Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is your approach to the treatment of metastatic renal cell carcinoma with unclassified histology?
The key to managing unclassified renal cell carcinoma is to obtain a detailed histological and molecular characterization. Clarify with pathologist(s) regarding unclassified nature - are there some features characterizing the tumor as being of a recognizable subtype? Next generation sequencing to de...
How would you treat high grade urothelial carcinoma of the prostate with only HGUC with CIS in bladder?
The optimal peri-operative systemic therapy for non-contiguous UC involving the prostate is unclear due to lack of high-quality prospective data. One key aspect of staging and evaluation would be to further evaluate the depth of involvement and exclude stromal involvement by the prostatic UC. Prior ...
What is the best approach to organ confined squamous cell cancer of the prostate?
This is a very unusual situation in the US and other developed countries. Most of the patients with this histology tend to have other chronic illnesses to the pelvis prompting the development of this chronic inflammatory driven disease. As such, they can represent difficult situations to treat. From...
For a young patient with small cell bladder cancer, what would you recommend following cisplatin + etoposide, if scans show no evidence of distant disease and repeat TURBT shows no malignancy?
We would proceed with locoregional definitive therapy with either radical cystectomy & PLND or (chemo)radiation. Would not rely on TURBT alone. Limited datasets from MDACC slightly favor radical cystectomy but there is no high level evidence comparing surgical vs (chemo)radiation consolidation strat...
Would you use pembrolizumab to treat patients with BCG-refractory Ta or T1 NMIBC without CIS?
Pembrolizumab FDA-approved indication includes BCG-unresponsive CIS with or without papillary tumor in patients who refuse or cannot undergo radical cystectomy based on the cohort A of KEYNOTE-057 trial. The question of data extrapolation to BCG-unresponsive Ta or T1 without CIS is a reasonable one....
Would you offer cytoreductive nephrectomy to a young, healthy patient with widely metastatic renal medullary carcinoma with partial response to cisplatin based chemotherapy?
This is a challenging situation due to the rapid growth of medullary renal cell carcinoma and the overarching need for systemic disease control with systemic therapy before considering any surgical intervention. We would want to see a deep response with chemotherapy, and some evidence of durability ...
How would you manage a patient who had salvage prostatectomy after cryotherapy failure and now has a rising PSA?
I would approach the decision to treat this case similarly to if the patient had never had cryo, counseling the patient that the risk of toxicity may potentially be somewhat higher.
Would you consider PARP inhibition in a patient with metastatic prostate cancer and a germline BRCA2 variant of unknown significance?
Over 90% of BRCA2 variants of undetermined significance in the past have been reclassified as benign variants, and thus VUS's should be treated as non-pathogenic and should not lead to a change in therapy and would not be predicted to be PARP responsive. It would be reasonable to confirm the signifi...
What treatment would you consider for metastatic urachal carcinoma following progression on FOLFOX and FOLFIRI?
Metastatic urachal adenocarcinoma is a challenging disease to treat with significant unmet needs. Initial therapy replicates therapy for metastatic colorectal adenocarcinoma and may include FOLFOX, FOLFIRI or FOLFOXIRI potentially combined with bevacizumab. Salvage therapy may include 1) trials (gui...
Do you recommend ADT for all patients who are unfavorable intermediate risk prostate cancer?
I recommend ADT for unfavorable intermediate risk patients who are not treated with a brachy boost. ADT is probably unnecessary for those treated with brachy boost. Of course, I also take into account the patient's concerns and preferences regarding sexuality, cardiac risk, and desire for maximal tr...