Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is your approach to managing patients with recurrent nephrolithiasis and nephrocalcinosis in the setting of hypoparathyroidism?
If patients truly have hypoparathyroidism, then the issue is to manage their hypocalemia, which usually requires large doses of oral calcium as well as treatment with VDRAs, which results in marked hypercalciuria, since they do not have PTH to help reabsorb calcium. This even occurs when they have C...
How does Decipher score inform your practice for treating pelvic nodes in otherwise favorable intermediate risk prostate cancer?
Nodal radiation therapy in prostate cancer remains controversial. While the Decipher score correlates with lymph node involvement in pathological specimens, I have not used it to decide on pelvic nodal radiation. Two randomized studies failed to show a benefit to pelvic radiation (old studies with i...
How would you manage asymptomatic radiographic progression from M0 CRPC to M1 CRPC to bone?
This is a relatively common scenario presently where the M0-->M1 transition is now occurring during potent AR inhibition in the nmCRPC setting. In general, I manage patients similarly to mCRPC patients progressing on an AR inhibitor and consider factors such as 1) pace of disease and symptoms, 2) co...
How are you using the Decipher score in the definitive setting for prostate cancer?
This is an excellent question.Before I can answer the question directly, you must ask yourself how do you currently decide who to give ADT to with RT?The easy answer is that you use RCTs to choose who to give short-term and long-term ADT to. However, I wish it was that easy.Lets take RTOG 9408- It i...
Is REZUM (water vapor thermotherapy for BPH) safe after EBRT?
Although I am not aware of any studies evaluating the toxicity rates in patients undergoing REZUM after RT, I am aware of a few studies reporting the toxicity of TURP after RT. For example, Liu and colleagues conducted a retrospective review of the outcomes of 1,192 patients, 246 of whom underwent a...
What is your preferred mode of vascular access for testicular cancer regimens?
Actually, we try to avoid all vascular access devices, especially PORT, which causes a 10-20% risk for clot as well as infection. These are young healthy patients usually with excellent veins. Over 90% of our large patient populations with testis cancer simply get their 5 days of chemo with a restar...
What is the preferred steroid regimen for metastatic prostate cancer patients on docetaxel?
TAX 327 (Tannock Et al NEJM 2004) used prednisone 5 mg bid in all patients (Q3 week Docetaxel and weekly Docetaxel). In addition, patients received dexamethasone 8 mg 3 times (12, 3, and 1 hour) before infusion. The prior phase 2 studies did not include prednisone with Docetaxel. Historically, low-d...
Do you hold or dose modify chemotherapy with BEP or EP for severe cytopenia or renal injury when treating testicular cancer in the curative setting?
No. In terms of cytopenias on day 22, it is usually granulocytopenia that concerns treaters. I look at the CBC and you will usually see a left shift c/w rapid recovery. If one is very concerned, you can add a granulocyte stimulating factor for this cycle. In terms of renal function, I would again ...
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
Erythrocytosis is a common adverse effect of testosterone therapy, and results from several studies suggest an association between elevated hematocrit (Hct) and risk of VTE (Braekkan et al., PMID 19833630; Ory et al., PMID 35050717). There is currently no data to support the routine use of aspirin o...
How would you treat a patient with metastatic Leydig cell tumor of the testes with extensive lung and abdominal metastases (peritoneum, retroperitoneal LN and soft tissue) following orchiectomy and maximal surgical resection of abdominal disease?
Nongerm cell tumors of the testis ( Leydig, Sertoli or sex cord stromal tumors) are not curable when metastatic when they are inoperable, as the case here. I would sequence his tumor to check for a targetable mutation, but this would provide a less toxic and hopefully more effective alternative to c...