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Systemic Therapy Considerations:

Risks and Resource Utilization cont.

Treatment Considerations

Corticosteroids • Consider avoiding or delaying treatments requiring corticosteroids, and
discontinuing those in progress 1
• Glucocorticoids should be minimized as an adjunct to systemic therapies;
use lowest effective dose 2

• Advice from WHO and CDC to avoid corticosteroids is based on concerns that viral replication might be prolonged
and clearance delayed (largely extrapolated from data on MERS-CoV and influenza) 3
• Currently no evidence that corticosteroid therapy in cancer patients increases the risk of COVID-19 infection or leads
to worse clinical outcomes in confirmed cases 3
• Benefit or detriment of corticosteroid use may be influenced by intended use, timing of use relative to viral infection,
dose, duration, and comorbidities
• The risk of viral infections at physiological steroid doses would appear low for patients with progressive prostate
cancer 3
Take Home Message:
• A risk-benefit analysis should be performed for each patient on the use of steroids in cancer care 3

1. Sante et Services sociaux Quebec. Recommandations pour la priorisation des patients en contexte de pandémie de COVID-19 – Volet Cancers urologiques. Apr.15, 2020.
2. Lalani A-K A, et al. Can Urol Assoc J 2020;14(5):E154-8.
3. Waterhouse JV, et al. Eur Urol. 2020;78. https://www.europeanurology.com/article/S0302-2838(20)30259-1/fulltext 21