Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
When does a rising PSA after prostatectomy indicate growth just of normal prostate?
The concept of residual prostate tissue after prostatectomy has been around since the advent of the PSA. The idea that BPH could exist within this residual tissue has been suggested for nearly the same amount of time. Very little data exists regarding this concept. It has been demonstrated that resi...
Per 2016 NCCN guidelines, is the addition of 6 cycles docetaxel now the standard of care for all (NCCN) high and very-high risk prostate cancer patients receiving definitive XRT/ADT?
Last year, the results of RTOG 0521 were presented at ASCO and showed that adjuvant docetaxel led to a small improvement in overall survival for men with high risk prostate cancer. To briefly recap, 563 eligible subjects were randomized to standard-of-care external beam RT (72-75.6Gy, with 46.8 to r...
Does a rare histology prostate cancer, such as ductal or mucinous, change your typical management recommendations?
Intraductal cancers are often associated with Grade 4 prostate cancer and getting a mpMRI and performing a fusion TRUS/mpMRI bx of any PiRads 3, 4 or 5 cancer to r/o Grade 4 would be of value to recommend treatment as opposed to active surveillance in an otherwise Gleason score 6 PC. If Grade 4 is c...
How do you incorporate the recent proposed guidelines for using a prostate cancer "Grade Grouping" system (i.e. scores 1-5) into your clinical practice?
As theMedNet is a less formal venue for discourse I will do away with any pretense and answer the question honestly. I have no idea how I or anyone should incorporate this new system into practice. Although validated, the new system has not been used in randomized trials and one musn’t be overly dog...
For high risk, stage I, non-seminomatous testicular germ cell tumors, are there particular circumstances under which RPLND is clearly preferred over chemotherapy or surveillance?
There are few indications for primary RPLND in pure nonseminomatous CSI. The only one I can currently think of is someone who has a strong contraindication to ever receiving chemotherapy.... renal failure or the like. The only time I consider it general is for patients with high risk Leydig or Serto...
Given the results of the recently published GETUG 16 randomized trial, should all men undergoing salvage prostate radiotherapy receive concurrent hormone therapy?
I'm not surprised to see this question posted on The Mednet. GETUG 16 was recently published (Lancet Oncol. 2016 May 6.) and provides additional prospective information regarding the role of ADT in the managment of salvage prostatectomy cases. Not to nitpick over the article excessively, but I did n...
When should intermittent androgen deprivation vs continuous androgen deprivation be used for the treatment of prostate cancer?
I think the question posed and the patient example are really 2 different questions. To address the title question, let me call your attention to a recent article in the JCO 34: 280-5, 2016, and an accompanying editorial, which review this issue in detail. The authors point out that there are signif...
In patients who are medically poor surgical candidates, what are the treatment options available for bulbomembranous urethral cancer?
The evidence is thin, but these patients may be treated by chemo-radiation. Whether they are urothelial cancer or squamous cell carcinoma the aim would be to get in a worthwhile radiation dose, say 65-70Gy, with reasonable sensitizing chemotherapy if they have the kidneys to tolerate it. Sometimes t...
Is there a role for adjuvant docetaxel in patients with high-risk localized prostate cancer who elect for prostatectomy?
Currently, there is no data to support the use of adjuvant docetaxel following radical prostatectomy. Given that these are two entirely different treatments in different patient populations, there is no rationale for extrapolating the results from RTOG0521 to a post-surgical (even if high-risk) popu...
Are there any situations in which you would offer postoperative RT for node positive prostate cancer?
The textbook answer, based on Messing NEJM, is ADT for node+ patients post-prostatectomy, but this is certainly a moving target.As node+ patients were excluded from all adjuvant (EORTC, German, and SWOG) and salvage (RAVES, RTOG 0534) randomized trials, there is currently no level I evidence for XRT...