Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
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...
How do you manage prostatic adenocarcinoma after a subtotal resection?
This is a complex question with many permutations, and a review of the operative note in addition to the surgical pathology can help to inform clinical decision-making. Direct discussion with the surgeon, when possible, is also important because presumably there is some reason this occurred, which m...
How would you treat a synchronous anal canal squamous cell carcinoma and localized high risk prostate adenocarcinoma?
The primary anal cancer and prostate cancer can be treated with a whole pelvic field to include the anus and prostate/SV (45-50 Gy) with a simultaneous integrated boost for the anal tumor (RTOG 0529). HDR brachytherapy can then be used to boost the prostate after a short recovery from the external b...
Are there any varying treatment considerations to make when managing patients with carbonate apatite versus hydroxyapatite kidney stones?
Both of these stone types require a relatively alkaline urine to crystallize. Not surprisingly, they are often found in combination within the same stone. My diagnostic and treatment considerations do not depend on which mineral composition predominates. Stephen B Erickson, MD
Is there a role of definitive radiation or prostatectomy, in a patient who has M0 castrate resistant prostate cancer and whose PSA is undetectable on ADT and enzulatamide?
The question posed comes from a rather unusual clinical situation. In most cases, M0 crpc would have evolved from a diagnosis of prostate cancer and the application of curative intent local therapy surgery/radiotherapy, with psa progression in the absence of metastatic disease managed with ADT now w...
Do you make any changes to surveillance imaging frequency, 24 hour urine stone risk collection frequency, and stone preventative medication approaches for patients with recurrent nephrolithiasis who become pregnant?
Pregnancy is a lithogenic state. Stone passages peak in the second trimester. I avoid imaging that involves radiation. I monitor with ultrasound. I prefer to withdraw prescription medication and manage stone disease with diet and fluid therapy. Certainly, there are exceptions to this rule. Encouragi...
What are the realistic, modern 10-year survival curves for localized prostate cancer given the improvements we have made in diagnostics and treatment?
Generally, outcomes are excellent for the average patient with localized prostate cancer. As all-cause mortality is driven by competing risks for patients with localized prostate cancer, the age and overall health of a patient are often the most important prognostic factors to predict overall surviv...
Which genomic test do you choose for a patient with favorable intermediate prostate cancer trying to decide between active surveillance and treatment?
Decipher.
What is your fluid intake target for patients with nephrocalcinosis and no history of kidney stones?
Nephrocalcinosis represents calcification of the renal parenchyma as opposed to nephrolithiasis that represents classification in the urinary space. The two conditions occasionally coexist, such as a medullary sponge kidney, distal renal, tubular, acidosis or primary hyperparathyroidism. For patient...
What is your approach to patients with chronic kidney disease who are found to have pelviectasis without hydronephrosis on renal ultrasound imaging?
Good question. I would involve urology early on. I would get more history as to other signs/symptoms of urinary obstruction (nocturia, BPH symptoms, history of retroperitoneal fibrosis). Then, consider a Lasix urogram.