Dr Dreicer on the Different Approaches to mCRPC Management

Robert Dreicer, MD, deputy director and director of solid tumor oncology in the Division of Hematology/Oncology, and professor of medicine and urology at the University of Virginia Cancer Center, discusses how approaches to metastatic castration-resistant prostate cancer (mCRPC) management can differ based on whether the patient is initially seen by a medical oncologist, a genitourinary (GU) oncologist, or a urologist.

Dreicer begins by emphasizing that each specialty brings a unique perspective and expertise to the management of this complex disease. A patient seen first by a medical oncologist specializing in prostate cancer is likely to receive a comprehensive evaluation focused on systemic therapies. Medical oncologists often have extensive experience with chemotherapy, novel hormonal therapies, immunotherapies, and targeted agents used in the treatment of mCRPC. They may prioritize treatments based on clinical trial data, guidelines, and individual patient factors such as comorbidities and treatment goals, Dreicer explains.

Conversely, a GU oncologist, who specializes specifically in GU cancers including prostate cancer, may offer a nuanced approach that integrates both urologic and oncologic perspectives, he expands. GU oncologists are knowledgeable about surgical interventions, radiation therapy, and systemic treatments for mCRPC. They may emphasize a multidisciplinary approach, collaborating closely with urologists and radiation oncologists to optimize patient care, Dreicer adds.

When a patient first sees a urologist, particularly in a large urology group practice with a designated advanced prostate cancer clinic, the focus may initially be on surgical options and local treatments. Urologists are experts in managing localized prostate cancer and may refer patients with advanced disease to medical or GU oncologists for systemic therapies, he elucidates. Urologists may have less experience with certain systemic treatments like taxane-based chemotherapy, which are often managed by medical oncologists.

Ultimately, while the expertise of each specialty is valuable, the approach to mCRPC may vary based on the practitioner's training, experience, and available resources. Collaboration among specialists is key to ensuring that patients receive the most appropriate and individualized treatment for their advanced prostate cancer.