The art and science of medicine: Advanced treatment for prostate cancer


An interview with Deepak A. Kapoor, MD, President of LUGPA

During the Large Urology Group Practice Association (LUGPA) annual meeting in November, an unprecedented number of urologists arrived one day early to attend a CME course focusing on how large-group urology practices can integrate and incorporate the new prostate cancer drug therapies for the treatment of advanced prostate cancer. Deepak A. Kapoor, MD, President of LUGPA said, “Currently, nationally, we lack a standardized approach for the treatment of advanced prostate cancer, but this is an exciting time when, as urologists, we have new treatment options for the mCRPC patient that are less toxic, have fewer side effects, and are demonstrating an improvement in the patient’s quality of life.”

The LUGPA prostate cancer session brought together a panel of thought leaders and specialists in surgical urology and oncology, including Paul Lang, Judd Moul, David Crawford, and Neal Shore, discussing how to deliver these therapies in a large group setting.

“Most urologists are very comfortable with localized therapies for prostate cancer; however, the newer modalities of treatments for CRPC are really challenging urologists because historically, once the patient becomes refractory, that patient is typically referred to the medical oncologist,” said Dr. Kapoor. "Most urologists don’t offer infusion therapies and are not prepared to manage the whole range of complications.”

How is this time pivotal?
Now, with a new spectrum of drugs, some being offered earlier in the treatment cycle, Dr. Kapoor says it’s an exciting time to manage these patients because we have options now besides chemotherapy. He suggests, “integrating these new drugs into practice involves a fundamental change. Urologists are well positioned, with their expertise, to manage the CRPC patient because they know this patient (often for 10 years or more) through active surveillance of the disease. The patients, in turn, are very comfortable with their urologists managing the care, creating the team, and quarterbacking the treatment regimen.”

Is the large group urology practice adaptable to these novel therapies?timeline2004 2012
“Many large group practices, like ours, are conveniently located to the patient, improving access of care. We work in the patients’ neighborhoods and collaborate with the medical oncologist to form a treatment team.” Dr. Kapoor is chairman/CEO of Integrated Medical Professionals, the largest urology group practice in the U.S., with more than 100 physicians in six clinic locations. Each of these clinics is within a seven-mile radius of one another in the NYC/Long Island area.

Would a standardized treatment paradigm benefit from one definition for CRPC? “This is a very important question. For the CRPC patient, we (as urologists) lack a standardized approach, nationally, to looking at the disease. Similarly, there is frustration among some of the urologic-oncology frontrunners involved in the clinical trials – asking why more patients aren’t getting access to these new novel therapies. We need to have more discussions within our groups and at association meetings – on how to initiate a bone scan, or what is the appropriate PSA doubling time , or how to quantify the radionuclear modalities for detecting metastatic prostate disease and recognizing the role of CT and MRI. It also includes asking the group practice to be proactive by fine tuning the active surveillance protocol with respect to the new drug therapies.”

What are the triggers when you select patients for these new treatments?
“We now have something to offer the CRPC patient besides chemo, and as result are paying more attention to profiling the patients who are well-suited for the new treatments. Urologists are one of the more pragmatic specialists in medicine. We focus on evidence-based medicine, but we also need to address real questions that can apply to real solutions for real patients. These drugs are no longer theoretical concepts. Ultimately the risk/benefit ratio applies, but it’s a challenge in these economic, cliffhanging times. As physicians and researchers, we are in the evolution of many great advances in the targeted delivery of medicine, yet our resources to treat the patients are really becoming very restrained. I believe urologists, especially those in multi-disciplinary organizations, will continue to move the treatment paradigm forward and embrace the knowledge, improve the access to care, enhance the outcomes of our cancer patients with a higher level of quality of life, while decreasing costs.“

So how can urologists bolster the CRPC patient as new therapies are approved?
“So much of what we (as urologists) focus on is the science of medicine, the evidence and facts that command decision making, and patient management. In my experience, the patient hears the technical facts, but those facts don’t help the man feel in control of the cancer-fighting process. Often the facts frighten the patient even more.” Dr. Kapoor refers to “high quality care delivery” as the foundation for every urology practice (it’s expected), but what makes the difference is an integrated and personalized urology-driven team approach. “The team needs to be sensitive to the patient’s fears and apprehensions and provide the man and his family with resources to foster a positive treatment experience.”

“Within LUGPA, we talk about providing a neighborly interaction that reflects the patient’s community,” says Dr. Kapoor. “Large urology group practices are often urologic cancer centers that are community centric and bring tertiary care to where the patient lives. I say this often. if you improve access, you will improve outcomes and reduce costs.”


LUGPA Logo COLORLUGPA represents 115 large urology group practices in the United States, with nearly 2,000 physicians who make up more than 20 percent of the nation’s practicing urologists. LUGPA and its member practices are committed to best practices, research, data collection, and benchmarking to promote quality clinical outcomes. For more information, visit


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Deepak A. Kapoor, MD, President, Large Urology Group Practice Association (LUGPA); Chairman and CEO, Integrated Medical Professionals, PLLC; President, Advanced Urology Centers of New York (a division of Integrated Medical Professionals and the largest urology group practice in the United States); Chairman, Access to Integrated Cancer Care (an informal advocacy group representing the rights of patients to access integrated services ; Chairman, SCRUBS RRG ; and member, Board of Directors of Allied Urological Services (the largest lithotripsy partnership in the U.S. and serves as Chairman of the Finance Committee). 




Written by Karen Roberts, Medical Editor,