Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Should enzalutamide be given concurrently with Sip-T in castration-resistant metastatic prostate cancer?
Enzalutamide was still in early development when Sip-T was approved. Currently there isn’t enough data in the randomized setting, to justify the use. It’s a fascinating clinical question, and hopefully during the next couple of years, more data will become available.
What imaging workup should be completed in patients with a detectable PSA following prostatectomy?
The imaging work-up of recurrent prostate cancer is a topic of considerable interest. Our approach at UCLA has been to recommend, at the very least, a multiparametric MRI to evaluate for locoregional recurrence, and we regularly recommend a technetium bone scan as well. That being stated, we have be...
Would you treat a muscle invasive urethral recurrence of bladder cancer with definitive chemoradiation?
Assuming that the urethral tumor is invasive of the prostatic stroma, there are multiple reasonable answers depending upon the patient's age and health status. Remember that stromal invasion is a bad sign and these patients are rarely cured. If the patient is young, but reluctant to consider cystopr...
In light of CHAARTED and STAMPEDE, should all men with newly-diagnosed, treatment-naive metastatic prostate cancer be treated with chemohormonal therapy?
This is an evolving answer but presently I do offer 6 cycles of docetaxel to men with M1 (not N1) CSPC who are initiating or who have recently initiated ADT. This would include men who present with M1 disease but also men with rapidly recurrent mCSPC who are hormone naive. There appears to be a grea...
Should bone-directed agents, such as denosumab or zoledronic acid, be given when patients are being treated with radium-223?
In ALSYMPCA, bisphosphonate use at study entry was associated with a delay in symptomatic skeletal events (Sartor, et al. Lancet Oncol 2014; 15(7) 738-46). Based on this, osteoclast-targeted agents (i.e. zoledronic acid and denosumab) should be offered to patients with mCRPC that will receive radium...
What chemotherapy regimen is best suited for patients with platinum-refractory metastatic bladder cancer who have good or excellent performance status?
I would try to get patient to a pd1/pdl1 study or try to get it off-label. Early results are promising for 1/3 of patients.
What is the optimal management of recurrent seminoma with small volume retroperitoneal disease initially managed with surveillance?
The question is how to manage pathologic confirmed CSII seminoma. If the nodal volume is on the larger side (> 3 or so cm), most experts would treat those patients with BEP X 3 with a very high cure rate, with very low likelihood of requiring any post-chemotherapy interventions. Most experts in the...
Without radiographic evidence for metastatic disease, is there a PSA value above which high risk localized prostate cancer should not be treated definitively?
The SPCG-7/SFUO-3 randomized trial randomized 875 patients to endocrine only therapy vs. endocrine therapy plus radiation therapy. 20% of the patients had a PSA > 30. The addition of radiation showed an overall survival benefit at 10 years (60.6% vs 70.4%), a prostate cancer specific survival benefi...
What treatment recommendations for a low or intermediate risk prostate cancer do you consider when treating patients with medical commodities such as ankylosing spondylitis and ulcerative colitis?
I do not think either of these would be a contraindication for radiotherapy. I have some experience with patients with ulcerative colitis, but not with ankylosing spondylitis. If there is any concern, either HDR or LDR brachytherapy are the most attractive options. The volumes for low and intermedia...
Is there a role for docetaxel for men with high risk prostate cancer receiving radiation and androgen deprivation therapy?
Standard of care for high risk localized prostate cancer remains radiation and long term androgen deprivation therapy. To date, there are no trials that have demonstrated an overall survival benefit with the addition of chemotherapy. Given the potential toxicity of adding chemotherapy, this should n...