From the Desk of the Editor: Volume 2, Issue 2

Optimizing the patient clinical outcome (prolonging survival, preserving quality of life, and preventing complications) while avoiding excessive healthcare economic burden is tantamount to the overall improvement of the healthcare system.  Certainly, combining an integrative, multidisciplinary approach, which can attain these aforementioned goals will align with the “Triple Aim”, which proposes that improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.  

Given the exceptional abundance of breakthrough diagnostics and therapeutics within all of oncology, and especially GU oncology, specialty as well as allied healthcare collaboration is essential for the treatment of   GU cancer patients.  At the University of Texas Medical Branch, Stephen Williams recently initiated a urologic oncology multidisciplinary care center (MDCC).  In this issue’s cover story, Dr. Williams and his former colleague, Ashish Kamat collaborate on their experiences and address the reasoning as well as the challenges of establishing a MDCC and review the implementation and factors impacting its success toward improving patient care.  An MDCC can potentially benefit both academic and community based care, with disease focus that may be disease or specialty specific; hence, the need for the development of an Advanced Prostate Cancer Clinic (APC), an Advanced Bladder Cancer Clinic (ABC), an Advanced Kidney Cancer Clinic (AKC) is now in keeping with the well-known heterogeneity of GU cancers. We recognize the heterogeneity of our clinical practice environments, and thus if we can adopt the learnings and experiences from Dr.s Williams and Kamat and their MDCC, this should offer other practices and centers concepts and goals for improvement. LUGPA, SUO, and AUA are also continuing to offer courses that can assist busy clinicians with up to date developments and information within GU oncology but also frameworks for initiating and/or enhancing their MDCC or Advanced GU Oncology Clinic (APC, ABC,AKC). 

This issue of Everyday Urology will review The Tenth Symposium on Targeted Alpha Therapy (TAT-10) which took place in Kanazawa, Japan. UroToday covered this program, recognizing that the field of targeted alpha therapies is evolving very rapidly, with Radium 223 heralding the 1st TAT to achieve therapeutic approval for mCRPC patients with bone metastases. The TAT-10 presentations reviewed the latest developments in radiotherapy with alpha emitters in multiple cancer types.  This issue’s Expert Perspective provides a summary of the findings from the meeting, discussing four of the major alpha emitters under active trial development; radium-223, thorium-227, actinium-225, and astatine-211.  A top highlight of the meeting was Professor Joe O’Sullivan of Queen’s University, Belfast, Ireland symposium which summarized bench to bedside for targeted alpha therapy and the ever evolving treatment for mCRPC.

Finally, at the 2017 Annual ASCO meeting there were two landmark phase III trials presented for patients with newly diagnosed metastatic prostate cancer, combing traditional androgen deprivation therapy (ADT) with abiraterone acetate/prednisone versus ADT, specifically, the LATITUDE trial, Fizazi et al and the STAMPEDE trial, James et al.  The overall survival results of both trials were compellingly positive for the combination arm, thus now adding further important discussion and evaluation regarding specific newly diagnosed prostate cancer populations most appropriate for this combined approach vs chemohormonal therapy as well as the ongoing questions regarding sequencing, cost, and accessibility. These seminal studies, both published in New England Journal of Medicine, last month, and over 20 more selected conference commentaries are featured in our Spotlight section from both this year’s annual ASCO and AUA meetings.  For all of us dedicated to the care of advanced GU oncology patients, it is an invigorating and inspiring era, and this issue will hopefully allow you to enjoy some of these breakthrough developments.    

Thank you for your ongoing readership and feedback.

Sincerely,

Neal Shore
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