Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How would you approach therapy for a patient with non-seminomatous germ cell tumor, cT3N3Mx and symptomatic lower extremity thrombus extending to the IVC when it is unclear if bland or tumor thrombus?
This is not a common setting, but it is well described and high volume centers have fairly uniform approaches to patients presenting with caval thrombus. With the pre-orch HCG of 850, he is likely IGCCC good risk unless he is found to have brain or hepatic mets. He is likely non seminoma with a larg...
What are your top takeaways from ASCO GU 2022?
My top abstracts and questions that arise from them: 1) ARASENS with darolutamide in high volume de novo mHSPC showing an OS benefit with darolutamide over ADT/docetaxel. Will this pertain only to high volume/risk patients who are chemo-fit and de novo which seemed to comprise the vast majority of ...
Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?
No.
How would you approach a patient with resected renal cell carcinoma, collecting duct type with sarcomatoid and rhabdoid features?
Although sarcomatoid differentiation is more common in clear cell RCCs, it is also well described in other RCC subtypes, including collecting cell carcinoma. Some argue that collecting duct carcinoma is histologically and clinically closer to a urothelial carcinoma than an RCC subtype. Urothelial ca...
Based on the STAMPEDE trial pooled analysis, which patients with high risk prostate cancer would you add abiraterone for 2 years?
I often use 2 years of Abi/pred (plus ADT) in patients with high-risk localized prostate cancer who have at least two of these features: Gleason grade group 4 or 5 Clinical/radiographic stage T3 or greater PSA 40 ng/mL or greater This is typically done in conjunction with primary radiotherapy.
How would you treat a patient with prostate cancer with de novo bone and bone marrow metastases with cytopenias?
Men who present with diffuse bone marrow involvement by definition have high volume de novo disease, and among the worst prognosis of all situations. Level 1 evidence now suggests that triple therapy with ADT/docetaxel and concurrent abiraterone or darolutamide (level 1), or sequential ADT/docetaxel...
Would you consider de-escalating abiraterone in a patient treated with ADT/abiraterone/prednisone for metastatic hormone sensitive prostate cancer who has had an excellent response with undetectable PSA and minimal side effects for over 2 years?
Wonderful question. There really is no data to guide this question. Some people are wondering about de-escalation of therapy from the start vs super escalation (triple therapy) for other patients. This strategy makes biologic sense. Match the therapy to the biology of the cancer. The challenge is th...
What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?
Great question. This comes up often. For males, they can continue to take their CML TKI and conceive a child. Of course, this is much more complicated for women as they should not be pregnant while taking a TKI. I would say that if the patient is having difficulties conceiving, he should undergo a ...
Would you give ADT + docetaxel -> darolutamide for a low risk castrate sensitive metastatic prostate cancer patient given ARASENS results?
ARASENS was designed during the era of docetaxel plus ADT emerging as the standard of care for men with mHSPC irrespective of disease volume, based on the improved OS observed in STAMPEDE for a largely de novo mHSPC patient population, where there was no heterogeneity observed for the OS benefit in ...
How would you manage prostate cancer in a patient who received prior chemoradiation followed by an APR for rectal cancer?
Patients who have been treated with chemoradiation followed by an APR for rectal cancer and now have prostate cancer and are not surgical candidates do have definitive treatment options despite the previous treatment. Although HDR brachytherapy is usually a great option for patients who have already...