Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Is there a role for neoadjuvant chemotherapy in upper-tract urothelial carcinoma?
Very common scenario with significant variability in clinical practice. There is no standard high-level evidence as compared to muscle-invasive bladder urothelial cancer, in which neoadjuvant cisplatin-based chemotherapy is the standard of care for cisplatin-eligible patients. The literature lacks d...
Is there any indication for monitoring for renal medullary carcinoma in patients with sickle cell trait?
Hematuria occurs episodically in approximately 5% of people with sickle cell trait. Although often recurrent and sometimes producing anemia, the causes of hematuria are usually benign and it is self-limited. Medullary carcinoma of the kidney is a rare highly aggressive tumor that occurs almost exclu...
How do you approach increasing urinary citrate levels in a patient with recurrent calcium nephrolithiasis who has hypocitraturia, non-acidic urine, and normal serum bicarbonate levels?
For the patient you describe, I would start Moonstone and monitor serum electrolytes and 24 hour supersaturation as I increase the Moonstone dose to optimize treatment. I have no financial interest in this product. Stephen B. Erickson, MD
Do you recommend salvage XRT to the prostate bed in the setting of oligometastatic prostate cancer after RP?
In the setting of oligometastatic disease, we currently have reasonable evidence to treat gross disease. Following that logic, I treat the fossa if there is gross disease on imaging (preferably with biopsy confirmation). In the absence of compelling evidence for a local recurrence, I only treat the ...
Would you treat the prostate alone, or prostate and mets in an oligometastatic prostate cancer patient?
It's a good question and we are tempted to answer "prostate and mets" as the literature is building up, but we are still waiting for randomized phase III trials. The evidence so far suggests that stereotactic ablative radiotherapy (SABR) is promising. SABR-COMET trial has shown an improved OS for SA...
How do you approach rising PSA many years after prostatectomy with negative PSMA PET?
The devil is in the details. What is the status of the patient? In other words, what is the expected survival of the patient given his age, performance status, and medical conditions? There are online calculators that can be used to help. At what PSA value was the PSMA scan obtained? The utility of ...
Do you recommend Moonstone supplements for patients with recurrent calcium oxalate nephrolithiasis who have hypocitraturia and mild hyperkalemia for which potassium citrate is contraindicated?
First, my conflict of interest: I am one of the inventors of Moonstone so I do have a financial interest in sales of the product. But 30 mEq of Moonstone product has only 7 mEq of K, so I consider it a useful way of alkalinization if serum K is an issue. And only 10 mEq of Na, the rest Mg. By spread...
When would you recommend adjuvant radiation following cystectomy for urothelial bladder cancer?
Local-regional recurrence for patients with ≥pT3 disease after radical cystectomy is a significant problem (1) and warrants consideration of adjuvant radiation therapy in patients who are likely to tolerate such treatment. Chemotherapy has not been shown to reduce the risk of local-regional recurr...
What is your preferred initial systemic therapy approach to metastatic clear cell adenocarcinoma of the urethra (CCAU)?
Clear cell adenocarcinomas of the urethra are very rare tumors, and the cell of origin remains unclear. These may arise from the urothelial lining, or alternatively the peri urethral glads or other stromal tissues. Given its rarity, it is not surprising that no standard treatment for metastatic dise...
Will prior novel hormonal therapy affect when/how you use olaparib plus abiraterone for patients with BRCA-mutated metastatic castration resistant prostate cancer?
Yes, there is no clear data at this time that an AR/PARP inhibitor combination prolongs rPFS or OS in men with mCRPC who have progressed on a prior potent AR inhibitor, as largely these men were excluded or not included in PROpel, MAGNITUDE, or TALAPRO-2. For patients who develop mCRPC but have not ...