Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Is there a role for orchiectomy in a patient with stage IV DLBCL who presents with a testicular mass?
Primary testicular lymphoma, almost always DLBCL, is primarily a disease of older men. The typical presentation is an enlarging testicular mass. Patients are referred to Urology, an orchiectomy performed, and the diagnosis is confirmed. The patient then undergoes a PET-CT for staging. Many patients ...
Would you treat the prostate per STAMPEDE in a patient who has oligometastatic disease after cryotherapy?
I agree with Dr. @Dr. First Last. This is one of the few scenarios that radiation has shown to improve overall survival for men with prostate cancer so you would not want to take important therapy off the table.
Would you use neoadjuvant chemotherapy to treat a patient with NMIBC on TURBT pathology but with CT imaging suggestive of cT3 disease?
Clinical staging in bladder cancer can sometimes be challenging and not always clear. Repeat TURBT, esp. for T1 stage is a standard practice to reduce risk of under-staging, even if MP is present. CT IVP (ideally before TURBT to avoid "stranding" effect), exam under anesthesia, and TURBT may all hel...
Are there any clinical scenarios where you would recommend adjuvant docetaxel for localized prostate cancer?
This is quite a controversial topic and good for a tumor board discussion! The RTOG 0521 trial is the only trial to demonstrate a potential survival benefit with docetaxel in the adjuvant setting following radiation and in the setting of long term ADT. The absolute difference in OS at 4 years was 4%...
For persistent PSA elevation after prostatectomy, would you recommend salvage radiation if pathologically negative nodes, but regional and non-regional lymphadenopathy on PSMA PET?
While based on classical staging methods, it appears that he would fulfill the criteria for salvage RT with a persistent PSA, it sounds like this patient has M1a disease by advanced imaging (possibly at presentation). I think that it is very unlikely that he would gain any meaningful benefit from ad...
How would you treat oligometastatic kidney cancer in a young, fit patient with recurrence <6 months after nephrectomy?
This is a good question. Short time to recurrence of mets would generally indicate more aggressive biology i.e., the mets aren't really oligo and other mets are lurking. Having said that, careful review of prior scans may reveal that the metastatic sites were present prior to being fully recognized ...
Do you recommend prophylactic ureteral stenting in patients who have recently completed SBRT to a region in close proximity to the ureter prior to the potential development of fibrosis?
No, just F/U MRI.
After completing 6 cycles of docetaxel plus ADT for metastatic hormone-sensitive prostate cancer per CHAARTED, are there clinical scenarios in which you would add an additional AR targeted agent (ex: enzalutamide, abiraterone, or apalutamide) to ADT?
This is an important question and has in part been asked as part of subgroup analyses of the phase 3 ENZAMET, ARCHES, and TITAN mHSPC trials. In these trials, there was clinical benefit observed with combined chemohormonal therapy AND potent AR inhibition, sequentially in ARCHES/TITAN, and in combin...
What is the importance of finding a positive titer for FGFR3 and what treatment would be advised for these patients?
The significance of positive FGFR3 antibodies in patients with neuropathy, and the optimal treatment regimen for those patients remain to be determined. Based on the largest case series of FGFR3-IgG + patients to date, the antibodies seem to be associated predominantly, if not exclusively, with non-...
How would you sequence therapies for a patient with chemotherapy-naive metastatic castration-resistant prostate cancer who is MSI-H on tissue-based NGS?
Yes, I absolutely would use Pembrolizumab (200 mg IV q3wk, or 400 mg IV q6wk) in a MSI-high patient with mCRPC who has not yet received chemotherapy. However, I would probably postpone this until after the patient has progressed on one novel AR-directed therapy. I think that the "sweet spot" for usi...