Through COVID-Colored Glasses: New Perspectives on Same Data.

Before COVID-19, my recommendation for this man (at his first diagnosis) would have been moderately hypofractionated radiation therapy (RT) (70 Gy in 28 fractions) and short-term androgen deprivation therapy (ADT). With re-biopsy, I agree with the treatment option of RT and long-term ADT. I will admit to being a slow adopter of prostate stereotactic body radiation therapy for intermediate-risk disease, although with the HYPO-RT-PC trial’s publication, I have been offering it more frequently. I will also say that in my practice at a community hospital within an academic enterprise, serving a varied socioeconomic base including the surrounding rural counties, the patient tolerance for toxicity and novel treatments is low.

COVID-19 and the significant concern about exposure felt by my patients with cancer has changed my practice. First, I offer a longer delay between start of ADT and RT. Second, although I have generally been a proponent of elective nodal irradiation, I have foregone that coverage in all but a few select patients, and only after discussion with them about potential risks/benefits. Third, I have found patients more willing to try stereotactic body radiation therapy for the reduced number of visits, although I would not offer it for high-risk patients (underrepresented in HYPO-RT-PC, significant variability within the traditional National Cancer Comprehensive Network high-risk cohort such that I do not know yet which men can be treated with tight fields).

Our institutional policy has been to not test asymptomatic radiation therapy patients for SARS-CoV-2 unless they have a known exposure or high-risk living situation. That may have changed between this writing and publication owing to community spread or other updates.