Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you manage significant fatigue caused by androgen deprivation therapy in prostate cancer patients?
This is a great question and one that I think comes up regularly in the clinic. The fatigue often is due to the hypogonadal state, lack of muscle mass and subsequent loss of muscle power that may reduce stamina. I generally recommend a regular activity or exercise program. As in many other patient p...
Do you perform a bone health assessment in men who will be receiving short term androgen deprivation for localized prostate cancer?
I do not order bone densitometry on patients I am treating with short term (<= 6 months) of AD, unless they have a risk factor like long-term glucocorticoid use or prior fracture. For patients I am treating with long term >=18 months I perform a baseline bone densitometry. If that is normal-mild ost...
What is your preferred regimen for metastatic bladder adenocarcinoma?
Clinical trials, e.g. ICONIC (PI: Dr. Andrea Apolo) would be very interesting if slots are available. Outside trials, would consider FOLFOX (or FOLFIRI if neuropathy is an issue) as a 'colorectal-like' regimen (GI Med Onc can help manage regimen based on their experience). Dr. Siefker-Radtke had a t...
What is the best treatment regimen for a fungating SCCa of the scrotum arising from untreated genital warts invading the groin and base of the penis with bilateral inguinal nodes?
This is a case where I would like to see the patient and the imaging before giving you my opinion. Management in this situation will take a multidisciplinary approach with med onc, urology, and possibly a colorectal surgeon being involved in addition to rad onc. I don’t think there is a single best ...
How would you approach a patient with Gleason 9 prostate cancer and regional lymphadenopathy as well as inguinal lymphadenopathy (M1a) but no bone metastases?
Definitely warrants a balanced discussion. Systemic therapy as the mainstay is definitely the right answer--long-term ADT for sure, at minimum. I think offering to treat the prostate with RT is fair, based on STAMPEDE. For a fit patient with good life expectancy, I would explain to the patient that ...
How would you manage prostate cancer with isolated presacral nodal metastasis?
Unfortunately, we can't really use RTOG 0521 to guide us here, as men with involved nodes detected by imaging were excluded. Also, according to the AJCC 8th edition staging manual, pre-sacral nodal involvement would be considered N1 rather than M1a, so although this man is at high risk for subsequen...
How would you manage a locally advanced TNBC and a malignant appearing renal mass suspicious for a synchronous renal cell carcinoma?
The answer to this question (in my view) depends largely on the extent of the renal cell carcinoma. Historically, renal cell carcinoma is still managed largely by up front surgical resection. If the suspected second primary were small and the oncologist felt like close observation was possible, one ...
What is a safe time interval from completion of hormones and external beam radiation to TURP in patients who develop refractory obstruction?
Great question. Ordinarily, in my past experience, if a patient had real LUTS >14 AUA score that was not relieved with alpha blockers, and/or had a large median lobe, we would prefer the TURP be done upfront and / or chemical debulking with ADT too. In these instances, we found we had less LUTS then...
For localized prostate cancer patients, do you routinely give antiandrogen therapy for patients receiving LHRH agonist therapy?
Although studies have given anti androgen for variable period of 4 weeks to 6 months, we use it only to suppress testosterone flare.
What is your approach to imaging for localization of biochemical relapse of prostate cancer after radical prostatectomy?
This is a complex question without a short answer. Men with a very low PSA of less than 0.5 have clear benefits from salvage RT after prostatectomy, particularly if they have T3 disease or positive margins; and these patients rarely have PET positive disease, even with PSMA or Axumin imaging. Thus t...