Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Is long term ADT now the standard of care with salvage prostate bed RT?
The dreaded hormone question...After 40 years of embarking on extremely well designed randomized trials, we still are confused about the who, what, when of ADT. Will RTOG 9601 create a new care standard? As @Dr. First Last said, I think we will see increased utilization. I have been using bicalutami...
Is there any evidence that ivermectin suppresses the PSA level in prostate cancer?
Is this even the right question, though? ADT drops PSA very reliably and yet does not cure patients. Finasteride suppresses PSA, but we do not use it as a mainstay of cancer treatment. Even if ivermectin *did* suppress PSA, unless there is a meaningful oncologic benefit (*at least* reduced recurrenc...
What is the optimal duration of ADT in high-risk prostate cancer treated with RT+ADT?
Nabib et al. presented "Final Results" of the 18 vs. 36 month ADT trial for high-risk M0 prostate cancer in Chicago during ASCO 2017. This trial has the potential to be practice changing, since most men receive 2+ years of ADT during RT-ADT for high-risk disease. 630 patients were randomized and OS ...
For muscle invasive bladder cancer, after neoadjuvant chemotherapy with cis/gem and surgery with residual tumor and lymph node involvement, would you consider adjuvant avelumab as an extrapolation base on the JAVELIN 100 results?
I would not use adjuvant avelumab following radical cystectomy finding residual high risk disease after neoadjuvant chemotherapy. Biologically, this group has disease resistant to neoadjuvant chemotherapy, and is not akin to those with stable or responding disease following platinum therapy included...
For post-prostatectomy radiation, are there any special considerations if there is a bladder sling or artificial urinary sphincter? How long would you wait post procedure?
Great question. I have treated patients with artificial sphincters and penile prosthesis, and the thing I noted was one of the most important thing to do: document the urinary status of his function. I can say that for the most part I typically saw my patients after they have developed PSA progressi...
Do you routinely use hemostatic agents in the renal defect after a partial nephrectomy?
Yes. I routinely employ Surgiflo/Floseal at the base of the defect. After the initial running sutures within the defect, I perform early unclamping and oversew any persistently bleeding arteries. Then I place the renorrhaphy sutures as part of the sliding clip technique, and use Surgiflo/Floseal at ...
Which patients would you treat with relugolix instead of injectable GnRH agonist therapy?
I would consider relugolix for patients with: 1. Intermediate-risk prostate cancer that needs a short course of androgen deprivation therapy 2. Patients with biochemical relapse that would benefit from a short course of ADT and salvage RT2.5 Patient with pre-existing cardiac comorbidities 3. Potenti...
What is your approach to foley catheter placement and duration in a patient with a prostatic abscess that is being managed with either aspiration, unroofing, or antibiotics alone?
My approach is to treat the Foley as bladder drainage, not as treatment for the abscess. Catheter use should be driven by degree of retention, bladder emptying, bleeding, and the extent of transurethral manipulation. There are no standardized catheter duration guidelines for prostatic abscess, so pr...
Is there any data on the use of PARP inhibitors in patients with metastatic urothelial carcinoma with deleterious DDR mutations?
Urothelial cancers harbor high rate of deleterious DDR alterations. Based on clinical data from other tumor types, especially TOPARP-A in metastatic castration-resistant prostate cancer where responses to olaparib monotherapy were observed especially among men with defective DDR genes, the use of PA...
How does the POSEIDON meta-analysis results influence your decision on which patients should receive hormone therapy with post-operative radiotherapy for recurrent prostate cancer?
POSEIDON is another landmark analysis from the MARCAP consortium. It adds to the seminal work performed in localized prostate cancer (Kishan et al., PMID 35051385), which serves as the reference study for the use and duration of ADT with radiotherapy, but now in the post-prostatectomy setting.The st...