Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you consider adding abiraterone or docetaxel in patients with high risk prostate cancer whose PSA does not become undetectable after ADT and radiotherapy with castrate level testosterone?
There are three concepts here at its core: Does adding abi or doce to ADT/RT in high-risk PCa improve outcomes in unselected patients? Does a detectable PSA while on ADT impact prognosis? Does intensifying therapy in patients with a detectable PSA while on ADT improve outcomes in this subset? Here a...
How do you define PSA progression after salvage or adjuvant prostate fossa radiotherapy?
This is an excellent question which in part mixes tradition, clinical practice, and the conduct of clinical trials both on-going and in the past. Fundamentally, from a clinical stand-point the definition of PSA failure should help manage the patient and improve outcome (prolong life, decrease harm s...
How do you approach treatment for a patient with an isolated perineal/pubic recurrence of penile SCC s/p definitive surgery?
This would be a case where multidisciplinary input would be very valuable including input from surgery, medical oncology, and radiology. An MRI may also be helpful to help better define the local extent of disease for the multidisciplinary evaluation, and I would try to get a PET/CT to aid in the as...
What could explain the contradictory results between CheckMate 274, IMvigor010, and AMBASSADOR?
The reasons for the discord between the results of IMvigor010 and CheckMate 274 are unclear and may be multifactorial. In the IMvigor010 trial, the primary endpoint of DFS was not met with adjuvant atezolizumab vs. observation in the ITT population (HR 0·89 [95% CI 0·74-1·08]; p=0·24). The median DF...
Do you perform routine interval screening for renal angiomyolipomas in patients with sporadic LAM?
The occurrence of angiomyolipomas (AMLs) in sporadic lymphangioleiomyomatosis (S-LAM) is less common compared to tuberous sclerosis complex-related LAM (TSC-LAM). One study showed that up to 50% of patients with S-LAM developed AMLs, whereas 100% of TSC-LAM patients were affected (Yeoh et al., PMID ...
Would you add an additional alkali medication for patients with recurrent uric acid nephrolithiasis who are on high doses of potassium citrate and continue to have acidic urine?
Maybe. My first concern is poor compliance with potassium citrate. I would like to see the patients home pH records. I strongly encourage patients on alkali therapy to test urine pH periodically, and more frequently if a dose adjustment appears to be needed. I prefer potassium citrate to sodium bica...
For patients with kidney stone disease and chronic kidney disease, is there an eGFR threshold at which you no longer recommend pursing 24 hour urine stone risk studies?
While I agree with Dr. Erickson's comments in general, though, I have encountered patients that newly presented for stone disease at late stages of CKD and even on dialysis. The critical consideration is whether there is evidence of ongoing stone formation/growth. We must be aware that a stone passa...
How do you approach hematuria in a patient with diabetic nephropathy?
This is a difficult question to answer. If young, no risk factors for GU malignancy and only microscopic hematuria would generally not pursue but make patient aware of small risk and make sure PCP also knows. Helpful to know if red cells are dysmorphic and if there is also proteinuria. Gross hematur...
Would you recommend a SGLT2i for a non-diabetic patient with recurrent uric acid or calcium phosphate nephrolithiasis?
No. A major risk factor for uric acid stones is low urine pH. A major risk factor for calcium phosphate (as opposed to calcium oxalate) stones is high urine pH. I am not aware that SGLT2 inhibitors substantially change urine pH. Stephen B. Erickson, MD
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...