Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
When would you recommend adjuvant therapy for a patient with urethral adenocarcinoma after partial urethrectomy?
My first approach in this setting is to have the pathology reviewed by an expert tumor pathologist, and to be sure of the T stage, margins, N/M stage, and whether any tumor markers are heavily expressed. If there is a strongly expressed tumor marker, such as CEA, I will obtain baseline, and interval...
How would you treat a patient with widely metastatic penile squamous cell carcinoma with mixed response to 4 cycles of TIP chemotherapy?
Penile squamous cell carcinoma (PSCC) is a challenging and rare malignancy. In those with metastatic disease following therapy with cisplatin-based combination chemotherapy, there are no optimal or approved options. Clinical outcomes are dismal with currently used salvage therapy agents. Cetuximab o...
Would you recommend surgery or radiation for newly diagnosed localized prostate cancer diagnosed on a urethral lesion biopsy?
I think the underlying question here is whether its urethral location changes the recommendations we would otherwise make, and really it doesn't. Let's talk it through: I don't feel that the urethral location affects my ability to treat this with EBRT as the urethra gets the same (curative) dose as ...
How do you manage testosterone replacement therapy-induced erythrocytosis?
Testosterone is a known risk for thromboembolism. What is not known is whether it is the hematocrit or the testosterone itself that is the trigger for thrombosis. Note also that epidemiologically, the age group that generally is prescribed testosterone also has a high prevalence of thrombosis. My ap...
At what PSA value do you obtain molecular imaging in a post RP patient with previous salvage prostate bed radiotherapy?
The answer to this question will strongly depend on what you intend to do with this information. If you have a patient with a very slowly rising PSA, say a doubling time of years, this patient may not benefit from any treatment so you may want to continue to observe them without any further testing....
How would you treat a seminoma if orchiectomy showed a burned out primary with positive pelvic and paraaortic lymph nodes?
If volume of disease is small, would treat with RT and if large, meaning bulky nodes >3 cm or entire chain which seems like the case here, then with chemotherapy CP regimen.
When using IO therapy for front line treatment of metastatic RCC, is there a role for cytoreductive nephrectomy?
The role and timing of debulking nephrectomy in mRCC has been evolving over the last several years. This is in part due to CARMENA, which in my opinion reinforced that patient selection is critical, and in part due to increased activity of systemic therapy. I think patients with limited IMDC risk fa...
Would you consider radical prostatectomy for a young male with unfavorable intermediate risk cT3a prostate cancer and PSMA PET concerning for regional lymph nodes involvement but negative conventional imaging?
I would approach this scenario by considering two main issues. The first issue is what the probability of the patient truly having pN+ disease based on cN+ findings on advanced imaging. There have recently been two trials published from the Netherlands, PEPPER (using 68¸Ga-PSMA-11) and SALT (using 1...
Can adjuvant nivolumab for bladder CA as per Checkmate 274 be extrapolated for the concurrent chemoRT bladder preservation setting?
Great question. Short answer is no. Different scenario and very hard to extrapolate from the adjuvant post radical cystectomy setting. We need dedicated bladder preservation trials, e.g. S1806 and Keynote992. Recommend to accrue in those 2 large phase III trials for patients who opt for bladder pres...
Would you treat the pelvis in a high risk prostate cancer patient who is anticipating pelvic kidney transplantation?
My decision to treat pelvic nodes depends on the specific risk criteria present, but let's assume that this patient meets those criteria. In this situation, it is important to discuss the options for locating the vascular anastomoses with the transplant surgeon. Typically, these would involve either...