Advanced Prostate Cancer Clinics Make Inroads in Practices

Gary Kirsh, MD

How has the practice of urology evolved with respect to oncology?

As the goal for treating prostate cancer moves toward greater use of targeted therapies to eradicate the disease while minimizing the risk of adverse events, urologists are challenged to delineate the optimal sequence and incorporate them into their treatment algorithms. In this interview at the 2015 Large Urology Group Practice Association (LUGPA) Meeting in Chicago with Gary Kirsh, MD, president of The Urology Group and LUGPA, Kirsh provides insight on treating prostate cancer within the context of urology, as well as 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.

How does a multidisciplinary approach aid in the treatment and management of prostate cancer?

We have more and more practices that are incorporating what we call advanced prostate cancer clinics into their practices. That means identifying ways to understand which patients will benefit from these therapies, directing the patients to the right providers who are interested in delivering these therapies, and wrapping everything together in a comprehensive program that involves physician extenders, algorithms, or pathways of treatment. Compared to a couple of years ago, we’re seeing this concept gaining acceptance.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.

Our integrated model allows for subspecialization, so if one of our urologists wants to improve his skills with robotic surgery, we can accommodate him so that he develops some depth of experience. Those physicians are very good at what they do.

The same can be said for radiation therapy. If you’re only treating patients with prostate cancer with radiation therapy, it becomes a very urology-centric skill set as opposed to treating a patient with prostate cancer, then a patient with breast cancer, then a patient with colon cancer, then a patient with brain cancer. Everybody gets better at treating prostate cancer. Everybody is oriented to that type of patient.

Our practice has a multidisciplinary tumor board. We have everybody in there—the pathologist, radiation oncologist, urologist, the medical oncologist—and so we are able to exchange information in that way, especially when it comes to the advanced prostate cancer patient, by having that kind of multidisciplinary tumor board.

Where do you see the direction of the treatment of prostate cancer going?

These integrated practices—when 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.Treatment for localized prostate cancer has been steady with improvements in surgical techniques, robotic surgery, 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.

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.