Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Is weekly Cisplatin considered a valid alternative to Cisplatin cycles every 3 weeks as part of definitive chemo-radiation for muscle invasive bladder cancer?
None of the RTOG trials had this approach, but extrapolating from head and neck cancer (cisplatin 30mg/m2) or cervical cancer (40mg/m2), people in the community are using weekly cisplatin. As far as data, there is a phase II study from Australia utilizing cisplatin 35mg/m2 weekly for 6-7 cycles show...
What is the best approach to management of newly diagnosed intermediate or high risk prostate cancer in a patient with high grade non-muscle invasive bladder cancer?
Perhaps the term "Best Approach" should be eyed with skepticism in the field of genitourinary radiation oncology. Is there extensive disease in the bladder, focal recurrences, or no visualizable lesions? The maintenance BCG element of the question suggests the patient has minimal measurable disease ...
What is the appropriate management of Stage 0 (testicular intratubular neoplasia) of the testicle?
For patients with ipsilateral TIN, usually one performs orchiectomy. This may be diagnosed as part of an infertility work up, as these patients often have primary infertility and atrophic testis. The issue of RT comes for patients with previous orchiectomy and then develop contralateral TIN. For the...
What is the best toxicity data to quote to patients for prostate IMRT vs nerve-sparing prostatectomy?
The surgery vs. RT question is a common one during a “2nd opinion†consultation with radiation oncology. More and more comparative data are being published regarding disease outcomes but many fewer exist regarding toxicity. I often hand out a copy of Sanda et al, NEJM 2008, which reports on qual...
At what PSA do you start calculating doubling time post-prostatectomy?
The problem you describe, I think, also applies to standard assays when values are at or near the limits of detectability. Is an increase from 0.1 to 0.2 in 3 months really indicative of a rapid rise? If you are seeing small changes at low PSA values, and you're not inclined to treat the patient, yo...
How do you manage high risk prostate cancer patients with well controlled Crohn's disease?
My first choice would be to manage them without the use of radiation therapy. A minority of patients with high risk disease are curable with surgery, and the population with inflammatory bowel disease is one that I tend to steer away from radiation therapy. Despite the adverse prognostic features of...
How long should the duration of hormones be in post-prostatectomy patients receiving salvage RT?
That depends upon why you are giving the ADT. If you think it is just to improve local control in the prostate bed then 6 months should be more than enough. If it is to address micrometastatic disease, then to be consistent with other precedents, it should be two years. An RTOG trial looking at salv...
Should enzalutamide be given concurrently with Sip-T in castration-resistant metastatic prostate cancer?
In the phase 3 trial of sip-T, enzalutamide was not available, and concurrent therapy with anti-androgens was not permitted. In fact, all patients were required to be progressing on ADT and prior therapies to be eligible, and additional anti-cancer therapy beyond the sip-T and concurrent ADT was not...
What imaging workup should be completed in patients with a detectable PSA following prostatectomy?
The imaging work-up of recurrent prostate cancer is a topic of considerable interest. Our approach at UCLA has been to recommend, at the very least, a multiparametric MRI to evaluate for locoregional recurrence, and we regularly recommend a technetium bone scan as well. That being stated, we have be...
Would you treat a muscle invasive urethral recurrence of bladder cancer with definitive chemoradiation?
Assuming that the urethral tumor is invasive of the prostatic stroma, there are multiple reasonable answers depending upon the patient's age and health status. Remember that stromal invasion is a bad sign and these patients are rarely cured. If the patient is young, but reluctant to consider cystopr...