Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
In patients who initially received chemo-hormonal first-line therapy for metastatic prostate cancer followed by abiraterone/enzalutamide for castration-resistant disease, would you re-challenge with docetaxel?
As we all know, very few things regarding therapeutic sequencing in prostate cancer are straightforward. Retreatment with docetaxel was used relatively commonly in the past in patients with mcrpc, especially in those with good initial responses primarily for want of other agents. In this setting, re...
What adjuvant treatment would you use for a cisplatin ineligible, node positive, upper tract urothelial cancer patient after radical nephroureterectomy?
Based on the recent POUT trial, there is no benefit in substituting cisplatin with carboplatin. In fact, node positive patients tended to do worse even with chemotherapy. I routinely consider adjuvant IO trials for these patients like AMBASSADOR. If patient is not able to participate in trials, it m...
Are you using prostate PET imaging for any newly-diagnosed prostate cancers?
December 2021 Update:In 2 years since this original post, a lot has changed. Two different PSMA PET/CT companies have gained FDA approval with broad indications that include the use in newly diagnosed men at risk for harboring metastatic disease. Distribution is well underway with many centers now h...
Would a history of receiving green light laser therapy for BPH change your management of newly diagnosed prostate cancer?
Your intervention will depend on his prostate cancer risk group, if he has a 'huge' prostate still, and bothersome LUTS. It will also depend on if you are in the private sector, or in institutional / academic setting, too. For some, the risk of prior "TURP" like procedures are a contraindication for...
Would you treat prostate cancer with hormone sensitive metastatic recurrence (after local treatment) the same as de novo metastatic hormone sensitive disease?
Yes, most of the phase 3 trials (ARCHES, ENZAMET, TITAN, STAMPEDE) permitted relapsed mHSPC patients in addition to de novo mHSPC patients. LATITUDE was the only trial that required newly diagnosed patients with mHSPC. For the AR inhibitors, a similar benefit in delaying radiographic progression or ...
How do you treat metastatic renal cell carcinoma with unclassified histology without sarcomatoid features?
There is limited data on optimal treatment of advanced non-clear cell RCC in general, including unclassified RCC. I have summarized the available data that I am aware of: The phase II study ASPEN randomized advanced nccRCC patients, including 20% with unclassified RCC, to sunitinib vs everolimus. Of...
How do you approach rectal spacer for the patient with renal failure?
Have not come across this but I would presume it would be filtered with dialysis in pts with renal failure.
How would you manage simultaneous muscle invasive bladder cancer and intermediate or high risk prostate cancer in a patient who refuses surgery?
When I'm faced with a situation like this, with 2 concurrent pelvic malignancies, I like to think about how I would manage each one independent of the other and then try to design a plan that incorporates management principals of both diseases. You also have to consider how treating both concurrentl...
What factors affect your decisions in in the initial management of a stage IIIB bladder cancer?
For cN+ bladder Ca, I start with induction chemotherapy aiming for 4-6 cycles (restaging initially after 3 cycles and continue to 1-3 more cycles depending on response & tolerance) since the risk of micro-Mets is exceedingly high. If a patient has a great response to induction chemo, options may be ...
Given the superiority of ADT+enzalutamide over ADT alone demonstrated in the ARCHES and PROSPER trials, would you recommend it in the definitive setting for men with high-risk castrate-sensitive prostate cancer?
The quick answer is: No.There is no level 1 evidence that next gen AR-signaling inhibitors (ASI) improve DMFS or OS in high risk localized prostate cancer. Multiple trials are ongoing or maturing in followup, nearly all in combination with RT.Given that most contemporary high risk studies show ~10% ...