Recommendations for Urological cancers During COVID19 Pandemic

Dear All,

We are all immersed with COVID19 as to Do’s and Don’ts Concerning Urological Disorders. AUA and few other organizations have produced Guidelines concerning this and these have been circulated and discussed in the two Webinars organized by USI.

The treatment for Urological Disorders is classified into three categories namely Delayed, Not so delayed and Emergency.

Urological Cancers, as are many diseases, do not wait for COVID19 to abate. These patients with or without COVID19 surfaces for treatment and it is our duty to adequately treat them irrespective of the Pandemic.

We are informed that certain procedures can be accepted for certain cancers depending on the stage of Presentation. I am providing an article with a table incorporated below on the recommendations to be followed regarding ‘Systemic Therapy in Patients with Urological Cancers during the COVID19 Pandemic’.

World over, with India no exception of late, we have become relatively obsessed regarding Prostate Cancer and give considerable attention concerning P Ca during the various stages of presentation. We as Urologists favour Radical Prostatectomy (now the preference is Robotic RP) as against other forms of treatment. A Radiation Oncologist will suggest RT in various avatars as against RP which we as Urologists cannot accept. We talk about the various toxicities associated with RT while the radiation Oncologists talk about the profound adverse events associated with RP. Recent articles on RT for P ca suggest that the long term results with RT is more or less same or even better when compared to RP. There are now some who mention that in most cases of P Ca, irrespective of stage, the appropriate definitive Treatments can be postponed by administration of ADT in the interim period.

The article I am providing is addressing the guidelines to be followed as regards RT in the era of COVID19.

If you peruse through the Guideline, many aspects mentioned can be accepted by Urologists as well in this era of COVID19 concerning treatment for P Ca.

Additionally, I am providing an Interview by Helen Moon with Samantha Kumar Pal and Sumeet K Bhanwadia on ‘Early Stage Operable RCC in Covid19 Era.

I am providing the table attached to the first two articles which will explains to what are being highlighted in the articles.

With warm Regards,



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  • Ravindra Sabnis
    Ravindra Sabnis
    22 Apr 2020 05:09:09 PM

    At present many guidelines are floating - every country has decided, how thy wish to go ahead. if every case is assumed to be +ve & take precautions accordingly, it is going to be huge financial burden. No hospital whether small, big or corporate will be able to sustain financially. Some where we shall have to compromise. My take on this issue, we will have to live with this problem. Whatever protection feasible, we take - which may be far from ideal - & continue to work. If wish to have full proof method, they we will not be bale to work for next 6 months. 

    Even if lock down is over, things are not going to change dramatically. let's be ready & work. We are in this profession & certain risks we have to take. Army people also when they go to war, they know what can be outcome. But still they work. 

  • Venugopal P
    Venugopal P
    22 Apr 2020 06:30:53 PM

    Dear All,

    I have posted yet another post Concerning P Ca and COVID19. Yes, I agree with Ravi that we have so many recommendations and Guidelines Choking us beyond our capacity to understand. But for those practicing and indulging in active treatment, as mentioned by Ravi soon, some of these recommendations could be useful to understand. I too believe that we will have work against much odds and take things in our strides as soldiers are bound to do.

    But as Doctors and Health workers we need peace to work and not keeping behind our back as to who is going to stab you.

    With warm Regards,


  • Venugopal P
    Venugopal P
    04 Jun 2020 08:22:25 AM

    Dear All,

    I had provided an article by the Italian Group of Urologists on ‘Urological Practice during COVID19 Pandemic’ and also the rapid guideline development manuscript prepared on behalf of European Urology.

    In my previous write ups, I had mentioned that in this present scenario, the needed guidelines to follow should be country specific (this is true even at other times) and have come out with the recommendations to be followed under Indian Scenario.

    In this recommendation, you will notice very little changes from the previous two materials provided. But the authors have put most facts in a clear perspective. The tables provided can give us the options to be followed at a glance and is welcome for all busy Urologists.;year=2020;volume=57;issue=2;spage=129;epage=138;aulast=Narain (PDF available)

    I would like to place another article that could assume importance is on ‘ADT therapies for P Ca and risk of SARS-CoV-2’. This hypothesis mentions that ADTs may protect patients affected by COVID19.

    Comparing the total number of COVID19 positive cases, Prostate Cancer patients receiving ADT had a significantly lower risk of SARS-CoV-2 infection compared to patients who did not receive ADT. In the recommendations provided, it is said that patients with P Ca could be offered ADTs but the reason why could be understood by this article.

    TMPRSS2 is an androgen-regulated gene implicated in the pathogenesis of prostate cancer. This gene is also involved in the lung effects of COVID-19). Men have been more severely affected by COVID-19 and speculation has surrounded higher levels of TMPRSS2 and higher androgen levels as a culprit. But the number of cases indicates that it is low to come to any definitive conclusion.

    But there are other studies ongoing as well. The Veterans Administration is studying Degarelix vs placebo in men admitted with COVID-19. Oestrogen therapy and oral bicalutamide vs placebo are also being studied. And Tom Beer and colleagues at OHSU are planning to test enzalutamide vs placebo in a pilot trial. This is based on the potential to down regulate TMPRSS2 in lung epithelium, but the actual science/data on this is very mixed and fairly negative. Most feel this is definitely worth trying in an era where very little can be offered to these patients with COVID19. If any of the ADT-COVID clinical trials spurred on by the data from Montopoli et al pan out, our use of ADT in the midst of the COVID pandemic may have been a good move for an unexpected reason!

    With warm regards,



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