Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you offer adjuvant chemotherapy/immunotherapy for resected pure squamous cell carcinoma (T2-T4 or N+/-) of the renal pelvis?
Primary or pure squamous cell carcinoma of renal pelvis is very rare and the role of adjuvant therapy after surgery is unknown. Squamous cell carcinomas in head-neck, anal and other sites, tend to recur locally. Based on that behavior, I would offer radiation with a sensitizer, preferably weekly cis...
Do you recommend checking a serum phosphorus level in patients with recurrent nephrolithiasis?
For patients with pure calcium phosphate or mixed calcium phosphate/oxalate nephrolithiasis, l routinely check serum phosphorus as part of a panel that also contains serum calcium, PTH, creatinine, and 25-vitamin D, looking for primary hyperparathyroidism, a surgically curable cause of these stones....
For patients who have completed up-front docetaxel for metastatic castration-sensitive prostate cancer, should they proceed to abiraterone before the development of castration resistance?
There is data for upfront triplet therapy currently in high-volume HSPC. The triplet therapy consists of ADT + docetaxel x 6 cycles + either darolutamide or abiraterone. Given that this patient has already completed a course of docetaxel, holding off on adding ARSI therapy until the first signs of P...
Do you recommend a waiting period to conceive after prostate radiation?
Yes, I typically advise that men and their partner use contraception for at least 3-4 months after the last fraction of radiotherapy based on the fact that the maturation cycle of sperm is estimated at approximately 2- 2.5 months. I typically counsel men prior to treatment that there is a chance (bu...
Do you recommend using anastrazole in men developing gynecomastia while on testosterone replacement treatment for hypogonadism depending on pre-treatment estradiol level?
There is no role for aromatase inhibitors (e.g., anastrozole) for the prevention of gynecomastia. A randomized trial of anastrozole for the treatment of gynecomastia demonstrated no benefit compared to placebo.There is no reason to administer prophylactic therapy prior to the initiation of testoster...
Do you advise patients with a personal or family history of germ cell tumors to avoid endocrine disruptors such as marijuana/CBD, lavender oils, or tea tree oils?
No, I do not advise against MJH or other putative endocrine disruptors, other than cautioning against the general health effects of MJH. I assume the question was triggered by the concern regarding older reports of an association of MJH and the development of germ cell tumors. Several things: Our un...
When considering cytoreductive nephrectomy in metastatic kidney cancer, in which situations would you consider nephron-sparing approaches such as partial nephrectomy or SBRT?
Nephron-sparing strategies (partial nephrectomy or stereotactic radiation therapy are reserved for patients with limited disease, favorable anatomy, or contraindications to surgery, where the goal is to maximize oncologic control while preserving renal function and minimizing morbidity. Careful mult...
Do you consider ADT intensification with enzalutamide or abiraterone in patients receiving adjuvant radiation with ADT?
I agree with Dr. @Dr. First Last.One thing to note is ~3% of RADICALS, for example, included pT3b and high grade disease, and almost no patients in the ART vs SRT trials had N+ disease. Was largely GS7 and pT3a population and not the very high risk patients that select surgeons choose to operate on....
What is your approach to using calcium containing medications for patients with recurrent nephrolithiasis and hyperoxaluria?
Depending on their 24 hour urine, I suggest taking calcium with meals to bind oxalate and follow 24 hour urines.
In a patient undergoing neoadjuvant 177Lu-PNT2002 + MDT for oligorecurrent prostate cancer as per the LUNAR trial, what are the implications for other escalated systemic therapies with ARPIs/chemotherapy, which may otherwise be used concurrent with ADT in this population?
The LUNAR approach was designed for men who did not want to have hormone therapy. It is true that hormone therapy, either via ADT, ARPI, or both, could be added to MDT as well. The RADIOSA trial did show that PFS was improved with 6 months of ADT added to MDT. However, in RADIOSA, the eugonadal PFS ...