Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you give adjuvant therapy for a urothelial carcinoma T2 on TURBT but pTis at margins on cystectomy?
No, this patient would be followed by active surveillance based on NCCN guidelines, e.g. visits, labs, urine cytology, CT chest, CT IVP; would pay attention for any symptoms to upper tract and urethra that may trigger further evaluation. Would discuss with Urologist & Pathologist about the case, the...
How do you treat localized prostate cancer with neuroendocrine differentiation?
Most hybrid or pure NEPC tumors lack PSMA expression as only 1/3 of metastatic NEPC tumors are PSMA PET+ and expression is typically very heterogeneous. For this reason, an FDG PET/CT would likely be a better staging test for this aggressive variant of prostate cancer. If this is also N0M0, RP is my...
Will you consider adding an AR targeted agent to ADT for a patient thought to have isolated pelvic nodal recurrence of prostate CA if next generation imaging reveals additional non-regional disease not seen on conventional imaging?
There are no formal prospective trials addressing the question of timing (i.e. initiation of systemic therapy) based on metastasis identified on molecular only imaging. The best data available is based on the three trials in non-metastatic castration-resistant prostate cancer (PROSPER, ARAMIS, and S...
How would you approach definitive treatment of intermediate-risk prostate cancer with baseline severe (AUA >25) urinary dysfunction and severe rheumatoid arthritis?
This case presented has a number of possible variables. First, does intermediate risk in this case, Gleason 7, 3+4, or 4+3 or some other set of variables making the case intermediate risk? That might change management in terms of use of ADT use, etc. However, the question's focus appears to ask for ...
How would you manage a patient with favorable intermediate prostate cancer patient who obtains a high Decipher test score at the end of their RT course?
Would favor adding 4-6 months of ADT.
How would you approach low grade non-invasive urothelial carcinoma arising from seminal vesicle and ejaculatory ducts with invasion into prostate?
Primary urothelial carcinoma of seminal vesicle is extremely rare. There is some skepticism whether this is a true entity. More common is the secondary spread from bladder primary. This can happen as a result of direct invasion through bladder wall or via mucosal spread. Formal is staged as T4 disea...
What is your approach to the treatment of metastatic renal cell carcinoma with unclassified histology?
The key to managing unclassified renal cell carcinoma is to obtain a detailed histological and molecular characterization. Clarify with pathologist(s) regarding unclassified nature - are there some features characterizing the tumor as being of a recognizable subtype? Next generation sequencing to de...
How would you treat high grade urothelial carcinoma of the prostate with only HGUC with CIS in bladder?
The optimal peri-operative systemic therapy for non-contiguous UC involving the prostate is unclear due to lack of high-quality prospective data. One key aspect of staging and evaluation would be to further evaluate the depth of involvement and exclude stromal involvement by the prostatic UC. Prior ...
What is the best approach to organ confined squamous cell cancer of the prostate?
This is a very unusual situation in the US and other developed countries. Most of the patients with this histology tend to have other chronic illnesses to the pelvis prompting the development of this chronic inflammatory driven disease. As such, they can represent difficult situations to treat. From...
For a young patient with small cell bladder cancer, what would you recommend following cisplatin + etoposide, if scans show no evidence of distant disease and repeat TURBT shows no malignancy?
We would proceed with locoregional definitive therapy with either radical cystectomy & PLND or (chemo)radiation. Would not rely on TURBT alone. Limited datasets from MDACC slightly favor radical cystectomy but there is no high level evidence comparing surgical vs (chemo)radiation consolidation strat...