Delaying Cancer Cases in Urology during COVID-19: Review of the Literature

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) is a global pandemic affecting hospital systems and the availability of resources for surgical procedures. Our aim is to provide guidance for urologists to help prioritize urological cancer surgeries. Materials and Methods: We reviewed published literature on bladder cancer, upper tract urothelial carcinoma, penile cancer, testis cancer, prostate cancer, renal cancer and adrenal cancer. Results: For muscle invasive bladder cancer delays should be less than roughly 10 weeks and neoadjuvant chemotherapy should be considered. Patients with nonmuscle invasive bladder cancer should be counseled appropriately based on risk and intravesical therapies can continue. Upper tract urothelial carcinoma should also be treated with minimal delays for high risk patients, especially with ureteral tumors. Surgery for T1 renal cancers when indicated can be delayed until adequate resources are available. Patients with T2 renal cancer should be considered for early surgery if there are unfavorable preoperative characteristics. Higher stage renal tumors should be considered for early surgery. An early multidisciplinary approach is recommended for metastatic renal cancers. High risk prostate cancer may need preferential treatment and consideration of neoadjuvant hormonal therapy. Penile cancer can have worse sexual or oncologic outcomes with prolonged surgical delay. Likewise, adrenal cancer is aggressive and needs early surgical treatment. Testicular cancer should be treated in a timely manner with surgery or chemotherapy, as indicated. Conclusions: This review should further assist urologists in recognizing patients with potentially aggressive tumor biology that warrants early treatment.

Cancer management during the COVID-19 pandemic: Choosing between the devil and the deep blue sea

“…Several articles have provided insight into how practitioners should approach this difficult dilemma accordingly to each cancer histology. Suggestions and guidelines are available for head and neck, sino-nasal, spinal, breast, upper tract urothelial, cervical, penile, testicular, pancreatic, kidney, gastric, colorectal, skin, adrenal, liver, prostate, ovarian, endometrial, bladder and endocrine cancer ( Cohen et al, 2020 ; Baumann et al, 2020 ; Werner et al, 2020 ; Tarantola et al, 2013 ; Catanese et al, 2020 ; Vecchione et al, 2020 ; Turri-Zanoni et al, 2020 ; de C. Zequi and Abreu, 2020 ; Gravas et al, 2020 ; O’Leary et al, 2020 ; Casco et al, 2020 ; Katims et al, 2020 ; Berjano et al, 2020 ; Kapuria et al, 2020 ; P. March 25 and 2020, 2021 ; Tachibana et al, 2020 ; Loveday et al, 2020 ; Jones et al, 2020 ; Villani et al, 2020 ; Fligor et al, 2020 ; Sanchez et al, 2020 ; Wallis et al, 2020 ; Topf et al, 2020 ; Matsuo et al, 2020 ; Colombo et al, 2020 ; Campi et al, 2020 ; Raghavan et al, 2020 ).…”

Effect of Covid-19 pandemic on the progression of bladder cancer patients

“…It is known that COVID-19 is a highly contagious disease that can cause respiratory problems that may require intensive care and ventilator support and can result in death. In the period of COVID-19, due to epidemiological factors and high hospitalizations, elective surgeries were canceled and emergency and oncological surgical procedures were prioritized in order to maintain the capacity of health systems to meet expected cases and to avoid unnecessary exposure to COVID-19 6 . However, despite this priority, some oncology patients have delayed or completely canceled their treatment during the pandemic process.…”

“…In this context, it was reported that cancer treatment services were partially or completely interrupted in 42% of the 155 countries examined by WHO 7,8 . COVID-19 has also significantly changed the management of urological cancers 6 . It is known that delay in surgical intervention in MIBC, which is one of the urological cancers, significantly reduces the life expectancy of the patient 9,10 .…”

“…Measures taken in health systems such as the reduction of elective services and diagnostic screening during the pandemic period, recommendations for patients to stay at home, and patients' desire to avoid exposure to a hospital environment have also caused delays in patients' reaching the physician and in diagnosis 6,11 . Wallace et al reported that at the time of bladder cancer diagnosis, the time from the onset of symptoms to the hospital visit of more than 14 days was associated with survival and that these patients had 5% worse survival outcomes at 5 years compared to those who did not experience a delay 6,12 .…”

COVID-19 im urologischen Alltag

“…Prognose zu rechnen ist, gibt es beim in-vasiven Urothelkarzinom der Blase und des oberen Harntrakts Untersuchungen, die zeigen, dass eine Aufschiebung der Zystektomie oder Nephroureterektomie mit einer Verschlechterung des Gesamtüberlebens einhergeht. Bei anderen Tumoren wie dem Prostatakarzinom kann durch eine Androgendeprivation ein längeres Intervall bis zu einer Operation erreicht werden[6].Urologe https://doi.org/10.1007/s00120-021-01451-6 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021…”