Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you treat a patient with ESRD on hemodialysis and penile cancer with neoadjuvant ifosfamide?
I do not have a particular expertise in penile cancer. My sense is that neoadjuvant therapy in general is not of proven value in penile cancer and, in someone like this with ESRD, likely to be more toxic than beneficial. The immunotherapy question is interesting, but there are no data to support suc...
What are the current recommendations for androgen blockade for patients undergoing salvage radiation after prostatectomy with PSAs between 0.6 and 1.5?
Just be a little careful here. Although Dr. Spratt did an amazing analysis and thorough presentation of the subgroups, one shouldn't look at PSA <=0.6 as a "cutoff". As Dr. Spratt pointed out in his presentation, the population on RTOG 9601 was mixed in terms of prognostic features.. Would you reall...
How would you treat a patient with poorly differentiated carcinoma with squamous differentiation of the kidney following nephrectomy with metastatic retroperitoneal adenopathy?
Unfortunately outcomes for patients with pure squamous cell carcinoma of urothelium do poorly with approaches that target urothelial type histologies. If surgical resection can render pt disease free with reasonable morbidity than may make sense. I agree with sequencing the tumor to identify perhaps...
In a patient with intermediate risk castration sensitive prostate cancer S/P prostectomy and now with biochemical recurrence + regional lymph node involvement 8 months post RP, would you do hormonal therapy (ADT or ADT+Abiraterone) with or without EBRT?
Yes, node positive (N1 M0) patients such as this were eligible for the STAMPEDE trial of ADT +\- abiraterone even in the relapsed setting after local therapy. These patients have both a disease free and overall survival advantage with abiraterone. See NCCN guidelines 2019.
How do you manage pelvic pain and hematuria due to recurrent high grade transitional cell bladder cancer who had received 70 Gy to bladder and is not a chemotherapy or surgical candidate?
It depends whether these symptoms are caused by radiation, recurrence, or both. One might not be able to distinguish. For hematuria I think a cystoscopy and focal fulguration if that is available to the patient, or else consider hyperbaric oxygen therapy, which may also improve pain (I don’t think h...
Would you skip adjuvant RT in post prostatectomy patients?
I suspect that once the paper is published and we get a chance to review the data that we may begin to hold off on routine use of adjuvant RT for prostate cancer patients after radical prostatectomy with higher risk features. That said, it should be noted that the study did randomize to early salvag...
Is there any role for "adjuvant" therapy for completely resected oligometastatic RCC?
The data re: adjuvant therapy for either high risk (bulky or node positive primary renal cell cancer) or completely resected metastatic renal cell cancer (either synchronous or metachronous) remains largely negative. Trials conducted with cytokines or with a variety of multi kinase inhibitors (sunit...
Would you recommend salvage RT in a patient who previously had prostatectomy for high risk prostate cancer who is no longer tolerating his intermittent hormonal therapy?
Why was hormone therapy started. BCr or adjuvant ? if adjuvant doesn’t need any treatment and just psa surveillance
Do you offer ADT in patients with intermediate risk prostate cancer who receive hypofractionated EBRT?
There is no good evidence that with different radiotherapy dose/fx or other RT modalities that the relative benefit of ADT is any different. This applies also to SBRT, brachy, and combo-brachy. The basic evidence and logic is as follows:1. ADT improves MFS and OS in multiple RCTs using lower dose co...
Should you offer radiation therapy to a low risk prostate cancer patient on active surveillance so that he may receive testosterone supplementation?
Great question. In my experience I can recall at least 3 or 4 patients who were subsequently dx'ed with PC after starting a testosterone supplementation.So, serious treatment and future considerations must be the matter of both doctor and patient in terms of the potential for tumor progression while...