Medical Oncology

Genitourinary Cancers   

Questions discussed in this category


If no testicular mass on exam or ultrasound - is there a role for orchiectomy? What chemotherapy regimen would you use and how many cycles?

Is there a role for neoadjuvant cisplatin-based chemotherapy? Do patients with sarcomatoid histology respond to checkpoint inhibitors?

An ASCO 2020 poster from the German Testicular Cancer Study Group found that 37% of CSIS seminoma and nonseminoma were miscatagorized resulting in ina...

Should treatment be based on current histology (rhabdomyosarcoma) or origin (germ cell)?

There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.

Would you forego neoadjuvant chemotherapy? Are you using growth factor support differently? Any changes to immunotherapy? Other considerations?

Is there data and FDA approval for this indication? What about for nodal failure after radiation? 

There was an abstract in European J of Cancer (Srinivasan R, 2014:50: S6, P8) showing a good response rate with Bevacizumab and Erlotinib. Would you u...

How would a much higher risk cancer affect decision making? How would you treat him? 

Abstract 5014 at ASCO annual meeting 2019 showed superiority of PSMA-PET imaging over fluciclovine-PET imaging.  Are you utilizing these speciali...

In the SPARTAN trial, median PSA at study entry was ~ 7. Does the MFS benefit extend to patients with low PSA(< 2 or < 1)?

For instance, if the fluclicovine scan shows a few small avid nodes not only in the pelvis but extending to the paraaortic region, would you treat the...

NCCN include active surveillance as an option in specific circumstances based on Rini et al. (Lancet Oncology 2016) however this set is not well defin...

Would you treat with chemoimmunotherapy based on IMvigor130 data presented at ESMO Congress 2019?

e.g. lymph node metastasis, presence of tumor involving the peritoneal surfaces and/or the abdominal wall. If so, which regimen would you offer?

Based on the RADICALS-RT trial presented at ESMO, can RT be omitted in post op prostate patients in favor of salvage RT? If not which group of patient...

For example, is there any data to suggest a benefit to starting with immunotherapy prior to TKI or the alternative?

i.e. gross disease on scans that is too diffuse to be removed completely and/or decreasing but not normal markers Do you pursue close surveillance, s...

Specifically, would you consider utilizing sodium thiosulfate in adults based on the pediatric data from Brock et al. NEJM 2018?

How do you assess risk of tumor lysis syndrome, and is hydration sufficient or should hypouricemic agents be used as well?

No actionable mutation on NGS testing. What approved therapy do you prefer? Are there specific investigational agents currently in clinical trial...

What would be a safe dose for ifosfamide and how would you time with HD? Alternatively, would you recommend a different regimen? What about using neoa...

UpToDate indicates that VIP is an alternative to BEP for men who are not candidates for bleomycin, and that one criteria for not being such a candidat...

Patient has small cell carcinoma of the bladder with extensive hepatic metastases. Would you extrapolate the approach from IMpower133?

Should cystectomy remain standard of care? (Recently debated in JAMA Oncology: http://jamanetwork.com/journals/jamaoncology/article-abstract/2520055...

In a patient with a prior response to ADT and progression on taxane and platinum chemotherapy, would you consider AR directed therapy?

Would you give chemotherapy concurrently with radiation? Would you change your radiation dose?

Does the STAMPEDE trial, showing a survival benefit with the addition of docetaxel to standard treatment, change the standard of care for high risk, n...

Would you offer definitive management with radiation and ADT? Or systemic therapy alone such as with ADT+abiraterone?

ENZAMET and TITAN trials published at ASCO 2019 show benefit to both 2nd generation AR antagonists when compared to placebo but wondering how this wil...

Some considerations: -Cabozantinib (Based on CABOSUN trial, NCCN does not list this as a Category 1 recommendation)-Nivolumab + Ipilimumab (CheckMate...

Are there any patient and/or pathologic features that would lend you to considering IL-2 over other approved I/O or TKI therapies?

I have seen the question regarding treatment of non-clear cell RCC in general: https://www.themednet.org/question/3934. Is there any data or experienc...

Arterial events have clear instructions to permanently discontinue on the FDA label.  Especially in HCC without many other treatment options, giv...

In light of the data from ERA223 showing increased deaths and fractures with the combination of radium-223 and abiraterone compared to abiraterone alo...

A recent NCBD analysis (Rusthoven et al, JCO 2016) suggests that the addition of prostate RT significantly improves survival compared to ADT alon...

Treatment for small cell/neuroendocrine prostate is extrapolated from data on small cell lung cancer. It now appears that Carboplatin + Etoposide + At...

Are you directed by symptoms, PSA changes or do you have a standard schedule regardless of those factors?

Abstract LBA5_PR ‘Radiotherapy (RT) to the primary tumour for men with newly-diagnosed metastatic prostate cancer (PCA): survival results from S...

