Urologic Oncology
11 cases on intravesical therapy sequencing during a BCG shortage, bladder preservation versus cystectomy in BCG-unresponsive disease, GnRH antagonist versus agonist cardiovascular risk, bone-protective agent selection during androgen deprivation, intermittent versus continuous androgen deprivation, treatment timing in biochemical recurrence, 5-alpha-reductase inhibitor use during active surveillance, upper tract urothelial carcinoma management, extended VTE prophylaxis after cystectomy, fertility preservation in testicular cancer, and antibiotic prophylaxis strategy for prostate biopsy — choose a case below to open its full multi-voice debate.
A BCG-naive man with high-grade Ta bladder cancer, caught in an active national BCG shortage. The disagreement isn't about whether BCG works — it's about what to do when the drug's own evidence base and the shortage's actual fix both sit just out of reach.
Two patients with BCG-unresponsive disease sit on opposite sides of the same approved indication — one just outside it, one squarely inside it — and neither position turns out to be the whole answer.
A man with metastatic prostate cancer and a prior MI needs androgen deprivation started now. HERO says one GnRH class is safer for his heart; PRONOUNCE, the trial built to actually test that question, says it can't tell the difference.
A man who may remain on androgen deprivation for the rest of his life needs bone protection now. Denosumab has the strongest trial in his exact situation; what happens if he ever has to stop it is the argument against starting it.
A man with a slow-rising PSA after prostatectomy, no detectable metastases, weighs intermittent androgen deprivation against continuous therapy — testing how far a landmark trial's inconclusive result in sicker patients can honestly reach.
A man's PSA is rising fast enough after radiation to meet EMBARK's own high-risk definition. The trial found real survival benefit without the usual quality-of-life cost — but only for patients who actually look like the ones it enrolled.
A man under active surveillance for low-risk prostate cancer needs relief from worsening BPH symptoms. The drug most likely to help is the one whose fifteen-year-old high-grade cancer signal was never fully closed, only mostly explained.
A man with low-grade upper tract cancer in his only kidney faces a choice where nephroureterectomy means dialysis, not just reduced function — testing what a trial's real complication rate should weigh against an alternative that isn't abstract.
A man discharged after radical cystectomy needs a full month of VTE prophylaxis. The real question isn't only which drug is better evidenced — it's whether either one actually reaches him, living alone, three flights up.
A 27-year-old man with elevated-risk stage I seminoma has days, not weeks, to choose between surveillance and adjuvant carboplatin — and a second, irreversible decision about fertility riding on the same compressed clock.
A biopsy-naive man with an elevated PSA faces the exact comparison PREVENT was built to settle. PREVENT answered it — and then the two other randomized trials asking the same question did not reproduce the answer.