Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you treat metastatic collecting duct carcinoma of the kidney in the first line setting?
As is the case with all extremely rare neoplams we operate in a nearly completely data free zone. This is a highly aggressive, lethal neoplasm. Cisplatin-based chemotherapy has some, albeit limited activity, thus gemcitabine/cisplatin is reasonable initial therapy if renal function is adequate. I wo...
Do you recommend dosing potassium citrate three times or two times daily for patients with recurrent calcium oxalate nephrolithiasis and hypocitraturia?
I recommend twice daily dosing to help with compliance. I monitor 24-hour urine citrate and increase the dose rather than frequency if adequate urine levels are not achieved. Stephen B. Erickson, MD
Does low Decipher score alter your duration of ADT for a high risk prostate cancer patient?
This question contains a few very important concepts that I think most of us were not trained to appreciate (I wasn't) that I will try to expand on: What truly is an NCCN risk group and what is its importance? How to incorporate more accurate prognostic biomarkers? While it may sound odd to some to...
How do you treat metastatic large cell neuroendocrine carcinoma of prostate with undetectable PSA, who had the treatment related transformation while on ADT monotherapy?
Treatment-emergent (or extra-pulmonary) high-grade neuroendocrine carcinoma (sometimes labeled HG-NEC or EP-NEC) is an increasingly seen phenomenon with the more widespread use of ARSI in the first-line setting. This is a distinct entity from prostate adenocarcinoma with neuroendocrine differentiati...
Do you offer adjuvant pembrolizumab post metachronous oligometastatic resection of RCC beyond the first year of diagnosis?
For patients with recurrence beyond 1 year of initial nephrectomy, I would not offer post metastasectomy pembrolizumab. Such patients would usually belong to the IMDC favorable risk category at the time of recurrence and could have a continued disease free interval post metastasectomy based on sever...
What is your preferred approach to low volume unresectable/metastatic favorable risk RCC?
For good-risk metastatic RCC patients, who are considered not a candidate for cytoreductive nephrectomy, systemic therapy with one of the IO/TKI combinations is indicated, taking into consideration the patient’s comorbidity and tolerance to the regimen. (For non-clear cell metastatic RCCs, systemic ...
How would you approach subtotal resection of a sarcoma of the scrotum/groin with grossly positive margin at the base of the penis?
These are clinically challenging situations. I would image to see if there is gross vs. microscopic disease. I would also have a surgical colleague evaluate to see if re-resection is possible to remove gross disease if present and obtain negative margins. With respect to adjuvant radiation, histolog...
How do you approach prevention of kidney stones in patients with an ileal diversion and recurrent nephrolithiasis?
My first step, is to perform a kidney stone analysis. Kidney stones are not a "monolithic" disorder; rather they are "symptoms" of a diverse group of renal mineral metabolism and acid-base disorders. my next step in this case would be to obtain a 24-hour urine supersaturation study. I would be parti...
What is your approach to weight loss interventions for patients with recurrent nephrolithiasis and obesity?
Obesity tends to be a little more common in stone formers. Integrating weight loss with stone prevention features can be tricky. We are fortunate to have a dietitian dedicated to our Stone Clinic and I rely heavily upon her expertise. More fluid, preferably water, and a diet tailored to the patient’...
Has use of PSMA PETCT revealed increased local failures than previously known after definitive prostate EBRT with biochemical failure?
Prior to the advent of PET imaging, the published rates of local recurrence (LR) after definitive RT vary widely in phase III trials from ≈ 1% (e.g., PCS IV) to ≈ 30% (e.g., PROG 9509). The heterogeneity is likely explained by several factors including (1) differences in baseline risk of local recur...