Prospective International Randomized Phase II Study of Low-Dose Abiteraterone with Food versus Standard Dose Abiraterone In Castration-Resistant Prost...

In a patient s/p orchiectomy and with pelvic lymphadenopathy, would you consider lymph node biopsy to confirm involvement by non-seminomatous germ cel...

Most of the studies have excluded non clear cell histologies. If you use a similar approach to clear cell, have you seen similar responses?

For which patients would you consider addition of apalutamide or enzalutamide? How do you decide between the 2 drugs?

The recent SPARTAN trial showed a remarkable improvement in metastasis free survival and many other secondary endpoints except the lack of significant...

NCCN recommends to change therapy or maintain current therapy in this setting without further clarification. What thresholds would cause a change in t...

What are the special considerations in the non-metastatic setting vs metastatic setting?

Testicular ultrasound, CT, and tumor markers are without abnormalities outside of the mass.

There are now five PD-1/PDL-1 inhibitors approved for metastatic bladder CA, one (Atezolizumab) as first-line therapy in cisplatin-ineligible patients...

What systemic therapy do you use? Do you incorporate any multi-modality therapies?

Would you initiate abiraterone or enzalutamide for the rising PSA or wait until the patient is symptomatic or has a new site of metastasis?

Pt previously treated with radical prostatectomy and adjuvant radiotherapy. If recommending therapy, what is the role of concurrent abiraterone + AD...

Based on new FDA approval of nivolumab plus ipilimumab in the first-line setting for intermediate- and poor-risk disease, would you give the combinati...

Could observation and serial cystoscopy be a reasonable option or is surgery necessary? If recommending surgery, can a procedure less than a nephroure...

Data reported by Motzer et al Lancet 2015 demonstrated a statistically superior PFS benefit of lenvatinib monotherapy over everolimus alone. In partic...

Recent evidence has been mixed, with no DFS or OS benefit in 1 trial (ASSURE, Haas et al, Lancet 2016) and DFS benefit in another (S-TRAC, Ravaud et a...

Given the apparently stronger results from KEYNOTE 052 (pembrolizumab) compared to IMvigor 211 (atezolizumab), would you consider pembrolizumab for pa...

The current treatment for bladder adenoCA is surgery. However in non-surgical candidates, RT is an option. Would you consider adding chemo ? Also woul...

If so, what chemotherapy regimen would you use? If not, what management options would you generally recommend?

Alternatively, would a biopsy of a metastatic bone lesion be preferred in a patient who has already progressed on chemo and hormonal therapy?

Given the FDA breakthrough therapy designation for olaparib in BRCA1/2 and ATM mutated mCRPC, when do you sequence mCRPC? Do you have a preferred...

Based on 2-3% MSH2 mutation and 1% MLH1 mutation rates in metastatic disease regardless of castration sensitivity, should we be looking for this earli...

If current systemic treatment is otherwise controlling the disease and is well-tolerated, is there value to locally aggressive therapy in an attempt t...

In patients with new bone pain and without any evidence of bone metastases receiving GnRH agonists, how do you manage pain symptoms?

Two recent studies show benefit to up-front abiraterone for metastatic castration-sensitive prostate cancer, although these studies used control arms ...

Are the results of the STAMPEDE trial presented at ASCO 2017 practice changing?

Given the non-specific nature of AFP and its elevation in various benign conditions, is there an AFP cutoff level or change over time for which you wo...

Which patients do you consider to be chemotherapy-ineligible for the sake of this treatment decision? How strong does the contraindication need to be?

What clinical considerations factor into your decision to choose leuprolide vs goserelin vs triptorelin vs degarelix, etc?

NCCN guidelines offer suggested schedules for interval imaging and laboratory studies, but also make it clear that the quality of evidence for these r...

What determines which you select first? How do concerns about cross-resistance factor in after progression on one of these agents?

To what extent do you worry about overlapping myelosuppression? Is there any advantage to overlapping therapy?

Is there a role for salvage LN dissection or salvage RT to the node? And is there a role for systemic therapy (ADT or chemotherapy) in addition? If yo...

Two retrospective studies from Stanford showed that patients who received ADT had an increased risk of dementia and Alzheimer's. Is this finding ...

Do you use a PSA threshold, PSA doubling time, or only evidence of metastatic disease to trigger ADT? For those without rapid doubling time, do you ev...

And how should we compare checkpoint inhibitors? Given the FDA approval of atezolizumab and nivolumab as second-line agents for metastatic urothe...

The Intergroup 0162 trial did not demonstrate noninferiority, although OS difference only 5.1 vs. 5.8 yrs.  Would pattern of spread affect your d...

When would you use surveillance versus repeat excision or adjuvant systemic or local therapy?

The CABOSUN trial showed a benefit in PFS and ORR, with unchanged OS, over sunitinib. 

