Children's Hospital Colorado

Urologic Oncology Cases: Beyond the 99th Percentile

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Even in the world of subspecialists, Nick Cost, MD, is more subspecialized than most. As one of the nation's few physicians who is fellowship-trained in pediatric urology and urologic oncology, Dr. Cost knows a lot about pediatric cancers and cancer predisposition syndromes of the urologic tract. And he performs a lot of pediatric urologic oncologic procedures.

In fact, he performs more of them than anyone else in the United States.

Pediatric urologic oncology experience

"We published an article in the Journal of Urology1 where we looked at the case logs of 281 pediatric urologists, and less than half listed even one oncology case," he says. "If you look at this graph, you can see the 90th percentile is three cases. The 99th percentile is 12. I did 42 oncology cases in kids and young adults under 30 that year."

That was in 2017. In 2019, he did 51.

For Dr. Cost, that number is about more than bragging rights. It's about experience. The entire U.S. sees about a thousand pediatric urologic malignancies – like kidney, bladder, prostate and testicular cancers – in a year. They're rare. The average pediatric urologist might see one of those. A pediatric oncologist might see a few more. Then they have to figure out how to work together across specialties.

The importance of multidisciplinary teams

Treating any complex disease is about teamwork, says Dr. Cost. One of the benefits of his narrow field of specialization is that his team works together constantly, and they work together well – from nurses to pediatric oncologists to radiologic oncologists. That's in addition to child life specialists, psychologists and many other team members dedicated to age-targeted support for kids and families coping with a rare disease.

"From the beginning of care, we know these conditions, so we're going to be able to do a targeted, streamlined workup where the patient doesn't have to go to a bunch of appointments," says Dr. Cost. "If a primary care provider suspects something is going on, we'd encourage them to just reach out directly."

Making specialized urologic oncology care available across the nation

Because his patients come from all over the region, Dr. Cost and his team have close relationships with clinics from Montana to New Mexico to the Dakotas. They also have a lot of experience working with primary care providers to set up chemotherapy and other ongoing care closer to home.

To that end, Dr. Cost hopes to be a source of knowledge for pediatric urologic oncologic conditions and care for providers everywhere. He's happy to offer consultations and second opinions, whether formally or informally.

"We want to cultivate a national community for conditions like these. If providers have questions, I want them to feel comfortable and confident in their treatment decisions, whether they send their patients here or not," says Dr. Cost. "And if they do work with us, I always reach out to the referring provider and give them my personal cell. These conditions are scary for families. I want to be available 24/7."

For referrals and consultations, contact Dr. Cost through OneCall at 720-777-3999.


  1. Patterns of Performance of Oncologic Surgery by North American Pediatric Urologists: A Report from the Pediatric Urologic Oncology Working Group of the Society for Pediatric Urology. Cost NG, et al. J Urol. 2017.