Coronavirus (COVID-19) and prostate cancer

27 March 2020

Below is some information about coronavirus (COVID-19) for people who have, or have had, prostate cancer.

This information aims to answer some of the questions you may have at this time. We will update this page in line with any official advice changes and to make sure it answers common questions. You can also contact our Specialist Nurses for further information and support.

As always, it’s important to follow the advice of your doctor, nurse or other people in your medical team.

We have also worked with other UK cancer charities as part of ‘One Cancer Voice’ and with NHS England to develop information on coronavirus for people who have, or have had, cancer and their loved ones, and for people who are worried they may have cancer. Both the ‘One Cancer Voice’ information and the information on this page will be kept up to date if official advice changes.

For the latest information about coronavirus for the general public, including symptoms to look out for, what to do if you think you have coronavirus, and ways to reduce your risk of catching or spreading coronavirus, visit the NHS website.

Help us to support you at this time

We want to know from you how we can best support people affected by prostate cancer during the coronavirus outbreak. Please complete our short survey to let us know what support and information would help.

The effects of coronavirus infection could be particularly severe for certain people with prostate cancer. These include:

• men having chemotherapy
• men having clinical trial drugs that affect the immune system, such as olaparib (Lynparza^®) or pembrolizumab (Keytruda^®).

If you're having one of these treatments, it's very important to follow the government's guidance and stay at home for the next 12 weeks. You may hear this called 'shielding'. It aims to protect those people who are at greatest risk of becoming very ill if they catch coronavirus.

It's very likely that your doctor or nurse will limit the amount of time you need to spend at the hospital or GP surgery. For example, you will probably have phone appointments, wherever possible, instead of visiting the hospital or GP surgery. It might also be possible to have blood tests done at home. Speak to your doctor or nurse if you’re concerned about your appointments.

If you've had one of the treatments listed above in the last three months, but are no longer having it, speak to your hospital doctor about your level of risk from coronavirus. They can help you decide whether or not to follow the government's guidance on shielding.

For other men with prostate cancer

Even if you aren't having one of the treatments listed above, it's very important to follow the expert advice on social distancing. This means avoiding contact with other people, including friends and family, to reduce your risk of catching coronavirus.

If the advice for people having cancer treatment changes at any time, health professionals and charities will take steps to make sure patients have the latest information.

If you’ve been in contact with someone with coronavirus, or if you have a new and continuous cough or a high temperature (fever), stay at home and contact your medical team at the hospital straight away.

If you’re having chemotherapy, you should already have the number of someone to call at the hospital if you have any signs of an infection. Call this number if you’re worried you may have coronavirus.

If you can't get hold of your medical team, contact the following:

• In England, Wales or Northern Ireland, call 111 for advice
• In Scotland, call your GP surgery (or 111 if your GP surgery is closed).

Make sure you tell them about your prostate cancer diagnosis and any cancer treatments you are having.

If you’re having one of the treatments mentioned above or you’re over 70, and someone you live with has a new and continuous cough or a high temperature (fever), it may be sensible to stay somewhere else for 14 days, if possible. If this isn’t an option and you have to stay at home together, try to keep away from them as much as possible.

The NHS is continuing to provide cancer treatments and has taken steps to make sure necessary drugs are still available. But some men and their doctors will have to decide whether to delay or change their prostate cancer treatment. This 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, which could put you at risk of catching coronavirus. 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.

Please note that calls from your GP surgery or hospital may come up on your phone as a withheld number, or you may not recognise the number that appears. It may be worth answering any calls from withheld numbers, or from numbers you don't recognise, at this time in case your doctor or nurse is trying to contact you.

Surgery (radical prostatectomy) is commonly used to treat localised prostate cancer (cancer that hasn’t spread outside the prostate). It is also an option for some men with locally advanced prostate cancer.

Having prostate surgery involves staying in hospital, which could put you at risk of catching coronavirus. This means it may be safer for you to have hormone therapy to control your cancer until this risk has reduced and you can safely have 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. Speak to your doctor if you have any concerns.

External beam radiotherapy is commonly used to treat prostate cancer, as well as to relieve symptoms in men with advanced prostate cancer.

