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Systemic Therapy Considerations:

Risks and Resource Utilization

Treatment Considerations

Chemotherapy • Frequent hospital resource utilization 1

• Toxicities eg, neutropenia risk 1,2 – consider G-CSF support
• Higher risk for severe illness 3

• Consider reducing number of cycles or lengthening intervals 2

ARAT • Use home monitoring programs to avoid unnecessary hospital/clinic visits* 3
• For patients progressing on abiraterone, consider switch from prednisone to

dexamethasone to delay time to chemotherapy (Ph 2 SWITCH study) 3

ADT • Consider longer-acting depots, eg, q 3-6 monthly LHRH analogs †ǂ3,4
• Home injection programs 3

*Maintain ongoing awareness of transmission risks associated with local home care services. Canadian home care guidance can be found at: https://www.canada.ca/en/public-
health/services/diseases/2019-novel-coronavirus-infection/health-professionals/infection-prevention-control-covid-19-interim-guidance-home-care-settings.html
† Degarelix may still be indicated in men with contraindications to GNRH depot injections and/or who require rapid testosterone suppression because of symptomatic disease burden.
ǂ6-month formulations available in Canada include leuprolide acetate and triptorelin injectable suspensions.
ADT = Androgen deprivation therapy; ARAT = androgen receptor axis therapy; GNRH = gonadotropin-releasing hormone; LHRH = luteinizing hormone-releasing hormone.

1. Lalani A-K A, et al. Can Urol Assoc J 2020;14(5):E154-8.
2. Sante et Services sociaux Quebec. Recommandations pour la priorisation des patients en contexte de pandémie de COVID-19 – Volet Cancers urologiques. 2020 Apr.15.
3. Kokorovic A, et al. Can Urol Assoc J. 2020 Apr 28. doi: 10.5489/cuaj.6667.
4. BC Cancer. Provincial Cancer Clinical Management Guidelines in Pandemic Situation (COVID-19). 2020 Apr.20. 19