Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What treatment would you consider for small cell neuroendocrine carcinoma of the bladder with a metastatic recurrence within 3 months of neoadjuvant cisplatin/etoposide followed by radical cystectomy (ypT0N0)?
Very poor prognosis with early recurrence in a very aggressive histology despite pCR in the primary tumor reflecting tumor heterogeneity and implying platinum resistance in the recurrence tissue. Would evaluate NGS for potential “actionable” genomic alterations and also consider clinical trials (e.g...
How soon after completion of salvage RT to the prostate bed do you allow urethral dilation?
In my experience, anastomotic strictures do not resolve spontaneously or with treatment interruptions. In part, the answer to this question depends on how symptomatic the patient is and how close you are to the end of treatment. If the patient is totally obstructed or close to it, you're probably go...
How would you approach local control in a patient with extra-osseous metastatic Ewing sarcoma of the kidney?
I would follow general guidelines for Ewing sarcoma – if the tumor is completely resected, no RT. If spread outside post surgery, then would follow Ewing Sarcoma dosing guidelines.
How do you manage patients with oligometastatic renal cell carcinoma after nephrectomy and metastatectomy?
Patients with oligometastatic renal cell carcinoma after nephrectomy and metastatectomy or M1 NED represent a challenging subset of patients given the heterogeneous nature of this subset and outcomes vary with the location and timing of metastatectomy.Prior VEGF-TKI studies after metastasectomy for ...
When discussing prostate cancer treatment options, how do you address that surgery side effects are considered acute and radiation side-effects are long lasting?
Stress urinary incontinence as well as ED can last a lifetime after surgery. So, both have acute and late effects. Also since urologists don’t typically (never in my experience) order an MRI prostate, they can expose patients to additional surgical and adjuvant radiation toxicity. If I see a patient...
Would you change chemotherapy to VIP in a young patient with stage IIIB intermediate risk non-seminomatous germ cell tumor with borderline DLCO after one cycle of BEP?
I generally agree with Dr. @Dr. First Last. There is an Australian study showing that those with lower received doses of bleomycin had worse therapeutic outcomes.In truth, I do not do PFTs each cycle of therapy but do follow them closely with physical exam (lung auscultation for findings of fine ral...
When staging prostate cancer, does MRI pelvis/prostate replace CT A/P?
The NCCN guidelines and recent NRG protocols allow for either CT or MRI to stage the pelvis. Assuming the MRI includes imaging of the pelvic LNs, I am not aware of an added benefit of a CT. With the increasing use of novel imaging for staging such as PSMA PET (which can be more sensitive at detectin...
What chemotherapy do you use with radiation for urothelial carcinoma with squamous differentiation?
In case of primary or dominant urothelial carcinoma with squamous cell features, would approach similar to pure urothelial carcinoma and consider same radio-sensitizing chemo that we are using in S1806 phase III trial. Doses below may not fully reflect S1806 protocol and also depends on the patient ...
Is there any role for neoadjuvant chemotherapy in renal leiomyosarcoma?
Contributing factors in this decision would include size, feasibility of organ preservation, and patient's PS/organ function. The regimen with some activity would include the combination of doxorubicin and dacarbazine.
Would you consider addition of docetaxel to abiraterone and ADT in metastatic hormone senstive prostate cancer patients who progress on ADT and abiraterone?
The question is incorrectly phrased, when a patient progresses on ADT and Abi they are not hormone sensitive. In patients with high risk metastatic prostate cancer, I would not add docetaxel to abi and ADT yet as OS data has not matured. However, I do sequence them in a select group of high risk pat...