Having radiotherapy involves regular hospital appointments, which could put you at risk of catching coronavirus. This means that other treatments that don’t involve spending time at the hospital may be safer for you until this 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.

If you are already having radiotherapy, talk to your radiographer or your hospital doctor about whether you should continue having radiotherapy as planned or change to a different treatment.

Many men with advanced prostate cancer are offered chemotherapy at some point – either as a first treatment for their cancer, or later on if the cancer is no longer responding to hormone therapy.

One of the side effects of chemotherapy is that it increases your risk of catching infections. This means that having chemotherapy could put you at increased risk of catching coronavirus. Chemotherapy also involves regular hospital appointments, which could also put you at risk of catching coronavirus during those hospital visits.

Because of the increased risk of catching coronavirus, other treatments that don’t affect your immune system or involve regular hospital visits may be safer for you until the risk has reduced. Your doctor will talk to you about other treatments to help control your cancer until it’s safe for you to start chemotherapy.

If you are already having chemotherapy, talk to your doctor about whether you should continue having chemotherapy or change to a different treatment.

If you’ve had prostate surgery in the last 6 weeks and are still recovering from the operation, follow the expert advice on social distancing. This means avoiding contact with other people as much as possible, to reduce your risk of catching coronavirus.

If you’ve had surgery to treat prostate cancer in the past and have recovered from the operation, this won’t increase your risk of catching coronavirus. It also won’t increase your risk of more severe symptoms if you do catch coronavirus.

Your risk should be the same as other people in general. All people need to be careful, and particularly if:

• you are 70 or over
• you have a long-term health problem, for example with your lungs or heart, or a weak immune system
• you’re having a treatment that puts you at increased risk of infections.

Some men have lymph nodes near the prostate removed during surgery – this is known as a pelvic lymph node dissection. Lymph nodes are part of your immune system. However, as coronavirus affects your respiratory system, having the lymph nodes near your prostate removed shouldn’t affect your risk of getting coronavirus.

External beam radiotherapy to the prostate shouldn’t affect your immune system. So if you’ve had – or are currently having – radiotherapy to treat cancer inside your prostate, this won’t affect your risk of catching coronavirus. It also won’t increase your risk of more severe symptoms if you do catch coronavirus.

However, if you’re going into hospital to have radiotherapy at the moment, there’s a chance you might catch coronavirus from other people there. Hospitals are taking extra measures to lower the risk of staff or patients catching coronavirus, but talk to your doctor, radiographer or nurse if you’re worried.

Some men have radiotherapy to a wider area, including the nearby lymph nodes. Lymph nodes are part of your immune system. However, as coronavirus affects your respiratory system, having radiotherapy to the lymph nodes near your prostate shouldn’t affect your risk of getting coronavirus.

Some men with advanced prostate cancer have radiotherapy to relieve bone pain in parts of the body where the cancer has spread. Depending on the bone that is being treated and the dose of radiotherapy, this might affect the bone marrow, which can cause a temporary drop in the number of blood cells that help fight infection. If this happens, it might mean you’re more likely to get infections. Speak to your doctor, radiographer or nurse if you’re having radiotherapy to treat symptoms of advanced prostate cancer and are worried that you might be at increased risk.

If you’re having radium-223 (Xofigo®) to treat bone pain caused by advanced prostate cancer, this can occasionally affect the bone marrow and increase your risk of getting infections. Speak to your doctor or nurse if you’re worried.

LHRH agonists, GnRH antagonists and anti-androgens

Standard hormone therapy treatments, including LHRH agonists, GnRH antagonists and anti-androgen tablets, don’t affect your immune system. This means that being on standard hormone therapy won’t increase your risk of catching coronavirus, or of having more severe symptoms if you do catch coronavirus. However, remember to think about any other treatments you might be taking, and whether those might increase your risk.

Abiraterone

If you’re taking abiraterone (Zytiga^®) tablets, you will also be taking a steroid called prednisolone or prednisone. Steroids cause some people to have a slightly higher risk of getting infections, but this will depend on the amount you are taking.

