Urology and precision medicine in the COVID-19 era

"As clinicians for patients requiring cancer care, we need to ensure that we are optimizing all precautions for both the elderly and for those with potential immunosuppression," writes Neal D. Shore, MD.

Dr. Shore, a member of the Urology Times Clinical Practice Board, is the medical director for the Carolina Urologic Research Center, Myrtle Beach, SC.

The COVID-19 global pandemic leaves specialty providers, like urologists, facing unprecedented decisions: we need to continue providing quality care to our patients while mitigating risks of spreading this highly infectious virus amongst our patients and health care team. Approximately 50-80% of urologists’ patients are of Medicare age, i.e. over 65 years old. As clinicians for patients requiring cancer care, we need to ensure that we are optimizing all precautions for both the elderly and for those with potential immunosuppression.

In the U.S., urologists are doing their best to abide by CDC recommendations for social distancing while still providing quality care for their patients. In my practice we have implemented the following:

• Temperature checks for all patients and staff member before entering the clinic

• Referring the appropriate patients to primary care with COVID-19 symptoms

• Postponing elective surgeries 30 to 60 days (we will reevaluate as more data is revealed)

• Postponing non-essential office visits and procedures

• Incorporating telehealth visits whenever possible

With the pandemic expanding, Medicare has relaxed telehealth requirements in order to communicate better with patients and improve reimbursement processes.  If you haven’t already, I urge all urologists to implement telehealth into their treatment practice as soon as possible. To learn more about Medicare’s expanded telehealth services, click here.

Thankfully, we can also utilize precision medicine tools to help us stratify and prioritize patients. Current prostate cancer biomarker tests are able to provide us with more precision in order to stratify high risk from low risk prostate cancer patients. While most of us are familiar with the use of biomarkers, the COVID-19 pandemic amplifies the potential value they bring to help identify which patient’s follow-up appointments might be postponed and which patients benefit from more immediate care. I compiled the chart below as a refresher on when each of these tests might apply to your patients and included important characteristics regarding office visits and laboratory choices.

In addition to the biomarkers providing risk stratification benefit, these tools are processed in independent laboratories, so they don’t add burden to larger, national labs. For example, when ordering ConfirmMDx, the information can augment your patients with a negative prostate biopsy to better explain whether or not they are at risk for having a missed clinically significant cancer, while completely avoiding an additional clinic visit.

These tools are provided to help inform and accelerate the prostate diagnosis and management decision-making process-a benefit that we can offer during this health care crisis.

By strategically deploying these available tests and other relevant resources, we can navigate our patient’s health care journey during these difficult times and alleviate burden on the health care system.

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