Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you manage patients with bilateral renal cell carcinomas?
Bilateral RCC without distant mets should be managed surgically if at all possible (e.g. bilateral partial nephrectomies), assuming adequate residual renal function. Pre-operative TKI to enable partial nephrectomy has been reported in multiple phase 2 trials with some success. If metastatic, then I ...
How do you manage anejaculation following definitive radiation for prostate cancer?
This is a very common side effect of prostate radiotherapy, either with brachy or external beam. Unfortunately there is no "fix" of which I am aware, as the glandular function of the prostate is reduced after radiation (think of the salivary glands and what we know happens to them!). The best option...
In a patient with localized prostate cancer with rising PSA would you consider EBRT if the patient is also undergoing chemotherapy for active recurrent colon cancer?
Hi. I, generally, agree with @Dr. First Last's response, but I would consider a few other things as well.For example:1. Disease extent or tumor burden of the recurrent colon cancer. Is the patient dying soon because of a heavy tumor burden, or does the tumor involve 5 or less metastatic sites, w/o c...
What is the utility of a biopsy in the setting of an elevated post-prostatectomy PSA and imaging noting a local prostate bed recurrence?
It would generally be reasonable to treat an imaging detected prostate bed mass without a confirmatory biopsy if one was going to treat the patient whether the biopsy was positive or negative. Some radiation oncologists are escalating doses to higher that standard levels in the postoperative setting...
How would you approach risk-stratification/staging of a extra-gonadal germ cell tumor with both mediastinal and retroperitoneal lymphadenopathy?
Actually there is zero chance a primary mediastinal germ cell tumor would ever have retrograde adenopathy to the RPLN's. Thus this is a primary retroperitoneal germ cell tumor. Assuming no non-pulm visceral mets and markers at good risk level, would treat with BEP x 3. You did not mention pathology,...
How does the finding of synchronous bladder cancer affect your treatment recommendations for high risk prostate cancer?
We have quite a few pts with synchronous early bladder ca with prostate ca treated with brachy. I have not seen any significant additional morbidity with IV therapy but have not evaluated objectively
What is your approach to metastatic non-clear cell RCC?
A majority of the clinical trials conducted in renal cell carcinoma are conducted exclusively in clear cell carcinoma. We know from retrospective analyses (De Velasco et al Clin GU Cancer 2017) that these patients have a worse prognosis with traditional therapy. Small randomized trials dedicated exc...
Is it acceptable defer or forgo biopsy and to start androgen deprivation therapy in an elderly, fragile patient with PSA in the 900s and evidence of bone metastases?
These questions come up regularly in practice. There seem to be two questions here.One is the acceptability of starting therapy for prostate cancer without biopsy confirmation. There is a small single institution retrospective evaluation and positive predictive value of PSA in diagnosing PCa. With a...
Are the cardiac risks of LHRH agonists also seen in patients undergoing bilateral orchiectomy for ADT in hormone-sensitive prostate cancer?
Although the true implications of testosterone suppression on cardiac risk/disease remains somewhat undefined, it is the low testosterone levels, not the mechanism of how these levels were obtained i.e. either surgical or medical castration that is the issue.
Should patients who received pelvic radiation get colonoscopy screenings more often than what is recommended for the general population?
The excess risk of secondary cancer after radiation has been estimated at 0.5% in a 15 year follow-up period. This relatively low incidence would not justify a higher interval of screening colonoscopy after pelvic radiation. As a component of our patient-reported quality of life survey, we do screen...