If you’re taking a steroid with abiraterone, you’ll only be having a low-dose steroid. This means the effect on your risk of getting infections should be small. We don’t yet know the effect that taking a low-dose steroid for a long time could have on your body’s ability to fight infections. Read more about steroids and coronavirus risk.

Enzalutamide

If you’re taking enzalutamide (Xtandi^®), this could affect the number of white blood cells in your blood. If this happens, you may be more likely to get infections, including coronavirus. Speak to your doctor or nurse if you’re concerned, and always contact your medical team at the hospital straight away if you have signs of an infection.

Steroids can affect the cells that help your body fight infections. This means they cause some people to have a slightly higher risk of getting infections, and can also lower the body’s response to existing infections. Whether or not this happens will depend on the dose of steroids you are taking.

Most men who take steroids as part of their prostate cancer treatment will be having a low-dose steroid. This means the effect on your risk of getting infections should be small. Check with your doctor or nurse if you’re not sure about your dose.

We don’t yet know the effect that taking a low-dose steroid for a long time could have on your body’s ability to fight infections. It’s possible that the effect on your immune system might increase over time, and you might become more likely to get infections. But we don’t know this for certain. If you’ve been taking a low-dose steroid for a long time and are worried about your risk of catching coronavirus, speak to your doctor or nurse.

Remember that if you’re taking a low-dose steroid while having chemotherapy, the chemotherapy itself will make your body less able to fight infections. You should follow the government’s guidance and stay at home for the next 12 weeks. You may hear this called ‘shielding’. It aims to protect those people who are at greatest risk of becoming very ill if they catch coronavirus. Always contact your medical team at the hospital straight away if you have signs of any infection, even if they are only mild.

If you’re taking a high-dose steroid, this could increase your risk of getting infections. You should avoid contact with other people as much as possible to reduce your risk of catching coronavirus.

The situation across the UK is changing from day to day. But where possible, GP surgeries and hospitals are continuing to provide routine tests as normal. This means that depending on the number of patients with coronavirus in your local area, your PSA tests may continue as planned.

If you are on hormone therapy and it is controlling your prostate cancer well, your doctor may decide to do your PSA tests every six months instead of every three months. This will only happen if your doctor thinks it is safe for you to have PSA tests less often. Talk to your doctor on the phone if you have any concerns.

If you usually have blood tests at your GP surgery, you will probably be asked to wait outside (for example, in your car if you have one). This is so that you don’t have to wait with other patients or spend very long inside the building.

In some areas, a nurse may be able to visit you at home to do blood tests – ask your GP surgery if this is an option.

If you usually have regular blood tests at the hospital, you may be able to have these at your GP surgery or at home instead. If the hospital hasn’t already contacted you to discuss this, call your medical team to ask if this is an option.

Standard hormone therapy treatments, including LHRH agonists, GnRH antagonists and anti-androgen tablets, won’t increase your risk of catching coronavirus, or of having more severe symptoms if you do catch coronavirus. This means it’s safe to continue having hormone therapy.

Your doctor may decide to change your hormone therapy so that you don’t have to visit your GP surgery or hospital as often. For example, if you usually have an injection every month or every three months, you may start having one every six months instead. This won’t affect how well your treatment works – six-monthly injections release the drug slowly over time and are just as effective as monthly or three-monthly injections.

If you’re worried about your hormone therapy being changed, speak to your doctor. They should be able to explain why they are changing it and reassure you that it is safe. You could also speak to our Specialist Nurses.

If you’re staying at home (self-isolating) or keeping away from other people (social distancing), you may feel worried or anxious about being on your own for some time. You may also find being away from your family or friends difficult or upsetting.

It’s a worrying time for everyone. It’s normal to feel anxious, stressed or even sad about what’s happening, especially if you have cancer. Remember, lots of people will be feeling this way too.

You can still talk to people on the phone or online, including your family and friends, health professionals and our Specialist Nurses. There are people who can help if you have a question or concern. You’re not on your own.

You can also use our online community to chat to other people in similar situations, share experiences, and ask questions. The online community is free and available to use any time.