In the setting of recent craniotomy and a plan for SRS to the surgical cavity, which systemic therapy would you choose and when would you&nb...

For a patient with a history of non-muscle invasive disease in the bladder, presenting with a prostatic urethra only recurrence, do you approach this ...

When do you offer trimodality bladder-sparing approaches? Is there any role for starting standard neoadjuvant therapy in an attempt to convert to rese...

Or in patients with metastatic disease on ADT who have not had primary therapy? In what situations do you consider palliative prostatectomy?

After confirming castration levels of testosterone, is the next best step to add docetaxel (as in CHAARTED and STAMPEDE, although not explicitly for G...

When are you concerned for a false positive? FDA guidelines include a suggestion to try another assay in case heterophile antibodies are causing a fal...

Radium-223 has an overall survival benefit and lower hematologic toxicity, but at a significantly increased cost.  Does the cost-effectiveness fa...

If so, at what point? McDermott et al. demonstrated some lasting responses after discontinuation of therapy (JCO 2015), but these responses are s...

How might a recent (within 6 months) myocardial infarction affect your recommendations?

For patients who developed oligometastases while off systemic treatment, do you start systemic therapy following local therapy or return to active sur...

Are there circumstances when you would choose IL-2 over checkpoint inhibitor trials or TKIs for fit patients? How should IL-2 be sequenced with these ...

In which circumstances should high-dose chemotherapy with autologous stem cell transplant be considered, versus second-line chemotherapy regimens or c...

Based on the abstract from IMvigor 210 presented at ASCO this year, are you offering atezo to patients who otherwise may not tolerate platinum-based c...

Based on a recent single-arm phase II trial, is there a role for paclitaxel, ifosfamide, and cisplatin (TIP) as a first-line regimen instead of BEP?

Given recent advancements in the understanding of biological differences in prostate cancer patients of African vs. other ancestry, does your manageme...

For patients who remain fit and interested in treatment, but for whom a clinical trial is not an option, what systemic therapy do you reach for in thi...

Only the mCRPC population was included in the Fizazi et al. study, but the FDA approval is for prevention of skeletal related events from any solid tu...

If so, how do you sequence this with other therapies?  In addition, in the absence of an effect on radiographic PFS or serum PSA, how do you asse...

In situations where there is a significant risk of either local or nodal persistence/recurrence post prostatectomy with a rising PSA, or nodal involve...

In the IMvigor 210 trial, increased PD-L1 expression in patients’ tumors was associated with response to atezolizumab, but some patients whose t...

A recent systematic review suggested that disease progression owing to a testosterone "flare" may not be a real phenomenon: http://www.ncbi.nlm.nih.go...

Since the benefit of neoadjuvant chemotherapy is well-defined in muscle-invasive bladder cancer, is it reasonable to consider this in upper-tract tumo...

The role of adjuvant docetaxel with ADT following RT for high risk disease has been previously elucidated by RTOG 0521.  Following prostatectomy,...

At the ASCO 2016 annual meeting, results of the PRINCE trial were reported. A strategy of intermittent docetaxel was found to be non-inferior to conti...

 In a patient with node positive disease, treated definitively with radiation, should continuous or intermittent ADT be administered? If a patien...

Typically radium-223 is reserved for men with symptomatic bone disease after failure of multiple other therapies.  Is there a population of men w...

Do you favor a short palliative regimen, or a full course definitive treatment to 64.8Gy? How does your management change if the patient has a good pe...

What factors should be considered with offering SBRT to oligometastatic bone disease in prostate cancer patients? Should this been done off of a proto...

Assuming a patient who could tolerate either, which is preferred? Does this depend on the choice for concurrent chemotherapy (5FU+mitomycin vs ci...


Papers discussed in this category


Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-04-10

Lancet, 2016 Mar 19

Eur. Urol.,

Radiother Oncol, 2006 Oct

Clinical cancer research : an official journal of the American Association for Cancer Research, 2015-09-01

Eur Urol, 2015 Jul 16

BJU Int, 2009 Feb

European urology, 2014-06

The New England journal of medicine, 2013-07-18

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-01-20

The New England journal of medicine, 2004-10-07

JAMA oncology, 2016-11-01

J. Nucl. Med., 2015 Jun 25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-04-01

Lancet Oncol., 2010-02-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-03-20

The Journal of urology, 2005-08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-06-20

The Journal of urology, 2002-09

Clinical cancer research : an official journal of the American Association for Cancer Research, 2009-01-15

Nature, 2005-12-08

J Clin Oncol, 1999 Jul

Lancet, 2015 Jan 3

The New England journal of medicine, 2001-12-06

Lancet, 2001-09-22

Breast Cancer Res. Treat., 2010-02-01

The Journal of urology, 1982-06

Cancer research, 2000-04-15

J. Clin. Oncol., 2009-04-01

Oncol. Rep., 2015-12-01

Nat Commun, 2015-04-01

PLoS ONE, 2016-01-01

J. Urol., 2002-04-01

European urology, 2018-02

Lancet, 2018 Oct 18

Indian J Urol,

The Lancet. Oncology, 2006-06

Lancet (London, England), 2016-05-07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-06-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-02-20

