Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is the best management for a patient with advanced renal medullary carcinoma?
Very interesting regarding case reports of long term responses with proteasome inhibitors. Thanks for sharing.
When will you consider doing a biopsy of a potential metastatic site (lymph node, lung/visceral) for testicular cancer after orchiectomy?
I will biopsy a potential metastatic deposit seen on the scan after the orchiectomy if tumor markers are negative, have reduced to normal with appropriate half-lives, or are equivocal. A raised LDH, in isolation, is not enough to support the diagnosis of metastasis, and I will usually biopsy if that...
How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?
Bacillus Calmette–Guérin (BCG) is the most widely used vaccine worldwide and has been used to prevent tuberculosis for a century. BCG also stimulates an anti-tumor immune response, which urologists have harnessed for the treatment of non-muscle-invasive bladder cancer. As rheumatologists, we occasio...
How do you treat muscle invasive bladder cancer with neuroendocrine differentiation?
Is there a role for neoadjuvant chemotherapy in upper-tract urothelial carcinoma?
Very common scenario with significant variability in clinical practice. There is no standard high-level evidence as compared to muscle-invasive bladder urothelial cancer, in which neoadjuvant cisplatin-based chemotherapy is the standard of care for cisplatin-eligible patients. The literature lacks d...
Is there any indication for monitoring for renal medullary carcinoma in patients with sickle cell trait?
Hematuria occurs episodically in approximately 5% of people with sickle cell trait. Although often recurrent and sometimes producing anemia, the causes of hematuria are usually benign and it is self-limited. Medullary carcinoma of the kidney is a rare highly aggressive tumor that occurs almost exclu...
How do you approach increasing urinary citrate levels in a patient with recurrent calcium nephrolithiasis who has hypocitraturia, non-acidic urine, and normal serum bicarbonate levels?
For the patient you describe, I would start Moonstone and monitor serum electrolytes and 24 hour supersaturation as I increase the Moonstone dose to optimize treatment. I have no financial interest in this product. Stephen B. Erickson, MD
Do you recommend salvage XRT to the prostate bed in the setting of oligometastatic prostate cancer after RP?
In the setting of oligometastatic disease, we currently have reasonable evidence to treat gross disease. Following that logic, I treat the fossa if there is gross disease on imaging (preferably with biopsy confirmation). In the absence of compelling evidence for a local recurrence, I only treat the ...
Would you treat the prostate alone, or prostate and mets in an oligometastatic prostate cancer patient?
It's a good question and we are tempted to answer "prostate and mets" as the literature is building up, but we are still waiting for randomized phase III trials. The evidence so far suggests that stereotactic ablative radiotherapy (SABR) is promising. SABR-COMET trial has shown an improved OS for SA...
How do you approach rising PSA many years after prostatectomy with negative PSMA PET?
The devil is in the details. What is the status of the patient? In other words, what is the expected survival of the patient given his age, performance status, and medical conditions? There are online calculators that can be used to help. At what PSA value was the PSMA scan obtained? The utility of ...