Coronavirus (COVID-19) and prostate cancer

19 May 2020

Below is some information about coronavirus (COVID-19) for people who have, or have had, prostate cancer and their loved ones, and for people who are worried they may have prostate cancer. This information aims to answer some of the questions you may have. You can also watch our Specialist Nurses discussing some common questions about prostate cancer and coronavirus.

We have also worked with NHS England and other UK cancer charities to develop information on coronavirus. If you live in Scotland, you may want to read the Scottish Government’s information on coronavirus for people with cancer.

As always, it’s important to follow the advice of your doctor, nurse or other people in your medical team. You can also contact our Specialist Nurses for information and support.

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

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If you’ve noticed changes in the way you urinate (wee), this is likely to be caused by a non-cancerous problem, rather than prostate cancer. The most common cause of urinary symptoms in men over the age of 50 is an enlarged prostate, which isn’t cancer and doesn’t usually need urgent treatment.

You should be able to get a phone appointment to discuss any symptoms with a GP. They’ll ask how long you’ve had symptoms – if they’ve started quite suddenly, you may have a urine infection that can be treated with antibiotics.

The GP will also check whether your symptoms could be caused by lifestyle changes. For example, if you’ve been drinking more coffee than usual, this could be irritating your bladder and making you urinate more often.

If your GP thinks you may have a prostate problem, they may offer you a PSA blood test at the GP surgery. If you have coronavirus symptoms, you’ll need to self-isolate at home for seven days before you can have the blood test.

Depending on your PSA level, the GP might suggest having another PSA test in the future to see if your PSA level changes. Or they may refer you to see a specialist at the hospital. If you’re given a hospital appointment, you may be asked to self-isolate for seven days before your appointment. This will make sure you don’t catch and spread coronavirus to other people at the hospital.

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

• chemotherapy
• 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 on 'shielding'. Shielding 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 spend at the hospital or GP surgery. For example, you will probably have phone or video call 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 stopped having one of the treatments listed above in the last three months, 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 stay at home as much as possible and follow the government's guidance on social distancing. This will help to limit your contact with other people, including friends and family, and reduce your risk of catching or spreading coronavirus.

For men with advanced prostate cancer that has spread to the lungs

If you have advanced prostate cancer that has spread to your lungs, this might increase your risk of becoming very ill if you catch coronavirus. If you haven’t received a letter from the government about shielding at home, speak to your medical team. They can help you decide whether or not to follow the government's guidance on shielding.

Surgery (radical prostatectomy)

If you’ve had prostate surgery in the last 6 weeks and are still recovering from the operation, stay at home as much as possible and follow the government's guidance on social distancing. This will limit your contact with other people and 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 severe illness 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.

Radiotherapy

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 severe illness if you do catch coronavirus.

However, if you’re going into hospital to have radiotherapy, 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.

Hormone therapy

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 severe illness 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

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 on shielding and stay at home. Shielding 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.

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

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 are making changes to ensure that people with cancer can be treated in places that are 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, 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.

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?

Having surgery for prostate cancer (radical prostatectomy) 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. Hospitals are making changes to ensure that people with cancer can be treated in places that are free from coronavirus. This means that your surgery may not happen at your usual hospital.

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, 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.

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.

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.

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 won’t affect your immune system.

If you are already having chemotherapy, talk to your doctor about whether you should continue having chemotherapy or change to a different treatment. Your safety will always be a priority in any discussions about changing your treatment.

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 illness 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.

If your doctor suggests stopping your hormone therapy and you’re not sure why, get in touch with our Specialist Nurses.

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. If you have coronavirus symptoms, you’ll need to self-isolate at home for seven days before you can have your blood test.

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.

When you’re talking to your doctor or nurse, you might find it difficult to take everything in. It can be particularly difficult having these discussions over the phone, rather than in-person with a health professional.

Usually, people with prostate cancer have face-to-face appointments with their hospital doctor or a specialist nurse. But recently, because of coronavirus, many people are having telephone or video calls instead. This is because visiting the hospital could put you at risk of catching coronavirus.

You may have a lot of questions, such as how coronavirus will affect your diagnosis, treatment or monitoring. You may also feel anxious about the future and how having prostate cancer will affect your life and your loved ones. It’s completely normal to feel like this. Everyone reacts differently when they have prostate cancer – there’s no right or wrong way.

It may help to think about some of the questions you want to ask your doctor or nurse. Write down your questions, as well as any concerns, thoughts or feelings, so that you remember to discuss them. You might find writing in a diary or a journal helpful.

