I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Jeff M. Michalski brought up other scenarios we should consider and he brings some more good points:

Many patients could get active surveillance for a period of time before ADT is contemplated.

Patients with High Risk disease could take a longer course of neoadjuvant ADT without much consequence (Pisansky RTOG trial supports up to 7 months ADT).

In patients that need treatment now, shorter course radiation schedules should be considered as clinically indicated.

Again, for patients older than 60 and/or who have cardiovascular disease, diabetes, chronic respiratory disease, hypertension,... the mortality from COVID-19 will exceed any potential mortality from prostate cancer. Moreover, the numbers of years of life lost from dying of COVID-19 in the near future will greatly exceed those lost from delayed prostate cancer treatment which should be extremely small in the case of ADT use.

https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/

Lets break it down by risk group:

Very low/low risk: Should be put on active surveillance and return in 6 months for a PSA.

Favorable intermediate risk: Should be put on active surveillance for the current time and return in 3-6 months for a repeat PSA. Very good data that early on active surveillance is safe for these patients. A delay of 3-6 months is trivial for this population.

Unfavorable intermediate risk: There is actually data for Klotz on these men being put on active surveillance, and a delay in treatment of 3 months is unlikely to cause net harm. I would favor delaying ADT for 2-3 months, and then giving them the usual 2 months neoadjuvant ADT, which puts them out 4-5 months.

High risk: Treatment delays of 1 month minimal issue, and then can give neoadjuvant ADT for 2-4 months as needed. This puts them out 3-5 months. They could of course stay on ADT longer if the pandemic has not slowed by then.

Adjuvant RT: Should not be done right now, and favor early salvage RT.

Salvage RT: Should be based on PSA doubling time. If >6 months doubling time, no issue at all to wait 3-4 months to start. If needing ADT too, that can buy another few months. If PSA DT <6 months, I would start ADT and delay RT 3 months (or as needed).

Oligomets: No survival benefit demonstrated (yet) for PCa. I would observe unless very rapid doubling time and then can be put on ADT.

Low Volume M1 (tx of the primary): Can delay RT 4-6 months while on ADT if newly diagnosed.

As @Hiram A. Gay nicely laid out, this is the balance you must strike for each patient:

1. COVID risk of infection multiplied by risk of serious morbidity/mortality. 

So if a patient has a 5% risk of infection and 10% risk of death = 0.5% risk of coming into for RT. Or if the patient is young and healthy, if 5% risk of infection and 1% risk of death = 0.05% harm from COVID-19.

2. Harm in treatment delay. There is unfortunately variable data quality here. For many prostate cancers, there will not be a 0.5% harm in OS from delay of RT by a few months. However, for more aggressive tumors with rapid doubling time, there easily could be. This is where using ADT helps to counteract the delay. However...

3. Morbidity and mortality impact of unnecessary ADT. SPCG and RTOG 9601 showed that long-term ADT/anti-androgen worsened other-cause mortality by nearly 10%. So using too long or unnecessary durations of ADT could easily cause greater net harm than risk of COVID-19. We should not be giving unnecessary durations of ADT.

This balance must be recalculated/estimated for each patient based on their risk factors for each of the 3 points above.

Stay safe.

Best,

Dan

I agree with my colleague, @Hiram A. Gay. I would add that many patients for whom ADT is not necessary can be convinced to a more appropriate Active Surveillance strategy and avoid or delay ADT and XRT altogether. High risk patients can safely be treated with a longer interval of 'neoadjuvant' ADT before getting definitive XRT. Finally, when we do give radiation, we should resort to shorter courses of treatment, 28 or even 20 treatments as evidence supports.

I agree with my colleagues above. Our hypofractionation regimen is 7020 cGy/26 fractions to the prostate and prox SVs and 5200 cGy/26 fractions to the distal SVs and lymph nodes. As @Eddie Zhang referenced above, the 10 year results from our phase III clinical trial were just published in the JCO.

In regards to the delay of treatment question, we are continuing the ADT and delaying the start of radiation for our unfavorable intermediate risk and high risk patients. For the favorable and favorable intermediate risk patients, we are delaying the start of treatment based on the fact that they remain candidates for active surveillance. We are not using ADT for these patients.

For the patients who are in the middle of their radiation treatment, we are completing it without change.

Don't forget prostate SBRT in 5 fractions, every other day.

A commonly employed regimen is 8 Gy to prostate and 5 Gy to SV. Some series have even given 5 Gy to nodes for high risk patients. There have been thousands of patients treated with prostate SBRT now with excellent PSA control and low single digit grade 3 toxicities, like 1-2% late GI/GU. 

Yes, at the Lynn Cancer Institute we have delayed all non-essential starts and follow ups, including prostate and breast patients that are on hormonal therapy.

As per FAQ’s posted by ASTRO:

New patient consults and new patient starts may be triaged on a case-by-case basis according to the urgency of the situation following discussion with the multidisciplinary care team. Examples of non-urgent cases that may be delayed for up to two months include prostate cancer patients; certain breast cancer patients, e.g., hormone receptor positive; and benign CNS patients, such as meningiomas or schwannomas. Patients with benign conditions requiring immediate post op radiotherapy, such as keloids or heterotopic bone, should discuss rescheduling with their surgeon. Care must be taken to avoid delays in consultation and treatment which may adversely affect potentially curable cancer patients. Staff reductions may force longer delays in planning and/or scheduling. Palliative care patients may also experience delays, with the exception of life- or function-threatening situations, e.g., spinal cord compression, cranial nerve compression, superior vena cava syndrome, airway obstruction, hemoptysis.

For the full ASTRO guidelines see: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs

Yes.

This is all very important what has been discussed so far about prostate cancer, but how about addressing the original question of this post "stopping new starts of patients who can be triaged for 2-3 months LIKE prostate cancers on ADT" (=but NOT prostate cancers, but other cancers)? I need your input about how you triage and decide to delay if you do so, other cancer new starts. Like our surgical colleagues who are not doing elective surgeries, we need to broaden the discussion beyond prostate cancer; any of our patients should be managed as "elective" in the COVID-19 world we live in now? Thank you for your help.