ORLANDO, FL USA (UroToday.com) - A new addition to the AUA meeting this year was a crossfire section, featuring debates. Speaking to a packed house, the panel debated a timely and hot topic, whether urologists should treat hormone resistant prostate cancer, or refer to medical oncology.
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“While medical oncologists have traditionally treated CRPC, the advances in available treatments have dramatically expanded. With five new drugs on the market and AUA guidelines to guide urologists, the landscape for advanced prostate cancer treatment is changing,” said the moderator, Dr. Brantley Thrasher.
Starting the debate on the con side was Dr. Daniel Petrylak, a medical oncologist: “All that matters is that it’s a qualified individual; would you want your prostate taken out by a urologist who operates on 3 patients a year?” Dr. Petrylak suggests that rather than having one practitioner making decisions, the multidisciplinary approach is most valuable. The multidisciplinary approach has shown efficacy in patients with high-risk, locally-advanced prostate cancer, for instance, and improves survival rates. A multidisciplinary approach improves access, optimizes outcomes, improves access to specialty therapies, and improves coordination of care.
Dr. Manfred Wirth then presented the pro side of the question. He argued that urologists are experts in giving hormone therapy and immunotherapy, and either a urologist or a medical oncologist can effectively administer therapy following appropriate structured training. Historically, urologists have administered systemic treatment, including chemotherapy for urological tumors. In other countries, such as Germany, urologists obtain board certified specialization in “medical tumor therapy.” A similar program is surely possible in the United States as well. Further, Dr. Wirth argued that when surveyed, 73% of patients prefer a single physician to provide their cancer care. Since the urologist knows the patient best, he/she should be the one to lead care.
Dr. A. Oliver Sartor countered that “too often the medical oncology or urology world thinks they can do it all…it simply is not true. It takes passion and focus to be a good castration-resistant prostate cancer doctor.” Just because one trains as a medical oncologist or urologist, it does not mean they treat CRPC well.
In summary, the best advice is for urologists to team up with an expert, such as a medical oncologist, and be proactive in multidisciplinary patient management. Adoption of one of four models of care was proposed for effective management of CRPC patients:
- Having a strong referral relationship with medical oncology.
- Multidisciplinary clinic with joint patient management; this is the classic academic model.
- Integration of a medical oncologist into a large GU practice.
- The urologist can provide immunotherapy, bone health, and androgen axis inhibitors.
It should be noted, however, that no one should be an “occasional advanced therapist.”
Moderated by Brantley Thrasher, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Debaters - Pro: Christopher P. Evans, MD; Manfred Wirth, MD
Debaters - Con: Daniel P. Petrylak, MD; A. Oliver Sartor, MD
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com