Urologic oncology practice during COVID-19 pandemic: A systematic review on what can be deferrable vs. nondeferrable

•The global COVID-19 pandemic has caused the majority of surgical procedures, including curative urologic oncology cases, to be postponed.•Few high-priority diseases, such as MIBC, high-grade UTUC, large renal masses (≥T3), testicular, and penile cancer, cannot have significant surgical deferrals without affecting oncologic outcomes.•A trial of NAC in MIBC and high-grade UTUC may be an acceptable alternative to immediate surgery, but increased risk of morbidity and mortality due to an immunocompromised state should be considered. To provide a review of high-risk urologic cancers and the feasibility of delaying surgery without impacting oncologic or mortality outcomes. A thorough literature review was performed using PubMed and Google Scholar to identify articles pertaining to surgical delay and genitourinary oncology. We reviewed all relevant articles pertaining to kidney, upper tract urothelial cell, bladder, prostate, penile, and testicular cancer in regard to diagnostic, surgical, or treatment delay. The majority of urologic cancers rely on surgery as primary treatment. Treatment of unfavorable intermediate or high-risk prostate cancer, can likely be delayed for 3 to 6 months without affecting oncologic outcomes. Muscle-invasive bladder cancer and testicular cancer can be treated initially with chemotherapy. Surgical management of T3 renal masses, high-grade upper tract urothelial carcinoma, and penile cancer should not be delayed. The majority of urologic oncologic surgeries can be safely deferred without impacting long-term cancer specific or overall survival. Notable exceptions are muscle-invasive bladder cancer, high-grade upper tract urothelial cell, large renal masses, testicular and penile cancer. Joint decision making among providers and patients should be encouraged. Clinicians must manage emotional anxiety and stress when decisions around treatment delays are necessary as a result of a pandemic.