It may also help to think about things you could do at home to keep busy while you self-isolate. You could try getting into a daily routine and keeping things as normal as possible. This may help take your mind off things. You may want to try some of the following tips:

• try to get washed and dressed every day, if you’re able to
• call your family, friends or neighbours to ask if they can pick up food and any prescription medicines you need – most people who are well will be happy to help if you ask
• drink plenty of water and eat a balanced diet
• keep active by doing some gentle exercises at home if it’s safe for you to do so, such as stretches, yoga, or light household chores or gardening
• write a list of jobs that need doing around your home, such as tidying a cupboard or doing some light DIY
• carry on doing things you enjoy at home, such as reading, baking or listening to music
• catch up with family or friends on the phone, by email or on social media – video calls can be particularly comforting when you’re on your own
• consider keeping a diary or planner, so that you remember to do activities that you enjoy every day.

Looking after yourself and keeping busy is important during this time. Try to stay connected to your friends and family – remember there are always people who can help, even if you’re on your own at home.

Charities such as Anxiety UK and Mind have more information on their websites about how to keep well if you’re self-isolating because of coronavirus.

Macmillan Cancer Support, Cancer Research UK and Maggie’s Centres also have information on their websites about coronavirus for people with cancer.

Many people are self-isolating (staying at home) at this time to avoid catching and spreading coronavirus. If you receive a letter from the government telling you to self-isolate for 12 weeks, you won’t be able to leave your house, even to buy food or collect medicines. You may hear this called ‘shielding’.

The letter is going to particular groups of people who are at risk of becoming very ill if they catch coronavirus. If you receive a letter, staying at home and avoiding contact with all other people will help to protect you against coronavirus.

If you live with a partner or family, they will be able to buy food and pick up any medicines you need. But they will have to follow expert advice on social distancing very carefully.

If you normally have a carer or nurse who comes to your house to give you medicines or other health care, this should continue as normal.

If you live on your own, or if the people you live with are also self-isolating, there are ways to get food and medicines safely.

• Ask family, friends or neighbours to do your shopping and pick up any medicines. They should leave these on your doorstep and stay at least 2 metres away from you.
• Contact your local pharmacy to see if a volunteer could drop off prescriptions for you.
• If you can, do your grocery shopping online. In the notes part of your order, write that you are self-isolating. The delivery driver will contact you to decide how best to deliver your groceries. You may also be able to order your groceries over the phone.
• Join local online communities, for example on Facebook – they may have local volunteers to help people who are self-isolating or shielding.
• Many areas now have groups of volunteers who would be happy to help – find your nearest local group on the COVID-19 Mutual Aid UK website.
• Contact charities, for example Citizens Advice or Age UK, to find out if they have any advice or local plans to help you get food and medicines.

If you can’t do online shopping or don’t have family, friends or neighbours that can help, contact your local council. They should be able to help you get groceries and medicines. If you live in England, register with your local council as an extremely vulnerable person to get the help you need. If you live in Wales, Scotland or Northern Ireland, contact your local council to find out how they can help.

If someone you don’t know calls and offers to pick up food or medicines, it’s best not to accept their help. Local councils have received reports of attempted scams, where a stranger offers to help buy food or medicines and then steals the person’s money. If you don’t have family or neighbours who can help you get groceries and medicines, contact your local council.

If you have to stay at home (self-isolate), you may be worried about money and unsure about the financial help available to you.

Citizens Advice has information on the help available to people self-isolating because of coronavirus. This includes information on:

• paying bills
• your rights if you rent your home
• statutory sick pay if you’re employed
• claiming benefits if you’re unemployed or self-employed.

If you currently use, or think you may need to use, a food bank, these are continuing to provide as much support as they can. The Trussell Trust and the Independent Food Aid Network have information about local food banks.

The government has advised British people to avoid all non-essential travel to other countries.

For the latest guidance and information on how to change or cancel your travel plans, visit the government website. You can also contact our Specialist Nurses for information and support.

Help us to support you at this time

We want to know from you how we can best support people affected by prostate cancer during the coronavirus outbreak. Please complete our short survey to let us know what support and information would help.