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© Translational Andrology and Urology. All rights reserved. The ongoing COVID-19 outbreak is an unprecedented global challenge especially for patients within the high-risk groups such as those with cancer. Protecting fragile patients from COVID-19 infection and exacerbation is of utmost importance. One of the risks of exacerbation of the systems has been the use of some currently used medications such as non-steroid anti-inflammatory drug (NSAID) and steroids (1). Patients suffering from advanced cancer may be more susceptible to develop severe COVID-19 symptoms due to their potential cancer-related or treatment-related immunosuppressive state. Based on the available literature, the prevalence of COVID-19 infection seems higher in cancer patients compared to the general population (2%) resulting in a higher risk for severe respiratory events (39% vs. 8%) (2,3). Moreover, COVID-19 patients with immune deficit should be at higher risk for developing severe respiratory diseases (4). In the past decade, several new compounds targeting the androgen axis such as abiraterone acetate have been approved and recommended for the treatment of metastatic castrationsensitive prostate cancer (mCSPC) and metastatic castrationresistant prostate cancer (mCRPC) (5). Abiraterone acetate is a CYP17 inhibitor which is prescribed with prednisone (daily dose of 5 or 10 mg) in order to prevent drug induced hyperaldosteronism (5-7). However, the non-essential use of steroids has come under scrutiny during COVID-19 pandemic due to its potential immunosuppressive effect which could predispose patients to more severe infection. Thus, several panels of experts such as the Guidelines Office Rapid Reaction Group of the European Association of Urology (EAU) or the National Comprehensive Cancer Network (NCCN) have warned against the use of abiraterone acetate during the COVID-19 period and recommended alternative approved treatment options with the same level of evidence and approved for the same indications, such as enzalutamide (8,9). There has, unfortunately, not been any data presented to support this deviation from pre-COVID19 standard recommendations without precision about the rational and the different situations in metastatic prostate cancer (mPCa). Therefore, to understand rational for the recommendations we evaluate the data underlying it and to provide simple recommendations for the stewardships use of androgen receptor targeting agents in the management of mPCa during the COVID-19 pandemic.

How to deal with steroids use in the management of metastatic prostate cancer during pandemic