Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What chemotherapy do you use with radiation for urothelial carcinoma with squamous differentiation?
In case of primary or dominant urothelial carcinoma with squamous cell features, would approach similar to pure urothelial carcinoma and consider same radio-sensitizing chemo that we are using in S1806 phase III trial. Doses below may not fully reflect S1806 protocol and also depends on the patient ...
Is there any role for neoadjuvant chemotherapy in renal leiomyosarcoma?
Contributing factors in this decision would include size, feasibility of organ preservation, and patient's PS/organ function. The regimen with some activity would include the combination of doxorubicin and dacarbazine.
Would you consider addition of docetaxel to abiraterone and ADT in metastatic hormone senstive prostate cancer patients who progress on ADT and abiraterone?
The question is incorrectly phrased, when a patient progresses on ADT and Abi they are not hormone sensitive. In patients with high risk metastatic prostate cancer, I would not add docetaxel to abi and ADT yet as OS data has not matured. However, I do sequence them in a select group of high risk pat...
Would you treat a patient with non-clear cell renal cell carcinoma with nivolumab and ipilimumab?
In your experience, is there an association between interstitial cystitis and systemic lupus erythematosus?
There are reports of interstitial cystitis associated with lupus. I have had two patients with that combination, one that is particularly severe. Lupus may or may not be active at the time. There are case reports in the literature of different treatments to try as the standard drugs may not be effec...
How would you treat a prostate cancer with malignant priapism due to direct tumor extension?
Carefully! No seriously, this is a case where MRI imaging and the utilization of complete androgen blockade can make a big difference. Also coordination with urology. I've treated one patient in this circumstance, and luckily for him, he did get symptomatic relief with LHRH antagonist (which I would...
How would you approach therapy for a patient with non-seminomatous germ cell tumor, cT3N3Mx and symptomatic lower extremity thrombus extending to the IVC when it is unclear if bland or tumor thrombus?
This is not a common setting, but it is well described and high volume centers have fairly uniform approaches to patients presenting with caval thrombus. With the pre-orch HCG of 850, he is likely IGCCC good risk unless he is found to have brain or hepatic mets. He is likely non seminoma with a larg...
What are your top takeaways from ASCO GU 2022?
My top abstracts and questions that arise from them: 1) ARASENS with darolutamide in high volume de novo mHSPC showing an OS benefit with darolutamide over ADT/docetaxel. Will this pertain only to high volume/risk patients who are chemo-fit and de novo which seemed to comprise the vast majority of ...
Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?
No.
How would you approach a patient with resected renal cell carcinoma, collecting duct type with sarcomatoid and rhabdoid features?
Although sarcomatoid differentiation is more common in clear cell RCCs, it is also well described in other RCC subtypes, including collecting cell carcinoma. Some argue that collecting duct carcinoma is histologically and clinically closer to a urothelial carcinoma than an RCC subtype. Urothelial ca...