Objective: To provide a contemporary picture of the risks from delayed treatment for urological cancers to assist with triage.
Evidence Acquisition: 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 weeks from diagnosis or completion of neoadjuvant chemotherapy. Prioritisation of these patients for surgery or management with radio chemotherapy 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 months without a change in outcomes. The same may be true for cancers with the highest risk of progression. With radiotherapy, neoadjuvant 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, whilst locally advanced renal tumors (≥T3) should be treated expeditiously. Patients with metastatic renal cancer may consider VEGF targeted therapy over immunotherapy. Risks for the delay in the treatment of upper tract urothelial cancer depend on grade and stage. For patients with high-grade disease, delays of 12 weeks to nephroureterectomy are not associated with adverse survival outcomes. Expert guidance recommends expedient local treatment of testis cancer. In penile cancer, adverse outcomes have been observed with delays of 3 months or more before inguinal lymphadenectomy. Limitations include a paucity of data and methodologic variations for many cancers.
Conclusions: Patients and clinicians should consider the oncologic risk of delayed cancer intervention versus the risks of COVID-19 to the patient, treating health care professionals, and the health care system.
Patient Summary: The COVID-19 pandemic has led to delays in treatment of patients with urologic malignancies. Based on a review of the literature, patients with high-grade urothelial carcinoma, advanced kidney cancer, testicular cancer, and penile cancer should be prioritized for treatment during these challenging times.
Authors: Christopher J.D. Wallis,1 Giacomo Novara,2 Laura Marandino,3 Axel Bex,4 Ashish M. Kamat,4,5 R. Jeffrey Karnes,6 Todd M. Morgan,7 Nicolas Mottet,8 Silke Gillessen,9 Alberto Bossi,10 Morgan Roupret,11,12 Thomas Powles,13 Andrea Necchi,3 James W.F. Catto,14 and Zachary Klaassen15,16
Affiliations:
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Royal Free London NHS Foundation Trust, UCL Division of Surgery and Interventional Science, London, United Kingdom
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
- Department of Urology, Mayo Clinic, Rochester, MN, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University hospital Nord, St Etienne, France
- Department of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland, and Università della Svizzera Italiana, Lugano, Switzerland
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
- Sorbonne University, GRC n°5, PREDICTIVE ONCO-URO, AP-HP, Urology, Pitié Salpetriere Hospital, F-75013 PARIS, France
- ESOU chairman, (European Section of Onco Urology) EAU
- Barts Cancer Center, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
- Department of Surgery, Division of Urology, Augusta University – Medical College of Georgia, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta, Georgia, USA
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