Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Does your recommendation for ADT change in an elderly patient with dementia and high risk prostate cancer?
Thank you for this question. There have been publications that have shown the association of ADT and cognitive decline. Probably one of the most robust studies was published in 2017 (Nead et al., PMID 27737437) in which the effect of ADT on dementia risk was assessed using propensity score-matched m...
What oral alternatives would you recommend as opposed to injectable GnRH agonists for those who do not wish to come to clinic due to COVID-19?
Casodex is an option. Due to liver toxicity, they would need LFTs checked before and at a future interval, effectively requiring them 3 visits to a health care facility—labs, pharmacy, labs. A single 6 month injection seems like a better proposition.
Would you consider a cisplatin-based regimen with hypofractionated radiation for bladder cancer?
Yes, with bladder only RT almost any chemo regimen is acceptable, including cisplatinum, Gemzar, or 5FU and MMC.
Would you offer immunotherapy for a patient with a history of kidney transplant on immunosuppression who has clear cell RCC in the native kidney?
While data to address this question remains retrospective in nature, a number of small series suggest a very high solid organ rejection rate (37-41%) and worrisome morality rates in the 40+% range. Fully understanding the potential for survival benefit from ipi/nivo or pem/axi, I would be inclined t...
What is your treatment approach for metastatic squamous carcinoma of the prostate?
There are limited data to guide the management of metastatic squamous cell cancer of the prostate. Outside clinical trials, I have typically treated patients extrapolating from squamous cell cancer of the lung /head and neck literature and have seen responses with gem and cisplatin, 5 FU, pembrolizu...
How do you approach a patient with ATM mutation with prostate cancer?
This is a good guide for a radiation oncologist suggesting no contraindication to RT, with a possible small increase in second cancer (most data based on breast cancer).
Would you offer neoadjuvant chemotherapy to a patient with muscle-invasive enteric adenocarcinoma of the bladder?
Do you adjust PSA for finasteride use when determining prostate cancer stage and risk category?
We generally use the rule of 50% (real PSA is twice the lab value when on Finasteride).
Will you be recommending relugolix due to rapid suppression of testosterone and lower risk of cardiovascular events?
Once FDA approved, it will be an option; but I'm not sure what the cost to the patient will be, as it is an oral drug and that may be a limiting factor.
Which genomic test do you use when considering active surveillance in prostate cancer?
As a prologue, molecular expression features, often grouped into "panels" with mathematical models for outcome estimation, can be useful to help patients and clinicians determine whether historical (often still standard) clinicopathological features don't under- or over-estimate risk of clinical sig...