Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How would you treat a metastatic pure urethral adenocarinoma?
The treatment of rare or unusual urologic tract tumors remains an area of active investigation to optimize approaches. In general, most practitioners would utilize a GI malignancy-focused regimen for a metastatic urothelial tract pure adenocarcinoma (mucinous/or enteric type) such as FolFox off of a...
What is your approach to elevated urine uric acid levels in a recurrent calcium based stone former?
There was good evidence from controlled trials supporting the use of allopurinol in hyperuricosuric calcium stone formers. That said, the trials are now pretty old and I would tend to treat other risks first (unless there was another reason to lower the uric acid like gout). In general, a lower anim...
Would you consider pelvic radiation in a patient with prostate cancer and myelofibrosis with mild cytopenias?
I would avoid prophylactic RT in this scenario as the absolute benefit has to be weighed against the worsening of cytopenia.
Do you ever initiate on degarelix and then switch to leuprolide for patients with prostate cancer and cardiac risk factors receiving ADT?
I do not believe that there is a major differential in cardiotoxicity between LHRH antagonists and agonists. The key issue is metabolic syndrome associated with long-term androgen deprivation. Randomized trials have not shown convincing evidence of a difference in cardiotoxicity between agonists and...
What are your top takeaways in GU Cancers from ASCO 2023?
THOR study. Improved overall survival (HR 0.64 p=0.005) and PFS (HR 0.58 p=0.0002) of the oral FGFR tyrosine kinase inhibitor erdafitinib in FGFR altered metastatic urothelial carcinoma over chemotherapy. Establishes a new standard of care in the second/third/fourth line setting after failure of ch...
Would you treat the prostate in a patient with widely metastatic disease who has CR to all metastatic sites after systemic therapy or ADT?
This is an interesting hypothesis, but requires further study before offering. The trials that define a benefit to prostate RT in the metastatic setting (HORRAD, STAMPEDE, and now PEACE-1) did not use response-adapted selection criteria. Therefore, we cannot say that radiation to the prostate in an ...
When is it safe for a rectal biopsy in a patient with prior prostate radiation?
A biopsy of rectal tissue that has been radiated will have a higher risk of developing non-healing wounds and ulcers. Part of the reason that biopsies are discouraged as well as radiation proctitis is a clinical diagnosis and that biopsies of proctitis are certainly not needed to confirm this. Recta...
Would you recommend prescribing testosterone replacement therapy to reduce osteoporosis fracture rates in men with hypogonadism?
100% yes. Especially if improved quality of life may be realized. Practitioners need to understand that TRT supersedes physiologic testosterone when it comes to quality-of-life benefits, especially INJ testosterone. That's assuming even normal testosterone to begin with. Clinical real-world benefits...
How often do you monitor labs such as complete blood count, liver function panel, and urine protein in a patient with cystinuria receiving tiopronin?
I check patients newly started on tiopronin or after an increase in dosage about one month later. Assuming the lab results are normal, I do not continue to check them. I think late adverse reactions must be very rare. Stephen B Erickson, MD
Would you recommend neoadjuvant chemotherapy for a 3.5 cm low-grade UTUC in a cisplatin-eligible patient?
Neoadjuvant chemotherapy (NAC) conceptually makes sense in UTUC. A number of retrospective studies showed improved surgical and oncologic outcomes with NAC in UTUC. A recent phase 2 clinical trial (Coleman et al., PMID 36603175) confirmed this (63% pathologic response, improved PFS and OS) using spl...