Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Do you consider ADT intensification with enzalutamide or abiraterone in patients receiving adjuvant radiation with ADT?
I agree with Dr. @Dr. First Last.One thing to note is ~3% of RADICALS, for example, included pT3b and high grade disease, and almost no patients in the ART vs SRT trials had N+ disease. Was largely GS7 and pT3a population and not the very high risk patients that select surgeons choose to operate on....
What is your approach to using calcium containing medications for patients with recurrent nephrolithiasis and hyperoxaluria?
Depending on their 24 hour urine, I suggest taking calcium with meals to bind oxalate and follow 24 hour urines.
Do you recommend CT or ultrasound imaging testing when monitoring a patient with nephrocalcinosis?
I recommend CT. It is much more sensitive for detecting small changes in calcification than US. Yes, it is more expensive and requires a small amount of radiation, but if monitoring is indicated, I think sensitivity is most important. Stephen B. Erickson, MD
In a patient undergoing neoadjuvant 177Lu-PNT2002 + MDT for oligorecurrent prostate cancer as per the LUNAR trial, what are the implications for other escalated systemic therapies with ARPIs/chemotherapy, which may otherwise be used concurrent with ADT in this population?
The LUNAR approach was designed for men who did not want to have hormone therapy. It is true that hormone therapy, either via ADT, ARPI, or both, could be added to MDT as well. The RADIOSA trial did show that PFS was improved with 6 months of ADT added to MDT. However, in RADIOSA, the eugonadal PFS ...
Would you consider adding abiraterone to ADT and salvage RT in a prostate cancer patient with pN1 disease at radical prostatectomy?
This is a question that is being addressed in the salvage setting by NRG GU008. Currently, we have high level evidence that adding abiraterone to ADT is superior to ADT alone for subsets of patients with metastatic disease and the combination with RT is superior to ADT alone plus RT for both clinica...
When do you find ultrasound guidance to be most helpful for botulinum toxin injection?
I occasionally use ultrasound to survey the target muscle and neighboring structures such as blood vessels. I find this most helpful in the groin area or abdomen. The main difficulties with ultrasound relate to maintaining aseptic technique and needing an extra hand to control the probe in some situ...
Would you use fezolinetant for hot flashes for men on ADT?
I might consider it after trying the usual agents that will at least partially relieve symptoms in the majority of patients, such as low-dose megestrol or venlafaxine (there are others, but these are the ones with which I have had the most experience and success). Fezolinetant is expensive and requi...
What are your top takeaways in GU Cancers from ASCO 2024?
KEYNOTE-361 trial, Abstract 4518 - Quantitative circulating tumor DNA (ctDNA) assessment in patients (pts) with advanced urothelial carcinoma (UC) treated with pembrolizumab (pembro) or platinum-based chemotherapy (chemo) from the phase 3 KEYNOTE-361 trial. -- This is particularly important as it...
How would you treat a patient with muscle invasive urothelial carcinoma with squamous differentiation?
In general, pure and predominant urothelial carcinoma (majority or >50% of tumor consisting of urothelial carcinoma) have been treated similarly at least in trials. Patients with predominant or pure non-urothelial histology have typically not been enrolled in trials of urothelial carcinoma. There ar...
Is there a serum potassium level for when you would recommend discontinuing potassium citrate in a patient with recurrent nephrolithiasis, hypocitraturia, and hyperkalemia?
I take hyperkalemia seriously, as cardiac effects do not correlate closely with serum levels. If evaluation does not reveal a correctable cause, I would decrease potassium citrate dosage to keep serum potassium below 5.0. Stephen B. Erickson, MD