In the early part of the COVID-19 pandemic, many areas of the country banned nonessential medical procedures in an effort to slow the spread of the disease. As a result, many physicians saw fewer patients for routine medical care, such as physical exams and screenings. A recent survey by The Physicians Foundation polled 3,513 physicians and found 41% saw volume decreases of 26% or more in their practices.
The impact on cancer screenings was even more profound. For example, screenings for prostate cancer — one of the most commonly diagnosed cancers in men in the United States — dropped by 56% by the peak of the pandemic in April according to a recent study published in JCO Clinical Cancer Informatics. The study used a large medical claims clearinghouse database representing 5-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the U.S. cancer population.,
“Last year, we saw many patients deciding to either reschedule or completely forgo preventative care in our office to avoid the risk of COVID-19 infection,” said Neal Shore, M.D., F.A.C.S., Medical Director, Carolina Urologic Research Center. “There was also a noticeable decline in the number of prostate cancer screens we conducted which, as a physician treating men with this cancer on a daily basis, makes me concerned that prostate cancer may not be detected in its earlier stages when outcomes are typically better for the patient.”
In the case of localized prostate cancer, the five-year relative survival rate is estimated to be 100 percent after diagnosis, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) database. For advanced prostate cancer types, such as metastatic castration-sensitive prostate cancer (mCSPC), which is prostate cancer that has spread to other parts of the body and responds to treatment to lower testosterone or castration-resistant prostate cancer (CRPC), which is prostate cancer that no longer responds to treatment to lower testosterone, the outlook is not as good. According to the same SEER analysis, only about 30 percent of men diagnosed with mCSPC will survive five years post-diagnosis and other studies have shown that men with CRPC have a median survival of between 9 and 30 months., This contrast in survival outcomes highlights why early prostate cancer detection is so critical.
In advanced prostate cancer treatment, a goal is to slow the spread of cancer cells in the body. All men have hormones known as androgens (the most common androgen is testosterone), which can fuel prostate cancer growth. For those with metastatic CSPC and CRPC, physicians may prescribe a treatment called a novel hormone therapy. These therapies interfere with the connection between androgens and androgen receptors. This can help slow cancer cell spread. Novel hormone therapies are paired with another treatment called androgen deprivation therapy (ADT) which reduces the total amount of testosterone in the body. Together, these therapies work to slow the spread of prostate cancer.
XTANDI® (enzalutamide), a prescription treatment approved by U.S. Food and Drug Administration (FDA), is an example of one of these novel hormone therapies, and is just one potential treatment option that patients can discuss with their doctors. XTANDI is FDA-approved to treat three forms of advanced prostate cancer: mCSPC (prostate cancer that has spread to other parts of the body and responds to a hormone therapy or surgical treatment to lower testosterone), nmCRPC (prostate cancer that has not spread to other parts of the body and no longer responds to a hormone therapy or surgical treatment to lower testosterone) and mCRPC (prostate cancer that has spread to other parts of the body and no longer responds to a hormone therapy or surgical treatment to lower testosterone). XTANDI may cause serious side effects, including seizure, a condition involving the brain called Posterior Reversible Encephalopathy Syndrome (PRES), allergic reactions, heart disease, and falls and fractures, and more. See Important Safety Information below, and talk to your doctor or pharmacist.
“While my goal is to detect prostate cancer as early as possible, this does not always happen, particularly with ongoing concerns around COVID-19 delaying periodic check-ups,” continued Dr. Shore. “When a man does present with or progress to mCSPC or CRPC, there are treatment options like XTANDI they can discuss with their healthcare providers.”
While COVID-19 continues to be a concern for many men across the country, organizations like the American Cancer Society recommend talking to your provider who can discuss whether screening is recommended and help balance the risk and benefits of being screened now or postponing. To learn more about prostate cancer and XTANDI, visit https://www.xtandi.com/.
What is XTANDI?
XTANDI is a prescription medicine used to treat men with prostate cancer that:
- no longer responds to a hormone therapy or surgical treatment to lower testosterone
- has spread to other parts of the body and responds to a hormone therapy or surgical treatment to lower testosterone
It is not known if XTANDI is safe and effective in females or children.
Important Safety Information
What should I tell my doctor before taking XTANDI?
