from withheld numbers or numbers you don't recognise at this time, in case your doctor or nurse is trying to contact you.
Will I be offered surgery?
You should be offered surgery for prostate cancer (radical prostatectomy), if your doctor thinks it is suitable for you. But you may have to wait a little longer than usual for your operation. This is because hospitals are now working hard to do all of the operations that were delayed during the coronavirus outbreak. Hospitals are also spending extra time cleaning equipment and rooms, which means many hospitals are still doing fewer operations than usual.
Your doctor may talk to you about having hormone therapy to control your cancer before your surgery. All types of radical prostatectomy (including robot-assisted keyhole surgery, keyhole surgery by hand, and open surgery) are still possible after being on hormone therapy.
Your doctor will talk to you to make sure you understand your options and help you decide what to do next. Most localised prostate cancer grows slowly. For many men with localised prostate cancer, having hormone therapy for a while first won’t affect how well the surgery works in the long term.
If tests show your cancer is more likely to grow quickly, your doctor should make your treatment a priority so that you get the treatment you need without unnecessary delays. Hospitals have made changes to ensure that people with cancer can be treated in places that are likely to be free from coronavirus. This means that your surgery may not happen at your usual hospital.
You will probably need to have a test 2-3 days before your operation, to make sure you don’t have coronavirus. Once you’ve had the test, you’ll need to self-isolate until you go into hospital for your surgery. The hospital will give you more information about what you need to do, and for how long.
Your safety will always be a priority in decisions about your treatment and care, but speak to your doctor if you have any concerns.
Will I be offered radiotherapy?
Having external beam radiotherapy involves regular hospital appointments. In parts of the country that have high levels of coronavirus, this could put you at risk of catching the virus. This means that other treatments that don’t involve spending time at the hospital may be safer for people in those areas until the risk has reduced.
If you’re having radiotherapy to treat localised or locally advanced prostate cancer, it’s normal to have hormone therapy for up to six months first. This helps to shrink the prostate and the cancer inside it, making the cancer easier to treat. Your hormone therapy should still be able to go ahead as usual.
If your doctor does need to delay or change your radiotherapy, they will talk to you about other treatments to help control your cancer – or relieve symptoms – until it’s safe for you to have radiotherapy. Speak to your doctor if you have any concerns.
Will I be offered chemotherapy?
Many men with advanced prostate cancer are offered chemotherapy at some point. Chemotherapy can increase your risk from catching infections, including coronavirus. This is because it can affect your immune system, which fights infections. Chemotherapy also involves regular hospital appointments, which could put you at risk of catching coronavirus during those hospital visits.
Many men are still being offered chemotherapy to treat their prostate cancer. Hospitals have made changes to ensure that people with cancer can be treated in places that are likely to be free from coronavirus. But your doctor may talk to you about other treatments to help control your cancer, instead of chemotherapy.
For example, if you’ve just been diagnosed with advanced prostate cancer, you may now be offered enzalutamide or abiraterone, which are types of hormone therapy. These medicines are usually only offered to men at a later stage in their treatment. But they’ve now been made available as a first treatment for advanced prostate cancer during the coronavirus outbreak. They are just as effective as chemotherapy for these men, but are less likely to affect your immune system.
Your safety will always be a priority in any discussions about your treatment.
If I have chemotherapy, will I need to shield?
You may have heard people talk about ‘shielding’. Shielding aims to protect those people who are at greatest risk of becoming very ill if they catch coronavirus. It was recommended when lots of people in the UK had coronavirus. But the latest government advice is that, in most parts of the country, the number of people with the virus is low enough that you don’t need to shield. If this changes, or if you live in an area with higher levels of coronavirus, the government will write to you and recommend that you stay at home and shield. There’s more information about shielding on the government’s website.
Even though the government doesn’t currently recommend shielding if you’re having chemotherapy, your hospital doctor may advise you to follow the shielding guidance. If you’re not sure what to do, or are worried about your risk from coronavirus, speak to someone in your medical team. They’ll be able to discuss shielding with you and help you decide what’s best for you.