Risks from Deferring Treatment for Genitourinary Cancers: A Collaborative Review to Aid Triage and Management During the COVID-19 Pandemic

Abstract

Context: The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of many urologic cancers. Objective: To provide a contemporary picture of the risks from delayed treatment for urologic cancers to assist with triage. Evidence acquisition: A collaborative review using literature published as of April 2, 2020. Evidence synthesis: Patients with low-grade non-muscle-invasive bladder cancer are unlikely to suffer from a 3-6-month delay. Patients with muscle-invasive bladder cancer are at risk of disease progression, with radical cystectomy delays beyond 12 wk from diagnosis or completion of neoadjuvant chemotherapy. Prioritization of these patients for surgery or management with radiochemotherapy is encouraged. Active surveillance should be used for low-risk prostate cancer (PCa). Treatment of most patients with intermediate-and high-risk PCa can be deferred 3-6 mo without change in outcomes. The same may be true for cancers with the highest risk of progression. With radiotherapy, neoadjuvant androgen deprivation therapy (ADT) is the standard of care. For surgery, although the added value of neoadjuvant ADT is questionable, it may be considered if a patient is interested in such an approach. Intervention may be safely deferred for T1/T2 renal masses, while locally advanced renal tumors (!T3) should be treated expeditiously. Patients with metastatic renal cancer may consider vascular endothelial growth factor targeted therapy over immunotherapy. Risks for delay in the treatment of upper tract urothelial cancer depend on grade and stage. For patients with high-grade disease, delays of 12 wk in nephroureterectomy are not associated with adverse survival outcomes. Expert guidance recommends expedient local treatment of testis cancer. In penile

Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis

“…The COVID-19 outbreak provoked a dramatic disruption in cancer care around the globe, leading to delays in diagnosis, treatment and follow-up and to reductions in the intensity of cancer treatment. [18][19][20] Additionally, several recommendations on how to manage cancer care during the COVID-19 outbreak have been published by oncological societies and by national groups, but given the absence of evidence on this subject, they are only expert-based. [21][22][23] Therefore, our results have implications for clinicians and public health authorities and they may inform future recommendations about cancer care during the COVID-19 outbreak.…”

To defer or not to defer? A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic

“…In contrast, our study confirmed an increase in urological emergency cases, like ureteral stent-placement, but we noticed a distinct reduction of TUR-Bs and primary surgical treatment of testicular cancer. Especially for the latter, this was surprising, as the reduced OR capacity was a rather negligible aspect; an orchiectomy is a short operation which can be done in a same-day surgery setting [17]. More likely, patients postponed an urological consultation for macrohematuria or a testicular nodule due to fear of a SARS-CoV-2 infection [18].…”

Bladder Cancer at the time of COVID-19 Outbreak

“…LG NMIBC has a low cancer-specific mortality rate of around 1-2%, therefore, active surveillance is an appropriate management option (16). 1) low priority diagnostics can be deferred by 6 months; 2) intermediate priority, diagnosed before end of 3 months; 3) high priority, diagnosed within <6 weeks which include CT urogram and USS in patients with visible haematuria (VH) and cystoscopy in patients with VH without clots; 4) emergency, diagnosed within <24 hours which include TURBT in patients with VH and clot retention requiring bladder catheterization (15).…”