Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you treat prostate cancer with hormone sensitive metastatic recurrence (after local treatment) the same as de novo metastatic hormone sensitive disease?
Yes, most of the phase 3 trials (ARCHES, ENZAMET, TITAN, STAMPEDE) permitted relapsed mHSPC patients in addition to de novo mHSPC patients. LATITUDE was the only trial that required newly diagnosed patients with mHSPC. For the AR inhibitors, a similar benefit in delaying radiographic progression or ...
How do you treat metastatic renal cell carcinoma with unclassified histology without sarcomatoid features?
There is limited data on optimal treatment of advanced non-clear cell RCC in general, including unclassified RCC. I have summarized the available data that I am aware of: The phase II study ASPEN randomized advanced nccRCC patients, including 20% with unclassified RCC, to sunitinib vs everolimus. Of...
How do you approach rectal spacer for the patient with renal failure?
Have not come across this but I would presume it would be filtered with dialysis in pts with renal failure.
How would you manage simultaneous muscle invasive bladder cancer and intermediate or high risk prostate cancer in a patient who refuses surgery?
When I'm faced with a situation like this, with 2 concurrent pelvic malignancies, I like to think about how I would manage each one independent of the other and then try to design a plan that incorporates management principals of both diseases. You also have to consider how treating both concurrentl...
What factors affect your decisions in in the initial management of a stage IIIB bladder cancer?
For cN+ bladder Ca, I start with induction chemotherapy aiming for 4-6 cycles (restaging initially after 3 cycles and continue to 1-3 more cycles depending on response & tolerance) since the risk of micro-Mets is exceedingly high. If a patient has a great response to induction chemo, options may be ...
Given the superiority of ADT+enzalutamide over ADT alone demonstrated in the ARCHES and PROSPER trials, would you recommend it in the definitive setting for men with high-risk castrate-sensitive prostate cancer?
The quick answer is: No.There is no level 1 evidence that next gen AR-signaling inhibitors (ASI) improve DMFS or OS in high risk localized prostate cancer. Multiple trials are ongoing or maturing in followup, nearly all in combination with RT.Given that most contemporary high risk studies show ~10% ...
How do you manage significant fatigue caused by androgen deprivation therapy in prostate cancer patients?
This is a great question and one that I think comes up regularly in the clinic. The fatigue often is due to the hypogonadal state, lack of muscle mass and subsequent loss of muscle power that may reduce stamina. I generally recommend a regular activity or exercise program. As in many other patient p...
Do you perform a bone health assessment in men who will be receiving short term androgen deprivation for localized prostate cancer?
I do not order bone densitometry on patients I am treating with short term (<= 6 months) of AD, unless they have a risk factor like long-term glucocorticoid use or prior fracture. For patients I am treating with long term >=18 months I perform a baseline bone densitometry. If that is normal-mild ost...
What is your preferred regimen for metastatic bladder adenocarcinoma?
Clinical trials, e.g. ICONIC (PI: Dr. Andrea Apolo) would be very interesting if slots are available. Outside trials, would consider FOLFOX (or FOLFIRI if neuropathy is an issue) as a 'colorectal-like' regimen (GI Med Onc can help manage regimen based on their experience). Dr. Siefker-Radtke had a t...
What is the best treatment regimen for a fungating SCCa of the scrotum arising from untreated genital warts invading the groin and base of the penis with bilateral inguinal nodes?
This is a case where I would like to see the patient and the imaging before giving you my opinion. Management in this situation will take a multidisciplinary approach with med onc, urology, and possibly a colorectal surgeon being involved in addition to rad onc. I don’t think there is a single best ...