Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
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-...
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...