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Erik Castle, MD
ErikCastleMD (Physician - Urology (Verified) )| Communities: Bladder and Urinary Cancer , Prostate Cancer , Kidney and Renal Cancer | Answers: 8 |
| Member Since: Jul. 2012 |
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Professional Statement
Dr. Castle is an associate professor of urology at College of Medicine, Mayo Clinic, and a senior associate consultant in the Department of Urology, where he also is assistant residency coordinator.
He was an assistant professor in the Department of Urology at Tulane University in New Orleans from 2004 to 2006 after serving as a clinical instructor/fellow at Mayo Clinic in Arizona for one year.
Dr. Castle's research interests include prostate cancer, bladder cancer and kidney cancer. He is the director of the Desert Mountain Prostate Cancer Research Fund and is the principal investigator of Castle labs housed at the Samuel C. Johnson Medical Research Building at Mayo Clinic in Arizona. His basic science research is focused on novel secondary hormonal therapies of prostate cancer as well as genomics of prostate and bladder cancers.
His surgical expertise includes laparoscopic urology, robot-assisted radical prostatectomy with nerve sparing, robot-assisted radical cystectomy with neobladder, robot-assisted retroperitoneal lymph node dissection, robot-assisted partial nephrectomy and other robotic urologic oncology procedures. He has performed many of these procedures as demonstrations internationally. He is a member of the American Association of Clinical Urologists, the American Urological Association, the Endourological Society, and the Society of Laparoendoscopic Surgeons. He is past president of the international Society of Urologic Robotic Surgery. He is also the director of the international laparoscopic nephrectomy courses throughout Mexico on behalf of the American Urologic Association.
He was an assistant professor in the Department of Urology at Tulane University in New Orleans from 2004 to 2006 after serving as a clinical instructor/fellow at Mayo Clinic in Arizona for one year.
Dr. Castle's research interests include prostate cancer, bladder cancer and kidney cancer. He is the director of the Desert Mountain Prostate Cancer Research Fund and is the principal investigator of Castle labs housed at the Samuel C. Johnson Medical Research Building at Mayo Clinic in Arizona. His basic science research is focused on novel secondary hormonal therapies of prostate cancer as well as genomics of prostate and bladder cancers.
His surgical expertise includes laparoscopic urology, robot-assisted radical prostatectomy with nerve sparing, robot-assisted radical cystectomy with neobladder, robot-assisted retroperitoneal lymph node dissection, robot-assisted partial nephrectomy and other robotic urologic oncology procedures. He has performed many of these procedures as demonstrations internationally. He is a member of the American Association of Clinical Urologists, the American Urological Association, the Endourological Society, and the Society of Laparoendoscopic Surgeons. He is past president of the international Society of Urologic Robotic Surgery. He is also the director of the international laparoscopic nephrectomy courses throughout Mexico on behalf of the American Urologic Association.
Professional Info
Credential: MD
Primary specialty: Urology
Medical school: University of Texas, Southwestern Medical School
Residency: University of Kansas Medical Center
Internship: Truman Medical Center/St. Luke's Hospital Kansas City, Missouri
Fellowship: Mayo Clinic in Arizona
Hospital affiliation: Mayo Clinic in Arizona
Practice address:
5777 E. Mayo Blvd.
Phoenix, AZ
85054
Practice phone number: 800-446-2279
ErikCastleMD Activities
The urologic oncology biorepository at Mayo Clinic Arizona is a prospective collection of tissue, urine and blood from all urological cancer patients within our institution. We also collect their urine and blood as they are followed within the institution after treatment for up to 5 years. The tissue, urine and blood are frozen and stored and available for analysis at anytime in the future. It is one of the most exciting programs for cancer patients we have.
The specimens will track with the patients as they receive their care. This will allow us to identify new markers in the urine and blood and correlate it to response to therapy. Furthermore, in some patients, we are able to “go back” to their original tumor and perform gene sequencing and compare it to the gene of recurrent tumors toe identify targets for experimental therapies!
The Mayo Clinic Arizona genitourinary oncology biobank is the only one of its kind in that all patients with urologic cancers (prostate, bladder, kidney, testicular, penile) have their specimens banked prior to treatment and at every follow-up visit. To date over 20,000 specimens have been stored for nearly 1000 patients.
The specimens will track with the patients as they receive their care. This will allow us to identify new markers in the urine and blood and correlate it to response to therapy. Furthermore, in some patients, we are able to “go back” to their original tumor and perform gene sequencing and compare it to the gene of recurrent tumors toe identify targets for experimental therapies!
The Mayo Clinic Arizona genitourinary oncology biobank is the only one of its kind in that all patients with urologic cancers (prostate, bladder, kidney, testicular, penile) have their specimens banked prior to treatment and at every follow-up visit. To date over 20,000 specimens have been stored for nearly 1000 patients.
New answer by ErikCastleMD (Physician - Urology (Verified))
1
Answer |
8 months ago
Assuming the bladder has not been removed, surgery is the primary treatment if a patient does not respond well to chemotherapy prior to surgery. In cases where patients have already had their bladders removed and have disease throughout other parts of the body, second line chemotherapy can be considered. There are some experimental trials for patients in this situation.
