Imaging Prostate Cancer
Posted: Nov 01, 2018
POSTED: March 23, 2020
Dr. Susan Slovin, MD, PhD, is a medical oncologist specializing in prostate cancer immunology at Memorial Sloan Kettering Cancer Center in New York City.
Prostatepedia spoke with her recently about what coronavirus-19 means for prostate cancer patients.
What is your view of what's going on right now? Do you have any particular concerns or recommendations for prostate cancer patients?
Dr. Susan Slovin: This is a disease about which we know very little. We know what has happened in China and Europe, which has certainly put a major point of emphasis on trying to understand this disease and trying to protect the American public.
We have to take it very seriously, but I think we also need to have good sense. Running to the supermarket, hoarding, and worrying about toilet paper is not the way to exert your humanity to other individuals.
When we had 9/11, we were faced with a life or death situation as well. People came together and there was tremendous camaraderie. People were giving blood and blood products at the local blood donation center.
But now, we're faced with the unknown. We don't know what the enemy looks like. We know we're dealing with a microscopic entity that can hurt us when we least expect it, and that's really what's causing problems.
I've been very taken with the fact that many of my patients with metastatic prostate cancer continue to want to come see me in the clinic. They put their faith in us, and they continue to want treatment. We have tried to institute safeguards for them. If they don't need to come in or we're just doing a prostate-specific antigen (PSA) check, there's no urgency in doing it.
People who need treatment, including chemotherapy, have been continuing with their treatment. We're checking on them, we're making sure their blood counts are good, and we're providing growth factors to maintain their white blood cell count, particularly in patients who have a predisposition to their counts going down.
Our patient population is aggressive about their care. They understand the concerns that are out there and we've asked them all to be very forthright about any symptoms they've had. They have been concerned about whether or not they should come in, what care they should get locally, and blood tests. We're giving them guidance. I'm concerned that every now and then, there's the rare patient who may have smoldering symptoms related to influenza instead of any other medical condition including, but not limited to, the coronavirus, who may not be upfront with letting us know exactly what's going on.
I worry about our medical colleagues and nursing and administrative colleagues, all of whom participate in registering patients, checking them in, and bringing them into the laboratories. If patients are not forthcoming, we are all at increased risk. We've seen a couple of patients with issues but they didn't mention the issues because they really wanted to be seen. We as healthcare professionals, including phlebotomists, the people at the front desk, secretaries, and even the cleaning staff, are all at risk. Therefore, unless there is a true medical or oncologic emergency, no one has to be seen unless absolutely necessary.
We are looking forward to trying to bring telemedicine into the current evaluation system so that patients can be evaluated via computer. We use that for patients who may need to have intercurrent follow up. Our patients should understand that they need the attention that our staff can provide, but they also need to know that we're equally vulnerable. We're trying to accommodate all their wishes and keep them safe at the same time.
Are you saying that men are worried about missing out on their prostate cancer treatments and coming in without mentioning that they have flu-like symptoms?
Dr. Slovin: Not all patients, but some patients have been that way. Again, some people do not need to be seen, but some people are highly anal-retentive about their disease. They are very PSA-centric. And they may not be volunteering all of their current symptoms. It may not be related to coronavirus at all, but there needs to be a consideration for the staff as well. We want to know if you have any symptoms so we can take better safeguards against anything that you report to us.
We have safeguards built throughout the institution. Our primary focus is the patient. But you need doctors to take care of you.
How effective are these measures to protect healthcare workers?
Dr. Slovin: We're still seeing patients in clinic. We are fully staffed on the hospital floors, but we are trying to minimize the number of visitors that patients have so that we're not exposing visitors to patients who may be sick, and we're not bringing in any other sources of infection, even if it's not coronavirus. There are coronaviruses and rhinoviruses that cause the common cold. We worry about those equally.
The staff itself is on a staggered schedule so that we have coverage every day of the week. But if you can work at home, you are encouraged to do so. Those of us who have a certain clinic time to see patients will continue to see those patients, including new visits. Every patient will be called before their visit to ask if there are any intercurrent issues that we need to address, any symptoms that are flu-related or coronavirus-related. We give them the option of staying at home and having a teleconference or faxing blood work in, at which point we would return their call or come in. We are screening heavily. You can't guarantee that everybody's going to be forthcoming. But thankfully, most of our patients are.