Uro-Oncology in Times of COVID-19: The Available Evidence and Recommendations in the Indian Scenario

Abstract: The Corona Virus Disease-2019 (COVID-19), one of the most devastating pandemics ever, has left thousands of cancer patients to their fate. The future course of this pandemic is still an enigma, but health care services are expected to resume soon in a phased manner. This might be a long drawn process and we need to have policies in place, to be able to fight both, the SARS-CoV-2 virus and cancer, simultaneously, and emerge triumphant. An extensive literature search for impact of delay in management of various urological malignancies was carried out. Expert opinions were sought wherever there was paucity of evidence, in order to reach a consensus and come up with recommendations for directing uro-oncology services in the times of COVID-19. The panel recommends deferring treatment of patients with renal cell carcinoma by 3 to 6 months, except for those with ongoing hematuria and/or inferior vena cava thrombus, which warrant immediate surgery. Metastatic renal cell cancers should be started on targeted therapy. Low grade non-muscle invasive bladder cancers can be kept on active surveillance while high risk non-muscle invasive bladder cancers and muscle invasive bladder cancers should be treated within 3 months. Neoadjuvant chemotherapy should be avoided. Management of low and intermediate risk prostate cancer can be deferred for 3 to 6months while high risk prostate cancer patients can be initiated on neoadjuvant androgen deprivation therapy. Patients with testicular tumors should undergo high inguinal orchiectomy and be treated according to stage without delay, with stage I patients being offered surveillance. Penile cancers should undergo penectomy, while clinically negative groins can be kept on surveillance. Neoadjuvant chemotherapy should be avoided and adjuvant therapy should be deferred. We need to tailor our treatment strategies to the prevailing present conditions, so as to fight and defeat both, the SARS-CoV-2 virus and cancer. Protection of health care workers, judicious use of available resources, and a rational and balanced outlook towards different malignancies is the need of the hour.

Authors: Tushar A Narain¹, Gagan Gautam², Amlesh Seth³, Vikas K Panwar¹, Sudhir Rawal⁴, Puneet Dhar⁵, Harkirat S Talwar¹, Amitabh Singh⁴, Jiten Jaipuria⁴, Ankur Mittal¹

Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Department of Uro-oncology, Max Super Specialty Hospital, Saket, India
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Department of Uro-oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Source: Narain, Tushar A., Gagan Gautam, Amlesh Seth, Vikas K. Panwar, Sudhir Rawal, Puneet Dhar, Harkirat S. Talwar, Amitabh Singh, Jiten Jaipuria, and Ankur Mittal. “Uro-Oncology in Times of COVID-19: The Available Evidence and Recommendations in the Indian Scenario.” Indian Journal of Cancer 57, no. 2 (April 1, 2020): 129.

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