New answer by ErikCastleMD (Physician - Urology (Verified))
1
Answer |
8 months ago
The first line chemotherapy (drug therapy through the veins) most often involves a regimen of more than one drug including an agent called cisplatin. The “old fashioned” standard was to use 4 drugs: methotrexate, vinblastine, adramycin and cisplatin. More recently, many chemotherapy regimens have consisted of two drugs: gemcitibine and cisplatin. Depending of the preference of your oncologist, one of those two regimens is employed. In some cases, carboplatin is substituted for cisplatin due to problems in kidney function in patients but this is felt to be less effective. Most first line therapy last approximately 3 to 4 weeks.
New answer by ErikCastleMD (Physician - Urology (Verified))
1
Answer |
8 months ago
Intravesical therapy refers to the use of chemicals or medications in the bladder to treat bladder cancer. The most common form of “intravesical therapy” is actually an immuno-therapy. It is called BCG therapy. BCG is a vaccine comprised of a live strain of tuberculosis. It was found to be effective as a therapy for specific types of bladder cancer, particularly high grade versions of the cancer. While it does not always “cure” patients life-long, it will often control the disease for many years in some patients. It is used in patients with carcinoma in situ (CIS) and high grade bladder cancer. It is inserted into the bladder using a catheter and administered weekly for 6 weeks as initial therapy. If an adequate response is seen then it can be used in a “maintenance” form per standard guidelines. Unfortunately, there is a current world-wide shortage of BCG and regimens are being restricted in some areas.
Other options for intravesical therapies are generally chemotherapeutic agents. These include: mitomycin C, thiotepa and valrubicin. Mitomycin C s the most commonly used chemotherapy in the bladder and is used most often at the time of the resection of the tumor in order to prevent or delay recurrences within the bladder.
Other options for intravesical therapies are generally chemotherapeutic agents. These include: mitomycin C, thiotepa and valrubicin. Mitomycin C s the most commonly used chemotherapy in the bladder and is used most often at the time of the resection of the tumor in order to prevent or delay recurrences within the bladder.
New answer by ErikCastleMD (Physician - Urology (Verified))
2
Answers |
8 months ago
The standard reasons for bladder removal for bladder cancer include: invasive bladder cancer that penetrates the bladder wall/muscle; bladder cancer that has yet to invade the muscle but has properties associated with a risk of invasion and does not respond to other less aggressive treatments; and recurrent bladder cancer that can not be adequately managed with techniques of removal through the urethra. Due to the lethality of invasive bladder cancer, bladder removal is virtually part of every treatment algorithm designed to cure invasive bladder cancer.
New answer by ErikCastleMD (Physician - Urology (Verified))
2
Answers |
8 months ago
Margins of resection are evaluated in all cases of bladder removal surgery with standard pathologic techniques using ink and appropriate analysis. Some people in the past have questioned whether minimally invasive surgery limits the ability of the surgeon to obtain adequate surgical margins since the surgeon can not “feel” with his or her own hands. Frankly, rates of positive margins are directly related to the surgeon experience with bladder surgery and robotic surgery. This is also the case in open surgery for the bladder. In and of itself, minimally invasive surgery does not increase the risk of positive margins and this has been demonstrated in numerous recent studies.
New answer by ErikCastleMD (Physician - Urology (Verified))
1
Answer |
8 months ago
Minimally invasive surgery can be considered in most cases. For superficial bladder cancer that is not invasive in nature, resection (scraping of the tumor from the bladder wall) and cauterization of the sites is often all that is needed and is minimally invasive.
In cases of an invasive bladder cancer that requires radical surgery to remove the bladder, minimally invasive techniques are now an option. The most common “minimally invasive” technique is a robot assisted radical cystectomy. This involves using a robot to assist with the bladder removal and lymph node removal and making only a small incision to do the urinary diversion. Whether this is an option or should be considered depends on the experience of the surgeon and the stage of disease. In most cases this is an option if the surgeon is experienced in this approach.
Cases in which minimally invasive surgery should not be considered are most often in situations where patients are not good surgical candidates, have had numerous intra-abdominal surgeries or have very locally advanced disease.
In cases of an invasive bladder cancer that requires radical surgery to remove the bladder, minimally invasive techniques are now an option. The most common “minimally invasive” technique is a robot assisted radical cystectomy. This involves using a robot to assist with the bladder removal and lymph node removal and making only a small incision to do the urinary diversion. Whether this is an option or should be considered depends on the experience of the surgeon and the stage of disease. In most cases this is an option if the surgeon is experienced in this approach.
Cases in which minimally invasive surgery should not be considered are most often in situations where patients are not good surgical candidates, have had numerous intra-abdominal surgeries or have very locally advanced disease.
New answer by ErikCastleMD (Physician - Urology (Verified))
1
Answer |
8 months ago
Blood in the urine (hematuria) can signify many conditions besides bladder cancer. Blood in the urine is generally classified into two categories: microscopic (seen only by microscope) and gross (seen with your eyes). In most cases of hematuria routine things such as urinary infection and other obvious sources should be ruled out. Once that is done, referral to a urologist for a “hematuria workup” should be next. This would include x-ray studies (CT scan) to evaluate the kidneys and ureters as well as a urine test for cancer cells and a cystoscopy (looking in the urethra and bladder). These tests will allow the doctor to evaluate you for a variety of conditions including: kidney cancer, bladder cancer, kidney stones, urinary obstruction and other conditions. Rest assured that in most cases, blood in the urine is not a cancer.
New answer by ErikCastleMD (Physician - Urology (Verified))
1
Answer |
8 months ago
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