Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you manage surveillance imaging for patients with metastatic castration-resistant prostate cancer?
Outside of trials - for SOC patients, I'll usually get imaging around treatment PSA nadir (understanding some of the changes in bone may lag PSA responses). Then, will re-image based on consistent/significant PSA rise or new symptoms. I try to adhere to working group radiographic criteria for SOC pa...
What are your top takeaways in GU Cancers from ESMO 2024?
1. Tivozanib–nivolumab vs tivozanib monotherapy in patients with renal cell carcinoma (RCC) following 1 or 2 prior therapies including an immune checkpoint inhibitor (ICI): Results of the phase III TiNivo-2 study. This trial confirmed (along with CONTACT-03: cabozantinib +/- atezolizumab) that cont...
What advice do you offer to patients with recurrent nephrolithiasis who are on a tube feeding diet and seeking stone prevention guidance?
As always, it is important to know their stone composition, so that you tailor the invention appropriately. Regardless, I have seen many such patients with calcium oxalate stones. It is important to get detailed information about their tube feeding formula and dosing, because tube feedings can vary ...
How does prior prostate artery embolization impact your treatment recommendations for prostate cancer?
PAE is a "newer" modality that is being used to treat LUTS in men with BPH and BPH symptoms at baseline. Case series report relatively impressive results, with the average AUA score dropping from around 20 to 8 in populations receiving this therapy. PAE is sold as a procedure that is unlikely to hav...
What are your management strategies for patients with recurrent uric acid nephrolithiasis and chronic kidney disease who have persistent hypocitraturia and acidic urine pH?
This is a good question. The primary goal is to correct the urine pH to at least 6 and preferably 6.5, regardless of renal function. Hypocitraturia is not a critical issue in uric acid stones disease, though it will likely respond to therapies listed below. Concurrent chronic kidney disease does not...
What adjuvant treatment would you offer a patient who underwent cystoprostatectomy for a muscle invasive bladder cancer and discovered to also have prostate cancer?
Complex case. If they have an indication for prostate RT (major: positive LN, persistent PSA, +SVI, minor: + margins, +ECE), I would consider treating the prostate fossa +/- LNs. As far as the bladder, we don't have the answer yet, but high-risk patients are being studied on the BART study from Tata...
Will you offer olaparib + abiraterone for all patients with metastatic castrate resistant prostate cancer based on results of PROPEL trial?
PROpel is clearly positive for its primary endpoint of delaying rPFS significantly in ALL first line mCRPC patients above and beyond abiraterone and prednisone alone. The delay of 8-10 months over an active comparator is significant both statistically and clinically, and is similar to the improvemen...
When is the ideal time to start adjuvant nivolumab after radical surgery in urothelial carcinoma?
In the reported and ongoing adjuvant therapy trials, patients must have had radical surgery (R0, with negative surgical margins) within 120 days before randomization. However, it is biologically rational to target initiating therapy as soon as he/she is fit for nivolumab following surgery (data in t...
Is there a role for cinacalcet suppression testing when evaluating patients for suspected primary hyperparathyroidism who also have recurrent calcium containing kidney stone disease?
I understand the physiology upon which the cinacalcet suppression test is based. However, I have not used it in my practice. Once I see a discordant result between a parathyroid hormone level and its main determinants: serum calcium, phosphorus, and vitamin D (or 1, 25-vitamin-D), I use a sestamibi ...
Given the different rates of testosterone recovery, do you alter the duration of ADT when using Leuprorelin (GnRH Agonist) vs relugolix (GnRH antagonist) in patients with intermediate or high-risk prostate cancer who received definitive radiation?
To my knowledge, there is no definitive answer to this question, and I think the vast majority of providers do not alter their recommendations for duration. A brief discussion of the issue and some evidence is offered below, for anyone interested. A recent review in the Red Journal (Roy et al., PMID...