A significant drop in the screening, diagnosis and treatment of genitourinary cancers was observed during the early months of the COVID-19 pandemic. Hereafter, a progressive recovery was observed. Notably, the screening rate for prostate-specific antigen was reduced the most, whereas declines in cystectomies were relatively limited. This pattern reflects the triaging of care based on severity that was exercised during the COVID-19 pandemic [1]. Physician’s Weekly interviewed Dr. Chris Labaki (Dana-Farber Cancer Institute, MA, USA), who presented the findings of a study conducted by the Mass General Brigham System during the annual genitourinary cancer symposium of the American Society of Clinical Oncology’s Genitourinary Cancers Symposium (GU22), held in San Francisco, CA from 17-19 February 2022.

Dr. Labaki and colleagues investigated temporal changes in the screening, diagnosis, and surgical management of genitourinary cancers, including prostate cancer, urothelial carcinoma, and renal cell carcinoma. Variables regarding the screening, diagnosis, and surgical treatment of these cancer types were assessed during four 3-month periods between March 2020 and March 2021. These assessments were compared to four corresponding 3-month time periods in the pre-pandemic year. In total, 206,133 patients at the Mass General Brigham System were evaluated for this study.

A significant reduction in screening, diagnosis, and treatment modalities of genitourinary cancers was observed during the first 3 months of the COVID-19 pandemic. Initial declines in screening methods were the highest, with a 65.0% reduction in PSA screenings and a 55.0% reduction of cystoscopies. Decrease in treatment modalities, such as prostatectomy (-31.0%), nephrectomy (-39.0%) or cystectomy (-16.0%) were lower. These results reflect the triaging of care based on severity during this period. In addition, during the first 3-month pandemic period, reduction rates regarding the diagnosis of prostate cancer, renal cell carcinoma, and urothelial carcinoma were 31.0%, 31.0%, and 28.0%, respectively.

After the first 3-month period, progressive recovery of screening, diagnosis, and treatment modalities was observed. In the fourth 3-month pandemic period (December 2020-March 2021), the number of PSA screenings (+5.0%) and cystoscopies (+25.0%) exceeded pre-pandemic levels. In addition, the diagnosis of prostate cancer (+10.0%), renal cell carcinoma (+17.0%), and urothelial carcinoma (+6.0%) were recovered beyond pre-pandemic levels. A similar trend was observed for treatment modalities.

Physician’s Weekly spoke with Dr. Labaki in San Francisco at GU22 to discuss the findings and implications of this study with regard to kidney cancer.

Physician’s Weekly: Can you tell me about the research that you presented at ASCO-GU?

Our research group at the Mass General Brigham Network, Massachusetts, investigated the trends on cancer screening during the COVID-19 pandemic and how these trends evolved during pandemic times as opposed to pre-pandemic times. Our focus was on genitourinary malignancies, with renal cell carcinoma being one of the included malignancies. Since there is no standardized screening protocol for kidney cancer, the research group rather evaluated trends on the diagnosis and the surgical treatment of kidney cancer and how these modalities were evolving during the pandemic.

During the early pandemic, from March 2020 to June 2020, we observed a large decrease in genitourinary cancer screening. The reductions in kidney cancer diagnoses and performed nephrectomies were alarming. Fortunately, after June 2020 we observed a pattern of progressive recovery. Eventually, the number of kidney cancer diagnoses was even higher than before the pandemic, meaning that we’re capturing a higher number of kidney cancer cases than we expect to see in normal times. Logically, patients who weren’t diagnosed during the early pandemic were eventually presenting with potential symptoms of disease and were incidentally diagnosed with kidney cancer. The same pattern of progressive recovery was observed for the rate of nephrectomies.

Further investigations on nephrectomies in relation to the stage of diagnosis will follow.

Currently, we’re investigating whether we are capturing kidney cancer cases at a later stage or whether we are predominantly diagnosing early kidney cancers, which was the trend in pre-pandemic times. Also, we aim to investigate the association between incidental diagnoses of kidney cancer and the increased imaging related to COVID-19. Since hospitalized patients with COVID-19 receive renal imaging behind the lungs, this might explain the high recovery of kidney cancer diagnoses.

Physician’s Weekly: We know that up to 30% of the patients with COVID-19 experience acute kidney injury, which may lead to a higher prevalence of a risk category for kidney cancer development. Do you think that we will see an increase in the prevalence of kidney cancer due to this association?

COVID-19 impacts the kidney and could potentially be a risk factor for an increased prevalence of kidney cancer. However, with the current clinical knowledge, it is too early to confirm this hypothesis. Therefore, it is crucial to look at the rates and the prevalence of kidney cancer during the upcoming years. Then we will be able to tell whether COVID-19 is associated with a higher rate of kidney cancer diagnoses.

Physician’s Weekly: What is your advice for colleagues in clinical practice regarding COVID-19 and kidney injury?

For the general population it is important not to disregard minor symptoms that might be early indicators of severe disease. Patients with COVID-19 need to be vigilant for symptoms in particular, because there is an association of COVID-19 with kidney injury. Also, I would encourage physicians to monitor patients with COVID-19 and to not disregard minor symptoms. Otherwise, you might be missing something important. The COVID-19 pandemic has taught us that, in a small percentage of cases, minor symptoms could be something very serious. Identifying and interpreting these signs early and correctly is crucial in kidney cancer, as well as in other cancer types, because an early diagnosis is the key to an optimal prognosis.