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Cystoprostatectomy with Recurrence
I have a patient who underwent cystoprostatectomy for high grade urothelial ca throughout the bladder and concurrent high risk prostate cancer Gleason was 10, PSA was 10ng/ml and he had positive margin and ECE in 2022. Initial PSA undetectable but 1 year later it was 0.2 and now 0.6. PSMA PET shows gross recurrence in the bed (1.5cm metabolic nodule) and a positive R ext iliac node. He has bowel hanging down and sitting just above the pet positive lesion (about 1cm of space). The ileal... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 16, 2024 Category: Universities & Medical Training Authors: Haybrant Tags: Radiation Oncology Source Type: forums

Johns Hopkins pathologist Jonathan Epstein has been on leave since May - The Washington Post
https://www.washingtonpost.com/health/2023/10/22/johns-hopkins-jonathan-epstein-pathology/ “A prominent cancer-detecting doctor at Johns Hopkins Hospital is on administrative leave after a misdiagnosis led to a patient’s bladder removal, and as allegations have surfaced that he bullied or intimidated others in his department, according to interviews and an accreditation report obtained by The Washington Post. The internationally regarded pathologist Jonathan I. Epstein has been... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 22, 2023 Category: Universities & Medical Training Authors: KeratinPearls Tags: Pathology Source Type: forums

Understated Risk of Radiation induced Malignancy?
Dropping this hear to poke the bear/stir up some discussion https://ascopubs.org/doi/full/10.1200/JCO.21.00596 RCT of adding docetaxel to RT+ADT for unfavorable intermediate risk disease. No difference in OS with adding docetaxel. But more concerning is the fact that they found a 4.6% incidence of radiation induced cancer (rectal or bladder) at 10 years of follow up. That I find highly concerning, I had quoted my patients likely a 1% risk. Sample size isn't huge, so luck could play... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - July 23, 2021 Category: Universities & Medical Training Authors: DoctwoB Tags: Radiation Oncology Source Type: forums

Another purely hypothetical scenario
60ish male needs cysto w/ biopsies for staging of bladder cancer. 6.4cm ascending thoracic aortic aneurysm found incidentally on CT as part of work-up. 40 pack year smoker, no features that scream Marfan, ehlers danlos, etc. Patient seen by medicine who says “patient is optimized for surgery”. Seen by thoracic who says, patient can proceed under anesthesia and will consider repair if prognosis from cancer is reasonable based on staging, biopsies, etc. You’re assigned the case and despite... Another purely hypothetical scenario (Source: Student Doctor Network)
Source: Student Doctor Network - August 28, 2020 Category: Universities & Medical Training Authors: Beeftenderloin Tags: Anesthesiology Source Type: forums

Very high risk prostate case
Hello all, Just wanted to get thoughts regarding a unique case. 55 y/o male with non-secretory GS 5+4 prostate cancer following RP/LND 2-3 years ago and treated with adjuvant long-term ADT alone, who now presents with a local bladder recurrence s/p salvage cystectomy with multiple +margins. No gross disease on post-op MRI and Axumin just shows mild avidity in the operative bed but no mets. What is the role for XRT in his case? Specifically, what would be your treatment volumes and to... Very high risk prostate case (Source: Student Doctor Network)
Source: Student Doctor Network - January 13, 2020 Category: Universities & Medical Training Authors: CodeRedDew Tags: Radiation Oncology Source Type: forums

Types of research that would benefit an application for Urology
Hi all, was hoping to pick your brains about some research opportunities. I had the good fortune of being paired up with an oncologist who specializes in kidney, bladder, and prostate cancer for my first year clinical experience, and he works closely with a team of urologists. I've been invited to do basic science cancer research in his lab. I'm interested in his work, and I think he would be a good mentor, but I'm also wondering if I should be seeking out something that is more overtly... Types of research that would benefit an application for Urology (Source: Student Doctor Network)
Source: Student Doctor Network - December 14, 2019 Category: Universities & Medical Training Authors: stickflip723 Tags: Urology Source Type: forums

Help with cervical cancer case
I have a very challenging mid-50's female, previously healthy and good performance status with FIGO Stage IIIB SCC of cervix. Disease extended to lower vagina and was wrapping around the uterus essentially and into the adnexa. By MRI, was intimately associated with both bladder and rectum, but no clear invasion by imaging nor by exam. She was treated with 2c of Carbo/Taxol and had an excellent clinical response. Plan was for standard chemoRT and brachy, however she sought alternative... Help with cervical cancer case (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2017 Category: Universities & Medical Training Authors: napoleondynamite Source Type: forums

What would you do?
Elderly man with pelvic pain Pain started after catheterization for urinary retention, he states. Pain includes perineum and anus. Especially bad with defecation. It is constant and severe. He has history of rad for prostate cancer several years ago. I've talked with a urology friend...said to make sure someone checked PSA recently, said to find out if he's had his bladder scoped recently. He sees a urologist, so I'm pretty sure these have been done. I tried superior hypogastric... What would you do? (Source: Student Doctor Network)
Source: Student Doctor Network - February 26, 2017 Category: Universities & Medical Training Authors: ateria radicularis magna Source Type: forums

TURBT within two months of MI/stents
Hey guys, I'm an anesthesiologist. I'm curious about the progression of bladder tumors. I've just finished a case where the patient had an MI less than two months ago, requiring a DES for RCA occlusion. Sent home on dual antiplatelet medication, ASA + Brilinta. Thereafter, he had some hematuria. Sent for cysto. Urology curbsided Cardiology, who just hears the word "Cancer" and says, ok go ahead with it, and ok to stop antiplatelets for 3 days. If this were completely elective, it... TURBT within two months of MI/stents (Source: Student Doctor Network)
Source: Student Doctor Network - September 7, 2016 Category: Universities & Medical Training Authors: Gas you down Source Type: forums

Re: Pioglitazone use and risk of bladder cancer: population based cohort study
(Source: BMJ Comments)
Source: BMJ Comments - April 30, 2016 Category: Journals (General) Source Type: forums

SSI after transplant
Has anyone been successful retaining SSI/Medicaid benefits post transplant? We're four years out and although the surgery was successful, my son's is experiencing other complications--diabetes, multiple skin cancers, gall bladder removal, low weight and pulmonary function levels that are stable but not great. There is no way we could afford the 20 prescriptions he is on and full time work is out of the question. He is undergoing a disability review. Thoughts? (Source: Cystic Fibrosis Transplants Forum)
Source: Cystic Fibrosis Transplants Forum - July 14, 2015 Category: Respiratory Medicine Authors: mackenziesmom Tags: Transplants Source Type: forums

Please State The Nature Of The Medical Emergency
I enjoy reading medical blogs so I thought I'd start one over on the Medlinks site. It's mostly a way of book marking the plethora of web articles I read, and making some kind of sense from what I've learned. Anyway: Focus on Drugs and various other things… March 16, 2014 Do you know where your gall bladder is located? gallstones Since I’ve been reading about drugs, I’ve developed an increased interest in news articles about them. In New Zealand, new synthetic drugs can be made legally available, however, other illicit drugs remain illegal. Will this see a rise in drug use in NZ? Will more people die by mixing diffe...
Source: New Media Medicine - March 16, 2014 Category: Universities & Medical Training Authors: Armadillo Tags: Weblogs Source Type: forums