Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you use pembrolizumab to treat patients with BCG-refractory Ta or T1 NMIBC without CIS?
Pembrolizumab FDA-approved indication includes BCG-unresponsive CIS with or without papillary tumor in patients who refuse or cannot undergo radical cystectomy based on the cohort A of KEYNOTE-057 trial. The question of data extrapolation to BCG-unresponsive Ta or T1 without CIS is a reasonable one....
How would use of adjuvant pembrolizumab after nephrectomy for ccRCC impact your treatment choice for metastatic recurrence?
I think treatment selection after recurrence/metastases will depend on the timing after adjuvant pembrolizumab has been completed. If it's about 9 months or more, I think re-challenge with pure IO/IO combination is fair, especially if a patient tolerated pembrolizumab well. If it's within 3-6 months...
Would you offer cytoreductive nephrectomy to a young, healthy patient with widely metastatic renal medullary carcinoma with partial response to cisplatin based chemotherapy?
This is a challenging situation due to the rapid growth of medullary renal cell carcinoma and the overarching need for systemic disease control with systemic therapy before considering any surgical intervention. We would want to see a deep response with chemotherapy, and some evidence of durability ...
How would you manage a patient who had salvage prostatectomy after cryotherapy failure and now has a rising PSA?
I would approach the decision to treat this case similarly to if the patient had never had cryo, counseling the patient that the risk of toxicity may potentially be somewhat higher.
Would you consider PARP inhibition in a patient with metastatic prostate cancer and a germline BRCA2 variant of unknown significance?
Over 90% of BRCA2 variants of undetermined significance in the past have been reclassified as benign variants, and thus VUS's should be treated as non-pathogenic and should not lead to a change in therapy and would not be predicted to be PARP responsive. It would be reasonable to confirm the signifi...
What treatment would you consider for metastatic urachal carcinoma following progression on FOLFOX and FOLFIRI?
Metastatic urachal adenocarcinoma is a challenging disease to treat with significant unmet needs. Initial therapy replicates therapy for metastatic colorectal adenocarcinoma and may include FOLFOX, FOLFIRI or FOLFOXIRI potentially combined with bevacizumab. Salvage therapy may include 1) trials (gui...
Do you recommend ADT for all patients who are unfavorable intermediate risk prostate cancer?
I recommend ADT for unfavorable intermediate risk patients who are not treated with a brachy boost. ADT is probably unnecessary for those treated with brachy boost. Of course, I also take into account the patient's concerns and preferences regarding sexuality, cardiac risk, and desire for maximal tr...
How would you treat a patient with metastatic RCC and significant baseline proteinuria after progression on immunotherapy?
- Tough situation no doubt. I would look for actionable genomic aberrations on NGS though limited in ccRCC. - Consult with a nephrologist and depending on severity of proteinuria, closely monitor proteinuria (urine checks as well as serum protein/albumin levels) with use of VEGFRi (short-acting ones...
Would you give EP to a patient with Stage I testicular nonseminoma with risk factors (LVI and 90% embryonal), who is not a candidate for bleomycin?
Personally, I would not and there are no strong clinical data supporting that approach in CSI NS. First if given, adjuvant chemotherapy for CSI NS with high risk features is BEP X1 if you ask what approach has the largest database, most mature results, and reporting of relapse and toxicity. (SWENOTE...
How would you treat a patient with new isolated enlarged lymph node <6 months after RPLND with prior pT2NX non-seminoma treated with orchiectomy then RPLND within 1 year due to nodal metastases?
If the patient were marker negative and the node was relatively small, I would probably just repeat imaging in 8 weeks to see what was happening. If the markers were definitively rising, I probably would proceed with BEP X 3. I do not typically recommend a re-do primary RPLND. Also, a lot would depe...