Diagnosed with Prostate Cancer during COVID — how has treatment changed

How Prostate Cancer Treatment Has Changed Since COVID

That's an excellent question, and the timing of your diagnosis actually puts you in a position to benefit from significant advances that have accelerated during and after the pandemic. Let me walk you through the major shifts.

The Big Picture: Treatment Has Become More Aggressive and Personalized

According to the CancerPatientLab webinars featuring leading prostate cancer experts like Andrew Armstrong and Oliver Sartor, MD, the field has moved toward treatment intensification — meaning doctors are now hitting prostate cancer harder and earlier with combination therapies rather than using single drugs sequentially.

Key Changes Since COVID:

1. Earlier Use of Powerful Combination Therapies

• Before COVID era: Doctors typically started with one hormone therapy, waited to see if it worked, then switched to another drug when resistance developed
• Now: For metastatic (spread) prostate cancer, doctors combine multiple drugs from the start — for example, androgen deprivation therapy (ADT) PLUS chemotherapy (docetaxel) PLUS newer hormone blockers like abiraterone, enzalutamide, or apalutamide together (called "triplet therapy")

This approach works better because hitting cancer hard early, when there's less genetic diversity in the tumor population, is more effective.

2. Expansion of Precision Testing According to Andrew Armstrong's guidance, most men in community practices still aren't getting adequate genetic testing. However, the field has dramatically expanded what's available:

• Germline testing (your normal DNA) — looking for BRCA mutations, ATM mutations, and other DNA repair defects
• Tumor testing — identifying specific mutations that predict which drugs will work
• Liquid biopsies — blood tests that can detect circulating tumor DNA and biomarkers like AR-V7

These tests help match you to the right treatment rather than using trial-and-error.

3. New Drug Classes and Combinations

Several newer treatment options have become standard:

• PARP inhibitors (olaparib, talazoparib) — especially for patients with BRCA mutations or other DNA repair defects. These block the cancer cell's ability to fix damaged DNA
• Radiopharmaceuticals — like lutetium-177 (Pluvicto), a radioactive particle that targets PSMA (a protein on prostate cancer cells). About one-third of patients have excellent responses
• Immunotherapy combinations — checkpoint inhibitors like pembrolizumab (Keytruda) are being combined with other therapies
• Bipolar Androgen Therapy (BAT) — cycling high and low testosterone levels, which works for about two-thirds of patients

4. Better Imaging and Monitoring

• PSMA PET scans (which specifically light up prostate cancer cells) have become more widely available
• FDG-PET scans help identify different types of prostate cancer (like neuroendocrine variants)
• Doctors are getting better at detecting early recurrence and oligometastatic disease (a few spots of cancer that can be targeted with radiation)

What This Means for Your Situation

The critical question is: What stage is your prostate cancer?

According to Oliver Sartor's framework, treatment depends on two dimensions:

• Localized (only in the prostate) vs. Metastatic (spread beyond)
• Castrate-sensitive (responds to hormone therapy) vs. Castrate-resistant (continues growing despite low testosterone)

Questions to Ask Your Oncologist:

1. Have I had comprehensive genetic testing — both on my tumor tissue AND germline (blood) testing? If not, why not?

2. What is my specific stage and risk category? This determines whether I'm a candidate for active surveillance, surgery, radiation, hormone therapy, chemotherapy, or combinations.

3. If my cancer is metastatic, are we using combination therapy from the start? (Rather than sequential single drugs)

4. Have we discussed PSMA imaging to better understand where my cancer is located? This can open up treatment options like Pluvicto or targeted radiation.

5. What biomarkers does my tumor have, and how do they guide treatment selection? (For example, BRCA mutations point toward PARP inhibitors; AR-driven disease points toward AR inhibitors)

6. What's the plan for monitoring treatment response? Modern approaches use PSA, imaging, and sometimes liquid biopsies — not just one marker.

The COVID Context

Interestingly, the pandemic actually accelerated some of these changes. According to Andrew Armstrong's observations, COVID disrupted screening, which means more men are presenting with advanced disease at diagnosis. This has pushed the field to develop better tools for managing metastatic disease earlier.

However, it also means if you were diagnosed during COVID, you may have had delayed care or limited access to specialized centers. This is worth discussing with your current oncologist — you may benefit from a second opinion at a comprehensive cancer center if you're not already being treated at one.

Bottom Line

Prostate cancer treatment in 2024 is substantially more sophisticated than it was in 2020. The shift toward:

• Combination therapies from the start
• Precision genetic testing to guide drug selection
• Newer drug classes (PARP inhibitors, radiopharmaceuticals, immunotherapy combinations)
• Better imaging and monitoring

...means your treatment options are likely better than they would have been a few years ago.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.