Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you treat a patient with non-clear cell renal cell carcinoma with nivolumab and ipilimumab?
In your experience, is there an association between interstitial cystitis and systemic lupus erythematosus?
There are reports of interstitial cystitis associated with lupus. I have had two patients with that combination, one that is particularly severe. Lupus may or may not be active at the time. There are case reports in the literature of different treatments to try as the standard drugs may not be effec...
How would you treat a prostate cancer with malignant priapism due to direct tumor extension?
Carefully! No seriously, this is a case where MRI imaging and the utilization of complete androgen blockade can make a big difference. Also coordination with urology. I've treated one patient in this circumstance, and luckily for him, he did get symptomatic relief with LHRH antagonist (which I would...
How would you approach therapy for a patient with non-seminomatous germ cell tumor, cT3N3Mx and symptomatic lower extremity thrombus extending to the IVC when it is unclear if bland or tumor thrombus?
This is not a common setting, but it is well described and high volume centers have fairly uniform approaches to patients presenting with caval thrombus. With the pre-orch HCG of 850, he is likely IGCCC good risk unless he is found to have brain or hepatic mets. He is likely non seminoma with a larg...
What are your top takeaways from ASCO GU 2022?
My top abstracts and questions that arise from them: 1) ARASENS with darolutamide in high volume de novo mHSPC showing an OS benefit with darolutamide over ADT/docetaxel. Will this pertain only to high volume/risk patients who are chemo-fit and de novo which seemed to comprise the vast majority of ...
Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?
No.
How would you approach a patient with resected renal cell carcinoma, collecting duct type with sarcomatoid and rhabdoid features?
Although sarcomatoid differentiation is more common in clear cell RCCs, it is also well described in other RCC subtypes, including collecting cell carcinoma. Some argue that collecting duct carcinoma is histologically and clinically closer to a urothelial carcinoma than an RCC subtype. Urothelial ca...
Based on the STAMPEDE trial pooled analysis, which patients with high risk prostate cancer would you add abiraterone for 2 years?
I often use 2 years of Abi/pred (plus ADT) in patients with high-risk localized prostate cancer who have at least two of these features: Gleason grade group 4 or 5 Clinical/radiographic stage T3 or greater PSA 40 ng/mL or greater This is typically done in conjunction with primary radiotherapy.
How would you treat a patient with prostate cancer with de novo bone and bone marrow metastases with cytopenias?
Men who present with diffuse bone marrow involvement by definition have high volume de novo disease, and among the worst prognosis of all situations. Level 1 evidence now suggests that triple therapy with ADT/docetaxel and concurrent abiraterone or darolutamide (level 1), or sequential ADT/docetaxel...
Would you consider de-escalating abiraterone in a patient treated with ADT/abiraterone/prednisone for metastatic hormone sensitive prostate cancer who has had an excellent response with undetectable PSA and minimal side effects for over 2 years?
Wonderful question. There really is no data to guide this question. Some people are wondering about de-escalation of therapy from the start vs super escalation (triple therapy) for other patients. This strategy makes biologic sense. Match the therapy to the biology of the cancer. The challenge is th...