JAMA oncology, 2016-04

JAMA oncology, 2017-01-01

JAMA, 2009-08-26

European urology, 2015-05

JAMA, 2008-01-23

Clinical cancer research : an official journal of the American Association for Cancer Research, 2015-02-01

Journal for immunotherapy of cancer, 2015

Cancer immunology, immunotherapy : CII, 2016-08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1995-03

The cancer journal from Scientific American, 2000-02

Cancer immunology, immunotherapy : CII, 2016-12

Urologic oncology, 2015-11

Lancet (London, England), 2016-05-14

The New England journal of medicine, 2016-12-08

JAMA oncology, 2017-09-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-12-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-06-20

Canadian Agency for Drugs and Technologies in Health, 2016-10-31

Medicine (Baltimore),

Future Oncol, 2015 Oct 05

JCO Precision Oncology, 2017 May 31

The New England journal of medicine, 2016-08-04

Prostate cancer and prostatic diseases, 2014-09

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-02-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-08-20

The New England journal of medicine, 2017-03-16

The New England journal of medicine, 2018-04-12

The New England journal of medicine, 2018-06-28

European urology, 2012-04

European urology, 2014-07

N. Engl. J. Med., 2012-04-19

J. Urol., 2007-09-01

J. Clin. Oncol., 2006-05-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-07-10

The New England journal of medicine, 2015-08-20

Lancet (London, England), 2017-01-07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-06-10

N. Engl. J. Med., 2017-07-27

Oncology, 2013-01-01

PLoS ONE, 2015-01-01

Ann. Oncol., 2018 Feb 26

Urologe A,

J Clin Oncol, 1998 Nov

Nature medicine, 2017-06

Oncotarget, 2016-08-16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-02-20

Clinical genitourinary cancer, 2018-08

Urology, 2013-06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-06-10

Nat Rev Urol, 2014 Apr

Clinical cancer research : an official journal of the American Association for Cancer Research, 2013-07-01

N. Engl. J. Med., 2018 Jun 03

Nature, 2013-07-11

The New England journal of medicine, 2015-10-29

N Engl J Med, 2010 Jul 29

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-04-10

The Lancet. Oncology, 2016-03

European urology, 2016-05

Clinical genitourinary cancer, 2017-12

Prostate Int,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-05-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-05-10

Nat Rev Urol, 2017 Dec 12

The New England journal of medicine, 2017-07-27

Journal for immunotherapy of cancer, 2018-01-29

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-11-10

Annals of oncology : official journal of the European Society for Medical Oncology, 2013-04

The Lancet. Oncology, 2016-07

The New England journal of medicine, 2018-04-05

Ann. Oncol., 2013 Nov 04

Lancet Oncol., 2013 Jan 08

N. Engl. J. Med., 2019 Jun 02

N. Engl. J. Med., 2019 May 31

JAMA Oncol,

The Lancet. Oncology, 2019-03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-07-20

Br. J. Cancer,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1998-04

The New England journal of medicine, 2019-03-21

Urology, 2007-02

Case Rep Urol, 2013 May 08

BJU international, 2012-10

European urology, 2018-08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-12-20

Annals of oncology : official journal of the European Society for Medical Oncology, 2010-04

Eur. Urol., 2018 Jul 03

The New England journal of medicine, 2003-08-28

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-06-20

Lancet,

JAMA Oncol, 2018 Nov 1

Lancet, 2019 Apr 11

J. Clin. Oncol., 2017 Dec 14

Eur. Urol., 2019 Jul 19

The Lancet. Oncology, 2017-11

Ann. Oncol.,

J. Clin. Oncol., 2011 Dec 12

European urology focus, 2019-11

Obstet Gynecol, 2009-09-01

J. Clin. Oncol.,

Lancet, 2008 Dec 16

Lancet, 2011-12-17

Eur. Urol., 2016 Mar 17

J Thorac Oncol. , 2019 Oct 17

Eur Urol Oncol, 2019 Oct 08

Eur. Urol., 2019 Sep 26

Cancer, 2020 Feb 19

Eur. Urol., 2020 Jan 17

JAMA Netw Open, 2020 Feb 05

Chest, 1997-03

J. Clin. Oncol.,

Clin Genitourin Cancer, 2017 Sep 04

Eur. Urol., 2020 Jan 01

Journal of the National Cancer Institute, 2005-09-21

Eur. J. Cancer,

Br. J. Cancer, 2007 Jan 30

Clin Genitourin Cancer, 2019 Mar 13