Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you use maintenance avelumab for a patient with metastatic urothelial carcinoma who progressed on first-line pembrolizumab, then had stable disease after at least four cycles of second-line carboplatin plus gemcitabine?
Great question. I would suggest that if the patient progressed on prior PD-1/PD-L1 inhibition, the standard would be observation (as challenging as that may be in clinical practice!). At progression, would probably not offer checkpoint inhibitor and would instead favor novel therapies like enfortuma...
What is your preferred treatment approach for a patient who has prostate cancer with disease only in retroperitoneal nodes, experiencing rapid biochemical progression on abiraterone, and who was previously treated with an androgen receptor inhibitor while non-metastatic?
I would consider a non hormonal option for this patient. I advise germline/somatic testing to evaluate for DNA repair mutations that are present in 15-20% of the patients. If these are present, it identifies PARP inhibitor as an option. Rarely next generation sequencing may identify MSI-high disease...
For persistent localized muscle-invasive bladder cancer following chemoradiation in patients who are not surgical candidates, what is an appropriate next therapy?
For this situation, optimal therapy is unclear. However, assuming the patient did not achieve clinical CR or recurred within a year, following maximal TURBT (which can achieve remissions in up to 15% of untreated patients), systemic therapy may be considered while tailoring therapy based on previous...
Can hydrogel, SpaceOAR, placed interstitially for prostate cancer embolize to the lung?
I doubt that this could happen as the Precursor and Accelerator solidify rapidly. Moreover, when injected between the rectum and prostate as indicated, there would not be a clear vascular route for it to reach the lung. However, if the Precursor alone containing undissolved polyethylene glycol (PEG)...
For a patient on dialysis with metastatic clear cell renal cancer, what regimen would you use after front line immunotherapy?
For patients with ESRD on dialysis, prior data showed that pharmacokinetics of VEGF-TKIs in subjects with severe renal impairment were similar to those with normal renal function (Khosravan et al. 2010, Chen et al, 2016, Nguyen et al, 2016). Also, other retrospective studies showed safety of VEGF-TK...
How do you treat patients with newly diagnosed metastatic MiT Family Translocation Renal Cell Carcinoma?
The AREN1721 clinical trial is accepting patients of all ages with unresectable or metastatic TFE/translocation renal cell carcinoma (RCC). The tumors must have either TFE3 expression by immunohistochemical staining or evidence of a TFE3 or TFEB translocation. The three arm trial compares nivolumab,...
Is there a role for orchiectomy in a patient with stage IV DLBCL who presents with a testicular mass?
Primary testicular lymphoma, almost always DLBCL, is primarily a disease of older men. The typical presentation is an enlarging testicular mass. Patients are referred to Urology, an orchiectomy performed, and the diagnosis is confirmed. The patient then undergoes a PET-CT for staging. Many patients ...
Would you treat the prostate per STAMPEDE in a patient who has oligometastatic disease after cryotherapy?
I agree with Dr. @Dr. First Last. This is one of the few scenarios that radiation has shown to improve overall survival for men with prostate cancer so you would not want to take important therapy off the table.
Would you use neoadjuvant chemotherapy to treat a patient with NMIBC on TURBT pathology but with CT imaging suggestive of cT3 disease?
Clinical staging in bladder cancer can sometimes be challenging and not always clear. Repeat TURBT, esp. for T1 stage is a standard practice to reduce risk of under-staging, even if MP is present. CT IVP (ideally before TURBT to avoid "stranding" effect), exam under anesthesia, and TURBT may all hel...
Are there any clinical scenarios where you would recommend adjuvant docetaxel for localized prostate cancer?
This is quite a controversial topic and good for a tumor board discussion! The RTOG 0521 trial is the only trial to demonstrate a potential survival benefit with docetaxel in the adjuvant setting following radiation and in the setting of long term ADT. The absolute difference in OS at 4 years was 4%...