Tell your doctor about all your medical conditions, including if you:
- Have a history of seizures, brain injury, stroke, or brain tumors.
- Have a history of heart disease, have high blood pressure, or have abnormal amounts of fat or cholesterol in your blood (dyslipidemia).
- Are pregnant or plan to become pregnant. XTANDI can cause harm to your unborn baby and loss of pregnancy (miscarriage).
- Have a partner who is pregnant or may become pregnant.
- Males who have female partners who are able to become pregnant should use effective birth control (contraception) during treatment with XTANDI and for 3 months after the last dose.
- Males must use a condom during sex with a pregnant female.
- Are breastfeeding or plan to breastfeed. It is not known if XTANDI passes into your breast milk.
- Take other medicines. XTANDI may affect the way other medicines work, and other medicines may affect how XTANDI works. These include prescription and over-the counter medicines, vitamins, and herbal supplements. Do not start or stop any medicine without talking to your doctor.
How should I take XTANDI?
- Take XTANDI exactly as your doctor tells you. Take your prescribed dose once a day, at the same time each day. XTANDI can be taken with or without food. Swallow XTANDI capsules or tablets whole. Do not chew, dissolve, or open the capsules. Do not cut, crush or chew the tablets. Your doctor may change your dose if needed.
- Do not change or stop taking your prescribed dose of XTANDI without talking with your doctor first.
- If you are receiving gonadotropin-releasing hormone (GnRH) therapy, you should continue with this treatment while taking XTANDI unless you have had surgery to lower the amount of testosterone in your body (surgical castration).
- If you miss a dose of XTANDI: Take your prescribed dose as soon as you remember that day. If you miss your daily dose, take your prescribed dose at your regular time the next day. Do not take more than your prescribed dose of XTANDI each day.
- If you take too much XTANDI: Call your doctor or go to the nearest emergency room right away. You may have an increased risk of seizure if you take too much XTANDI.
What are the possible side effects of XTANDI?
XTANDI may cause serious side effects including:
- Seizure. If you take XTANDI, you may be at risk of having a seizure. Avoid activities where a sudden loss of consciousness could seriously harm you or someone else. Tell your doctor right away if you lose consciousness or have a seizure.
- Posterior Reversible Encephalopathy Syndrome (PRES). If you take XTANDI you may be at risk of developing a condition involving the brain called PRES. Tell your doctor right away if you have a seizure or quickly worsening symptoms such as headache, decreased alertness, confusion, reduced eyesight, blurred vision or other visual problems. Your doctor will do a test to check for PRES.
- Allergic Reactions. Allergic reactions have happened in people who take XTANDI. Stop taking XTANDI and get medical help right away if you develop swelling of the face, tongue, lip or throat.
- Heart Disease. Blockage of the arteries in the heart (ischemic heart disease) that can lead to death has happened in some people during treatment with XTANDI. Your doctor will monitor you for signs and symptoms of heart problems during your treatment. Call your doctor or go to the emergency room right away if you get chest pain or discomfort at rest or with activity or shortness of breath during your treatment with XTANDI.
- Falls and Fractures. XTANDI treatment may increase your risk for falls and fractures. Falls were not caused by loss of consciousness or seizures. Your doctor will monitor your risks for falls and fractures during treatment with XTANDI.
Your doctor will stop treatment with XTANDI if you have serious side effects.
The most common side effects of XTANDI include:
- Weakness or feeling more tired than usual
- Back pain
- Hot flashes
- Joint pain
- Decreased appetite
- High blood pressure
XTANDI may cause fertility problems in males, which may affect the ability to father children. Talk to your doctor if you have concerns about fertility.
These are not all the possible side effects of XTANDI. For more information, talk to your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
This article is sponsored by Astellas.
 Patt D, Gordan L, Diaz M, et al: The Impact of COVID-19 on cancer care: How the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform 2020;4:1059-71.
 Kirby M, Hirst C, Crawford ED. Characterising the castration-resistant prostate cancer population: a systematic review. Int J Clin Pract 2011;65(11):1180-92. doi: 10.1111/j.1742-1241.2011.02799.x. PMID: 21995694.
 American Society of Clinical Oncology. ASCO Answers: Prostate Cancer (2018). http://www.cancer.net/sites/cancer.net/files/asco_answers_guide_prostate.pdf. Accessed 09-02-2020.