Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you offer neoadjuvant chemotherapy to a patient with muscle-invasive enteric adenocarcinoma of the bladder?
Do you adjust PSA for finasteride use when determining prostate cancer stage and risk category?
We generally use the rule of 50% (real PSA is twice the lab value when on Finasteride).
Will you be recommending relugolix due to rapid suppression of testosterone and lower risk of cardiovascular events?
Once FDA approved, it will be an option; but I'm not sure what the cost to the patient will be, as it is an oral drug and that may be a limiting factor.
Which genomic test do you use when considering active surveillance in prostate cancer?
As a prologue, molecular expression features, often grouped into "panels" with mathematical models for outcome estimation, can be useful to help patients and clinicians determine whether historical (often still standard) clinicopathological features don't under- or over-estimate risk of clinical sig...
Would you consider "adjuvant" pembrolizumab for a patient with muscle invasive bladder cancer who is cisplatin ineligible and found at surgery to have T4aN2M0 disease?
This good question will be answered in the ongoing AMBASSADOR trial led by @Dr. First Last at NCI (pembro vs observation phase 3 adjuvant trial). There is also another adjuvant IO trial: Checkmate-274 trial (nivolumab vs placebo), while IMvigor010 did not meet primary endpoint of DFS benefit with ad...
Would you introduce AR targeted therapy if a patient has already been successfully treated with LHRH for low risk, low volume metastatic hormone sensitive prostate cancer?
Most trials of novel AR targeted therapies, started the novel AR blockers within 3 to 6 months of starting standard androgen deprivation therapy. Hence, if that period has passed and the patient is doing well on standard Androgen deprivation therapy, I do not see a need to introduce a novel AR inhib...
Does diffuse high grade PIN in a low risk prostate cancer patient affect your recommendation for surveillance?
No. If the patient otherwise has low-risk prostate cancer, surveillance is appropriate. The diffuse high-grade PIN might raise the chance of occult cancer (that could be higher grade), but not more so than a widespread Gleason 3+3 disease, which is not, by itself, a contraindication to active survei...
What do you tell men with low but detectable PSA who have completed ADT and RT?
Several analysis have shown that patients who do not achieve undetectable PSA levels after 6 months of ADT have worse outcomes. This is a bit of a moving target and the definition of undetectable has changed over the decades. An important question is - are these patients failing due to incomplete lo...
How would you approach a new pelvic mass in a patient with history of mixed germ cell tumor but normalized tumor markers?
By the type of treatment received, I assume this was likely a post-pubescent male, probably under 18? In my view, this sort of patient should be managed identically to what we do in the much larger populations of non-seminoma seen between 18-40. Clinical and biological evidence is mounting that post...
What is your approach to bladder cancer surveillance in patients who have received cyclophosphamide?
Risk of bladder cancer following cyclophosphamide treatment can be associated with oral therapy and likely also related to cumulative dose (1). Risk of bladder cancer with intermittent IV cyclophosphamide has been reported in some observational studies, but has not been consistently reproduced (2). ...