27 August 2021
COVID-19 Vaccine and Prostate Cancer
Interview with Dr Jane Crowe, Prostate Cancer GP
Vaccination is highly recommended for people with cancer. People with malignancy are at increased risk from COVID-19, and cancer patients with COVID-19 can experience a more severe disease and have higher rates of hospitalisation and requirements for intensive care treatment1. The available vaccines do not contain live SARS-CoV-2, and do not pose an infectious risk to patients. The immune response to the COVID-19 vaccine in patients with cancer may be reduced, so other measures eg hand washing, social distancing and wearing face masks are still important to reduce risk of acquiring COVID-191.
To explore COVID-19 vaccination in men with prostate cancer, we interview Dr Jane Crowe, Prostate Cancer GP at the Australian Prostate Centre.
Is it safe for men with prostate cancer to get a COVID-19 vaccine?
It is safe for men with prostate cancer to go ahead and receive the COVID-19 vaccine. If they are on chemotherapy or immunotherapy, then it is recommended to speak with the oncologist first, in order to determine the best timing for them to receive of the vaccine in relation to their chemotherapy or treatment cycle.
If your patient is having a PET scan then it is recommended that the timing of the vaccine relative to the imaging is discussed beforehand with the treating specialist or nuclear physician and ensure the receipt of any recent vaccination is highlighted or communicated to the PET imaging team.
Does this advice change if they have metastatic disease?
If the patient has metastatic prostate cancer, then once again, it is important for them to receive the vaccine. As mentioned earlier, if they are currently undergoing treatment with chemotherapy then it is advised to speak with the oncologist first to sort out the best time to get the vaccine.
What about men who are on Androgen Deprivation Therapy (ADT)?
The vaccine is safe for men who are on androgen deprivation therapy.
Are there any additional risks or side effects from the AstraZeneca vaccine for men on ADT?
There are no additional risks for men on ADT receiving the vaccine.
The same “contraindications” apply:
- men who have anaphylaxis to Polysorbate (an ingredient to the AZ vaccine) or PEG (In the Pfizer vaccine).
Also, men who have the following rare medical conditions should avoid the AZ vaccine:
- Cerebral venous sinus thrombosis (clots in the veins in the brain)
- Heparin Induced thrombocytopenia (clots associated with the use of the drug Heparin + low platelets)
- Antiphospholipid syndrome with blood clots or miscarriage
- Blood clots in the abdominal veins
- Capillary leak syndrome (a very rare condition with severe swelling / oedema)
What about if a patient is on active surveillance for prostate cancer?
If a patient is on active surveillance, then there is no reason to not be vaccinated.
And if someone is undergoing radiation therapy?
If they are undergoing radiotherapy, then it possible there may be a skin reaction "radiation recall reaction”, if they have received radiotherapy before they have their vaccine. This reaction is usually mild and, if you they any concerns, should be directed to speak with their radiation team.
Any the any further resources or information you have to share on this topic?
Some helpful resources:
- For people affected by cancer- Not prostate cancer specific: https://www.canceraustralia.gov.au/affected-cancer/covid-19-and-cancer/covid-19-vaccines-and-cancer/FAQs -
- For people affected by cancer- Prostate cancer specific: https://www.prostate.org.au/news-media/news/covid-19-vaccines-and-prostate-cancer/-
- Information about obtaining consent: https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-consent-form-for-covid-19-vaccination-covid-19-vaccination-consent-form_2.pdf.
- Vaccine eligibility checker: https://www.health.gov.au/resources/apps-and-tools/covid-19-vaccine-eligibility-checker
- Melbourne Vaccine Education Centre advice for patients on chemotherapy or immunotherapy: https://mvec.mcri.edu.au/references/covid-19-vaccines-in-people-with-immunocompromise/
- A video from Prostate Cancer Foundation (USA) about COVID-19, Vaccines and Prostate Cancer https://www.pcf.org/covid-19/
Current ATAGI recommendations (as of 25/8/21):
Aged over 60 years- Astra Zeneca Vaccine
Aged under 60years ; Pfizer remains the preferred vaccine, due to the risk of a rare clotting disorder (TTS) associated with the Astra Zeneca vaccine. However, anyone from age 18-59 can receive the AstraZeneca vaccine if they have weighed up the risks and benefits of the AZ vaccine for their circumstances. Here is a link to a decision aid:
1 Melbourne Vaccine Education Centre https://mvec.mcri.edu.au/wp-content/uploads/2021/03/Clinicians-guide-to-COVID-19-vaccination-for-patients-with-cancer-version-1-19052021_-1.pdf.pdf
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