Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What adjuvant treatment would you offer a patient who underwent cystoprostatectomy for a muscle invasive bladder cancer and discovered to also have prostate cancer?
Complex case. If they have an indication for prostate RT (major: positive LN, persistent PSA, +SVI, minor: + margins, +ECE), I would consider treating the prostate fossa +/- LNs. As far as the bladder, we don't have the answer yet, but high-risk patients are being studied on the BART study from Tata...
Will you offer olaparib + abiraterone for all patients with metastatic castrate resistant prostate cancer based on results of PROPEL trial?
PROpel is clearly positive for its primary endpoint of delaying rPFS significantly in ALL first line mCRPC patients above and beyond abiraterone and prednisone alone. The delay of 8-10 months over an active comparator is significant both statistically and clinically, and is similar to the improvemen...
When is the ideal time to start adjuvant nivolumab after radical surgery in urothelial carcinoma?
In the reported and ongoing adjuvant therapy trials, patients must have had radical surgery (R0, with negative surgical margins) within 120 days before randomization. However, it is biologically rational to target initiating therapy as soon as he/she is fit for nivolumab following surgery (data in t...
Is there a role for cinacalcet suppression testing when evaluating patients for suspected primary hyperparathyroidism who also have recurrent calcium containing kidney stone disease?
I understand the physiology upon which the cinacalcet suppression test is based. However, I have not used it in my practice. Once I see a discordant result between a parathyroid hormone level and its main determinants: serum calcium, phosphorus, and vitamin D (or 1, 25-vitamin-D), I use a sestamibi ...
Given the different rates of testosterone recovery, do you alter the duration of ADT when using Leuprorelin (GnRH Agonist) vs relugolix (GnRH antagonist) in patients with intermediate or high-risk prostate cancer who received definitive radiation?
To my knowledge, there is no definitive answer to this question, and I think the vast majority of providers do not alter their recommendations for duration. A brief discussion of the issue and some evidence is offered below, for anyone interested. A recent review in the Red Journal (Roy et al., PMID...
How do you manage prostatic adenocarcinoma after a subtotal resection?
This is a complex question with many permutations, and a review of the operative note in addition to the surgical pathology can help to inform clinical decision-making. Direct discussion with the surgeon, when possible, is also important because presumably there is some reason this occurred, which m...
How do you approach a patient with stoma bag adhesive allergic contact dermatitis?
To keep the area dry, I have patients use Cavilon spray and Skins, an antimicrobial spray.
How would you treat a synchronous anal canal squamous cell carcinoma and localized high risk prostate adenocarcinoma?
The primary anal cancer and prostate cancer can be treated with a whole pelvic field to include the anus and prostate/SV (45-50 Gy) with a simultaneous integrated boost for the anal tumor (RTOG 0529). HDR brachytherapy can then be used to boost the prostate after a short recovery from the external b...
Are there any varying treatment considerations to make when managing patients with carbonate apatite versus hydroxyapatite kidney stones?
Both of these stone types require a relatively alkaline urine to crystallize. Not surprisingly, they are often found in combination within the same stone. My diagnostic and treatment considerations do not depend on which mineral composition predominates. Stephen B Erickson, MD
Is there a role of definitive radiation or prostatectomy, in a patient who has M0 castrate resistant prostate cancer and whose PSA is undetectable on ADT and enzulatamide?
The question posed comes from a rather unusual clinical situation. In most cases, M0 crpc would have evolved from a diagnosis of prostate cancer and the application of curative intent local therapy surgery/radiotherapy, with psa progression in the absence of metastatic disease managed with ADT now w...