TABLE 2.

Prioritization of urologic cancer treatment during pandemic‐related limited access

Condition	Safe to Defer Therapy (Time)	Additional Considerations (strength of recommendation)	Surgical Urgencya
Prostate cancer
Low‐risk	Indefinite	Active surveillance may be changed to watchful waiting without biopsy	None
Intermediate‐risk	>6 months	No changes to the planned management	Low
High‐risk	Up to 6 months	May discuss alternative such as RT or ADT (week)	Intermediate
Very high‐risk	3‐6 months	May offer neoadjuvant therapy in select cases (moderate)	Intermediate
Kidney cancer
Small renal mass (≤4 cm)	>6 months	Surveillance; establish growth kinetics, using existing protocols (strong) Repeat imaging in 6 months	Low
Large renal mass (> 4 cm; T3) Asymptomatic	3‐6 months	Surveillance; establish growth kinetics. Repeat imaging in 3 months. Prioritize treatment if concerning growth rate > 0.7 cm/yr (strong)	Intermediate
Large renal mass symptomatic (bleeding, pain)	<2‐4 weeks	Renal or tumor embolization may allow additional time (week)	High
IVC tumor thrombus	<1 month	Prioritize Surgery	High
Metastatic	<1 month	Initiate systemic therapy (strong) Defer cytoreductive nephrectomy. Risk‐stratification, Response to therapy	Low
Bladder cancer
Newly diagnosed mass: TURBT		Deferred resection: Risk of hematuria, clot retention, ER visit or admission, increase resource utilization
Papillary, asymptomatic	1‐2 months		Intermediate
Solid, asymptomatic	1 month		Intermediate
Symptomatic (hematuria, pain)	Days	No alternatives	High
NMIBC: Radical cystectomy	2‐3 months	Longer delays associated with worse pathology and survival. Alternative intravesical agents may be tried (week).	Low
BCG‐refractory
T1, High‐grade
Asymptomatic
T1, High‐grade + CIS	1‐2 months	Longer delays associated with worse pathology and survival.	Intermediate
Symptomatic
MIBC: Radical cystectomy	2 months	NAC, with deferred surgery may be offered (week). Primary RT may be used if surgery is not desired (Intermediate). The facility should be isolated to mitigate the risk of Covid‐19 due to frequent visits.	Intermediate
Stage cT2
Cisplatin‐ineligible or
Increased risk of COVID‐19 (age, frailty, immunity)
Stage ≥ cT3	1‐2 months	NAC with deferred surgery, if resources available to mitigate Covid‐19 (strong).	High
Cisplatin‐ineligible		Otherwise, proceed with surgery.
After NAC for any stage	1‐2 months	Further delay can compromise survival benefit.	High
Upper tract UC
Low‐grade: Endoscopic	3 months	Initial endoscopic ablation should be thorough to reduce the need for multiple repeat procedure (strong)	Low
Symptomatic			Intermediate
High‐grade or large	<3 months	Initial treatment should be the most definitive (strong). Avoid repeat endoscopic procedures.	High
Nephroureterectomy
Partial ureterectomy
Testicular cancer
Testicular mass	2 weeks	Delays in orchiectomy associated with risk for metastasis and reduced cancer survival (strong)	High
Stage I	>3 months	Surveillance should be the primary management (strong). RPLND and chemotherapy should be avoided	Low
± High risk features
Stage ≥ II	<2 months	Defer primary RPLND. Encourage use of chemotherapy (strong).	Intermediate
Post‐chemotherapy Retroperitoneal Mass	<1 month	RPLND (strong). High‐risk for tumor progression and reduced cancer survival. <3 cm mass: observation, imaging is an option	High

The colors represent overall severity of the condition and the need for treatment, Green: least concerning; Yellow: Intermediate; Orange: most concerning. The strength of additional recommendation is given in parenthesis (weak; intermediate; strong)

Abbreviations: ADT: Androgen deprivation therapy; BCG: Bacillus Calmette–Guérin; HG: high grade; MIBC: Muscle‐invasive bladder cancer; NAC: neoadjuvant chemotherapy; NMIBC: Non‐muscle invasive bladder cancer; RT: Radiation therapy; TURBT: Transurethral resection of bladder tumor; UC: Urothelial cancer.

^aSurgical urgency defined as the need to perform surgery in <1 month: high; 2‐3 months: Intermediate; >3 months: low