Expert perspectives on the importance of forging collaborative relationships between urologists and medical oncologists in prostate cancer care, focusing on shared decision-making and patient-centric approaches.
David Morris, MD, FACS: Ben, you can speak to this. Has it been easy to work with more than 1 urologist? You’re getting referrals not just from myself but from other partners within our group. Has it been something where you’ve needed a one-on-one focus, or is it finding that center hub within the world of medical oncology and urology who’s your point of contact? And they find like-minded individuals who are willing to build the partnership in the same way. What has been your viewpoint on that?
Benjamin Garmezy, MD: From a medical oncology standpoint, maybe it’s different. Maybe it’s the same as the urology standpoint. From my experience, urologists are the ones who are [providing diagnoses for] our patients, especially as a GU [genitourinary] medical oncologist. I see only GU disease[s], and they all require diagnosis from urologists. So having a relationship with multiple urologists is essential to sustain a practice as a working medical oncologist out in the community.
But when it comes to the more advanced disease, those in the Venn diagram of treatment where urologists could handle the treatments or a medical oncologist could handle the treatment, I think the partnership there is you want to be a bit strategic. You want to make sure that you align yourself with providers who are going to support your decision-making and accept it but also know that they’re going to tend to agree with it and have the same philosophies on care of the patient and whether or not they’re interested in only standard treatments, clinical trials, open to everything. You want to make sure that everything about your practice is understood and everything about their practice is understood.
And there is room for several of these relationships, especially when you’re navigating a large city [such as] Nashville. Perhaps having those relationships with multiple providers across different regions of the city so that you can have patients stay closer to home is key and helpful for that patient relationship because they always want to know why they’re traveling to see someone. Sometimes there’s a good reason, and sometimes it’s just the nature of the referral that got piped in from the system and there’s nothing more than that.
But you don’t want to spread yourself too thin. I also think [it’s important] that [you’re] developing these relationships with somewhere between 3 and 6 providers [where] you understand how they’re thinking [and] they understand how you’re thinking. And the key between medical oncology and urology, especially when you’re dealing with all providers who are providing therapeutics, is that there’s enough trust that if somebody disagrees with the plan, you can discuss that and have an open conversation so that you can come to an agreement together to bring the confidence for the patient [and] they’re not getting mixed communication. You have to be able to trust that other partner in order to do that. So that doesn’t have to be a one-on-one relationship. That can be multiple relationships that you foster. Is it any different from the urology side of things?
David Morris, MD, FACS: I don’t think so. It’s largely about finding someone who’s willing to play in the same sandbox and understand that each of us have medical knowledge that is an expertise. We may not have the exact same viewpoint on everything but are willing to at least understand some data and share the decision-making because the patients may choose therapy A, B, or C. And just because you’re the one pushing A and I’m the one choosing B, it doesn’t mean we’re necessarily right.
It’s largely about making sure that they’ve heard all the options and can make that informed decision. Similar treatment ideas and willingness to be open to communication are probably the most important factor[s], not necessarily proximity, other than [the fact that] the patients have to be willing to be between those 2 offices. It’s not great for me to pick somebody who’s a hundred miles away if all my patients say, “I don’t want to go a hundred miles away to be seen.” You should find somebody in the local community if you can. They’re out there; you just have to have communication to establish that.
Benjamin Garmezy, MD: My recommendation for the medical oncologist out there who might be tuning in to listen to us today is…when you’re first establishing these relationships with your urology colleagues and partners, it’s key to identify the roles and responsibilities going forward. Coming out of training, medical oncologists are often used to doing everything. But our urology colleagues in the community, a lot of them are very skilled and adept at advanced therapeutics and early phases of these diseases. And the key is when you get a referral from your urologist…is to pick up a phone. “If you want to do the surveillance imaging, do you want me to handle it? Are you going to continue that LHRH [luteinizing hormone-releasing hormone] injection or do you want me to take it over?”
Have that conversation so that it’s all very clear up front, and that starts to establish and build that trust so that you know you’re on the same care team. And that doesn’t have to just be with 1 person, right? Whenever I get a new referral from one of Dr Morris’ partners in the community, I always reach out and say, “Oh, saw your patient with testicular cancer. Do you want me to do the surveillance imaging, or are you going to handle it? I’m going to talk to this patient about their options, right?” And oftentimes, a lot of the urologists want us to handle it, but sometimes you have a urologist who likes to do it themselves, and that’s great too, because then you can trust that the patient is getting what they need.
Transcript is AI generated and edited for readability.