Questions to ask your doctor or nurse might include:

• Will coronavirus affect which treatment I can have?
• Which treatments are currently available to me, and what are the side effects?
• Will there be a delay in starting my treatment?
• Will any delay affect how well my treatment works in the long term?
• Will I need regular blood tests and, if so, where and how often?
• Am I safe to go to hospital for my appointments?
• Can you reassure me that I’ll still get the monitoring and tests I need at this time?
• Who can I contact if I have questions or concerns, and will they have time to answer my questions?
• Where can I go for support?

If you’re planning a phone or video appointment, remember that 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.

When your doctor or nurse calls, you might find it helps to talk in a quiet or private room in your home. You may want to put the phone on speakerphone so that your partner or a family member can also listen to the call. If your loved one doesn’t live with you, you could ask if it’s possible to include them in the phone call as well.

It can also help to write down or record what’s said to help you remember or to listen again in your own time. You have the right to record what is said because it’s your personal data, but you should always let your doctor or nurse know that you are recording the conversation.

It might also help to keep a note of the names and contact details of the health professionals you speak to. This will help you remember who is involved in your care, and who to contact if you have any questions.

Make sure you take all the time you need to ask the questions you want. Just because you’re speaking on the phone doesn’t mean you have to rush the conversation. Your doctor or nurse will want to be sure you have all the information you need.

Remember, there’s always someone you can talk to for information and support. You could contact our Specialist Nurses on 0800 074 8383, or chat to them online. They can help you understand your diagnosis and treatment options. You can also ask them questions and talk through any concerns or worries you may have.

You might also find it helpful to order or download our publications or read more online. Or you can join our free online community to chat to others with similar experiences.

Many people have now been self-isolating for weeks or even months. If you’ve been self-isolating you may have started to feel bored, lonely, worried or anxious. You may be missing your family or friends and wondering how long the situation will go on for. Being away from your loved ones for a long time can be very difficult and upsetting. Remember, lots of people will be feeling this way.

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. If you have prostate cancer, you may be concerned about how the current situation will affect your treatment options and the medical care you receive.

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.

Many prostate cancer support groups are holding meetings online at the moment. You may want to look up your nearest support group and ask them about this. They should be able to help if you’re not sure how online meetings work.

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.
• Try breathing exercises or meditation if you feel anxious – there are lots of apps available to help you do these, some of which are free to use. Visit the NHS website for examples of apps for mental wellbeing.
• 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, Mind and CALM have more information on their websites about how to keep well if you’re self-isolating because of coronavirus. You can also visit The Help Hub, which supports people who are currently isolating. They have a free service where they can listen, help and support people who need it.

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

If you are 'shielding' at home, you shouldn't leave your house, even to buy food or collect medicines.

Shielding is recommended for particular groups of people who are at risk of becoming very ill if they catch coronavirus. 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 the government's guidance 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 staying at home, 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 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.

When someone close to you dies, it can be very upsetting and difficult to come to terms with. But now is a particularly difficult time to lose a loved one.

Feelings of grief and sadness may be even more difficult to deal with if you’re isolating because of coronavirus. If someone you love has recently died, you’ll probably be experiencing normal feelings of grief, as well as extra uncertainty, loneliness and even anger about not being able to see other loved ones at this time.

When someone dies, it’s natural to want your family and friends around you for comfort and support. For many people, being with others helps them manage their feelings and come to terms with their loss.

Funerals

You might not be sure if your loved one’s funeral can go ahead, or whether you can go to it. At the moment, funerals are still taking place. But only a small number of people can go – usually just immediate family and very close friends.

If you’re going to a funeral, you’ll need to keep at least 2 metres apart from anyone who doesn’t live with you. It’s common to hug or hold hands at funerals – so not being able to do this could be very difficult and upsetting.

If you’re not able to go to a funeral, you may be able to watch it online from your home, if the family decides to share it in this way. Some families may also have a memorial service or gathering at a later date, when everyone can be together and remember the person who has died.  

Getting support

If you can’t be with your family or friends for comfort and support, make sure you find other ways to stay in touch – for example regular phone calls, video calls or social media.

You can also call our Specialist Nurses on 0800 074 8383, or join our free online community. Remember, there’s always someone you can talk to.

You may also want to contact other organisations who specialise in helping people deal with loss and grief. Cruse Bereavement Care have information and a free helpline for anyone who is dealing with bereavement or grief. Sue Ryder has an online community where you can chat to others who are experiencing grief. Samaritans and Mind also have information and support if you’re finding things difficult to deal with.

Help us to support you at this time

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Our Specialist Nurses answer common questions