Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How are you managing patients with recurrent NMIBC with CIS who decline cystectomy with the recent BCG shortage?
https://suonet.org/resources/news/bcg-shortage-addressed-by-urologic-community.aspx
How would you treat margin positive, node positive (pN+) prostate cancer with detectable post-op PSA but negative PSMA-PET after radical perineal prostatectomy?
Ideally, enroll the patient in a clinical trial like NRG GU-008. Off trial, would treat with salvage RT to the prostate bed and lymph nodes with long term (2 years) ADT. You can consider an MRI to see if there's a nodule in the prostate bed to boost, which may be more likely given a positive margin....
How do you manage surveillance imaging for patients with metastatic castration-naive prostate cancer with an initial low PSA?
Low PSA progression is common at the time of radiographic progression in the mHSPC setting, particularly among men treated with potent AR inhibitors. As we recently presented in the ARCHES phase 3 study, while enzalutamide significantly improves rPFS and OS and reduces progression events, among thos...
How would you approach a patient considered to be unfit for cystectomy with recurrent NMIBC refractory to BCG, failed pembrolizumab and unable to do more intravesical Rx?
This seems to be a very difficult scenario, what are the reasons for not being able to pursue intravesical therapies? Nadofaragene firadenovec just got FDA approval, while there have been data with intravesical gemcitabine/docetaxel. We are waiting for the FDA decision on N-803/BCG combo (QUILT-3.03...
Would you consider bone antiresorptive therapy in mCRPC with only 1 lesion per PSMA scan?
This is an important question. One of the best studies to examine this is here:Francini et al., PMID 34292336 from the abiraterone chemo naive mCRPC multicenter cohort study, in which both survival and SRE free survival were improved with the use of bone resorption inhibitors, especially in men with...
How long after initiating ADT/androgen blockade is it acceptable to start docetaxel in a patient with high burden, de-novo metastatic HSPC where you are recommending triplet therapy?
In ARASENS, patients were allowed to enroll if they had received no more than 3 months of ADT prior to starting docetaxel +/- darolutamide. The biologic underpinnings suggest that the combination is most likely to be effective if given together. Therefore, I generally prefer to start the patient on ...
How do you risk stratify patients with MRI guided prostate biopsies?
If the patient has had standard template biopsies and targeted biopsies, I only consider that standard biopsies in the quantification of the proportion of cores involved since the data used to derive the prognostic significance of this feature was based on standard template biopsies not targeted cor...
Does acute radiation cystitis cause microscopic hematuria and pyuria?
Radiation cystitis is the diagnosis.
How do you approach a urethral carcinoma s/p non-oncologic resection?
I have treated a few of them. It usually tends to be clear cell histology. For a non oncologic resection, I treat with chemo RT and have had mixed results.
What is your approach to the diagnosis and management of lupus cystitis?
Lupus cystitis is a rare complication of lupus but there does appear to be an association. I depend on the urologist to confirm the diagnosis of interstitial cystitis. If mild to moderate in activity, will use standard treatments for cystitis with bladder infusions, bladder relaxants in collaboratio...