Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using dutasteride or finasteride?
I advise against dutasteride for those trying to conceive or who might have unprotected intercourse with pregnant women since dutasteride is in the semen. For 5 alpha-reductase inhibitors in general, the effects on sperm count and sperm motility are very well characterized. There is a reduction in s...
Which method provides a more accurate assessment of hypercalciuria: 24-hour urinary calcium excretion or the spot urine calcium-to-creatinine ratio?
24-hour urine should be more accurate. F. Singer
What chemotherapy regimen would you use for a testicular cancer patient in need of BEPx3 but unable to use platinum based chemotherapy regimen due to cochlear implants?
To be succinct, the correct answer is BEP x 3 if he wants the therapy that would achieve optimal cure rate. If disease is limited to retroperitoneal nodes, especially if < 3 cm is the largest node and normal postorchiectomy, serum hCG and AFP, RPLND would then be the preferred option.
What is your approach to managing patients with recurrent nephrolithiasis and nephrocalcinosis in the setting of hypoparathyroidism?
If patients truly have hypoparathyroidism, then the issue is to manage their hypocalemia, which usually requires large doses of oral calcium as well as treatment with VDRAs, which results in marked hypercalciuria, since they do not have PTH to help reabsorb calcium. This even occurs when they have C...
How does Decipher score inform your practice for treating pelvic nodes in otherwise favorable intermediate risk prostate cancer?
Nodal radiation therapy in prostate cancer remains controversial. While the Decipher score correlates with lymph node involvement in pathological specimens, I have not used it to decide on pelvic nodal radiation. Two randomized studies failed to show a benefit to pelvic radiation (old studies with i...
How would you manage asymptomatic radiographic progression from M0 CRPC to M1 CRPC to bone?
This is a relatively common scenario presently where the M0-->M1 transition is now occurring during potent AR inhibition in the nmCRPC setting. In general, I manage patients similarly to mCRPC patients progressing on an AR inhibitor and consider factors such as 1) pace of disease and symptoms, 2) co...
How are you using the Decipher score in the definitive setting for prostate cancer?
This is an excellent question.Before I can answer the question directly, you must ask yourself how do you currently decide who to give ADT to with RT?The easy answer is that you use RCTs to choose who to give short-term and long-term ADT to. However, I wish it was that easy.Lets take RTOG 9408- It i...
What is your preferred mode of vascular access for testicular cancer regimens?
Actually, we try to avoid all vascular access devices, especially PORT, which causes a 10-20% risk for clot as well as infection. These are young healthy patients usually with excellent veins. Over 90% of our large patient populations with testis cancer simply get their 5 days of chemo with a restar...
What is the preferred steroid regimen for metastatic prostate cancer patients on docetaxel?
TAX 327 (Tannock Et al NEJM 2004) used prednisone 5 mg bid in all patients (Q3 week Docetaxel and weekly Docetaxel). In addition, patients received dexamethasone 8 mg 3 times (12, 3, and 1 hour) before infusion. The prior phase 2 studies did not include prednisone with Docetaxel. Historically, low-d...
Do you hold or dose modify chemotherapy with BEP or EP for severe cytopenia or renal injury when treating testicular cancer in the curative setting?
No. In terms of cytopenias on day 22, it is usually granulocytopenia that concerns treaters. I look at the CBC and you will usually see a left shift c/w rapid recovery. If one is very concerned, you can add a granulocyte stimulating factor for this cycle. In terms of renal function, I would again ...