Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?
Great question. This comes up often. For males, they can continue to take their CML TKI and conceive a child. Of course, this is much more complicated for women as they should not be pregnant while taking a TKI. I would say that if the patient is having difficulties conceiving, he should undergo a ...
Would you give ADT + docetaxel -> darolutamide for a low risk castrate sensitive metastatic prostate cancer patient given ARASENS results?
ARASENS was designed during the era of docetaxel plus ADT emerging as the standard of care for men with mHSPC irrespective of disease volume, based on the improved OS observed in STAMPEDE for a largely de novo mHSPC patient population, where there was no heterogeneity observed for the OS benefit in ...
How would you manage prostate cancer in a patient who received prior chemoradiation followed by an APR for rectal cancer?
Patients who have been treated with chemoradiation followed by an APR for rectal cancer and now have prostate cancer and are not surgical candidates do have definitive treatment options despite the previous treatment. Although HDR brachytherapy is usually a great option for patients who have already...
In a patient with stage 1 mixed germ cell tumor who cleared tumor markers post-orchiectomy but with subsequent rise to borderline abnormal within 6 weeks, would you treat with 3 cycles BEP as for S1 disease?
Several points to begin with. My strong preference is to recommend active surveillance for all well documented clinical stage 1 nonseminoma whether or not there is embryonal predominance or lymphovascular invasion present. Second, I do not make treatment decisions based on borderline abnormal normal...
How does urinary obstruction impact your choice of therapy for metastatic or locally advanced prostate cancer?
Bladder outlet obstruction due to locally advanced prostate cancer is typically due to bladder wall and ureteral orifice invasion and T4 disease. These patients can suffer from pain and urinary obstructive symptoms for long periods of time despite the use of ADT, ADT plus AR inhibition, or ADT plus ...
Do you treat de novo metastatic hormone sensitive prostate cancer presenting with a paraneoplastic syndrome more aggressively?
For these patients, I will likely add a GnRH antagonist early on to drop testosterone quickly. Depending on performance status and other patient characteristics, we still go through the discussion of adding docetaxel, abiraterone, enzalutamide, and apalutamide (I generally add about 3-4 weeks after ...
Do you measure testosterone in men who will be receiving ADT?
I do check before starting ADT. I make sure to check after ADT completion as well. A post-treatment low PSA level in the setting of a low testosterone has a different meaning than a low PSA in the setting of a recovered testosterone. It also gives you a potential explanation for a slight temporary P...
Would you offer adjuvant chemotherapy to a patient with high grade pT1 bladder cancer with concurrent pT2 prostatic urethral stroma involvement?
I would adopt the data from the CheckMate 274 trial. If the patient is post-neoadjuvant cisplatin-based chemotherapy, I would consider adjuvant nivolumab, especially if the tumor PD-L1 is high and/or post-op ctDNA is positive for minimal residual disease. If the patient has not received neoadjuvant ...
What are your top takeaways in GU Cancers from ASCO 2022?
1. Bladder cancer. Potential new non-muscle invasive bladder cancer immunotherapy with N-803, an IL-15 superagonist plus BCG. Abstract 4508. Demonstrated striking complete and durable remissions (70%), bladder preservations over 1-2 years of follow up (>90% cystectomy free survival), favorable toxic...
In metastatic/recurrent clear cell carcinoma with a solitary site of metastasis to the bone when, if ever, do you consider local therapy adequate and hold systemic therapy?
If I have a patient with a treated solitary metastatic site in RCC (bone or otherwise), I generally give local therapy and historically would not give systemic therapy. A point of discussion would be use of adjuvant pembro in this setting. While bone mets were not included in KEYNOTE-564 resected M1...