Urologists face a challenge in delineating the optimal sequence of treatment more and more as the goal for treating prostate cancer moves toward greater use of targeted therapies. While these treatment eradicate disease, urologists must minimize the risk of adverse events.
Gary Kirsh, MD
Urologists face a challenge in delineating the optimal sequence of treatment more and more as the goal for treating prostate cancer moves toward greater use of targeted therapies. While these treatment eradicate disease, urologists must minimize the risk of adverse events. Gary Kirsh, MD, weighs in with his insights for treating prostate cancer within the context of urology and the benefits of a multidisciplinary approach.
"Prostate cancer is a huge part of our business, and there is so much excitement around advancements in prostate cancer over the last 5 years. So many new agents have become available; the challenge is using these treatment options for optimal benefit. It has taken time for urologists to recognize the value of these new products and to develop an understanding of their appropriate use. Integrating the treatment of advanced prostate cancer into the urology practice is becoming more widespread," said Kirsh, president of The Urology Group and of the Large Urology Group Practice Association (LUGPA), in an interview with Targeted Oncology.
Kirsh said more practices than ever are utilizing advanced prostate cancer clinics into their practices, or identifying ways to understand which patients will benefit from these therapies, directing patients to providers who are interested in delivering these therapies, and wrapping everything together in a comprehensive program.
Kirsh also stressed the importance of a multidisciplinary approach in the treatment of prostate cancer.
"Urologists provide the continuum of care in prostate cancer, from diagnosis all the way through end-of-life, and everywhere in between. For example, at the diagnostic level with prostate biopsy, you might ask why should we have a pathology service in our practice? The answer is because the pathologist in our practice has special certification and training in urologic pathology. Our pathologist deals with so many more prostate specimens than he otherwise would if he were just working at the average pathology laboratory. It really becomes a level of expertise and a community resource in our region that we have that kind of pathology expertise," explained Kirsh.
"These integrated practiceswhen done correctly—are able to elevate care for our urology patients, especially patients with prostate cancer. We believe we have convinced our community in Cincinnati of that, and that is why we have been able to create win-win relationships with the rest of the healthcare community in our town because we really are a center of excellence for the urologic patient."
Looking toward the future of treatment for prostate cancer, Kirsh said improvements have already been made in surgical techniques and various forms of radiation therapy.
"Advanced prostate cancer, however, is rapidly moving and we have five or six agents that have been approved since 2010. They address different clinical areas including bone health, immunotherapy, oral agents, and bone-targeting agents like radium-223. And more agents are on the horizon," he said. "So, where do I see it going? I see us having more tools. I see urology increasingly involved in advanced prostate cancer. I see urology really dominating and controlling advanced prostate cancer, at least in the LUGPA environment where we have groups that are forward-thinking and integrated doctors that have the wherewithal and the infrastructure to put together pathways and algorithms."