Urology Practices Thrive When Administrative and Clinical Champions Emerge

OncLive Chairman,

Mike Hennessy

The practice of urology finds itself at an interesting point in history. With new therapies in prostate, kidney, and bladder cancer on the horizon and tightening regulatory and reimbursement restrictions in place, urologists need to adapt to a quickly changing landscape. And this change cannot happen soon enough.

Group practices, the lifeblood of urologic practice, are trying to find a steady foothold, and many practices find themselves adapting to care and practice management models that incorporate a unified approach in order to survive and thrive in the current reform environment. That unified approach involves the clinical and administrative champions within the practice coming together and working towards the common goal of providing expert and compassionate patient care, without incurring excessive use of medical resources.

The Large Urology Group Practice Association (LUGPA) is trying to train and equip its members to embrace these new models during a spring meetings rollout. The meetings focus on 3 broad categories: the establishment of an advanced prostate cancer clinic, practice management tips, and the integration of clinical and business challenges. Gary Kirsh, MD, president of LUGPA told us that some large groups have successfully adopted this model, but others have not. He said that by and large, the groups understand, from an intellectual standpoint, the importance of creating an integrative group practice that accounts for these categories, but that the steps to implement these changes can prove challenging. He pointed out that many large groups started out as smaller groups that were initially cobbled together, before healthcare reform and other changes that we see today. They are finding themselves somewhat adrift.

In keeping with our practice management theme, our Practice Profile column this month highlights Minnesota’s largest private urology practice, Metro Urology. The 26-physician practice was founded in 1994. We interviewed Basir U. Tareen, MD, who highlighted many advances that have him excited, notably, the emergence of MRI-guided biopsies and greater use of joint cancer clinics, in which urology practices partner with medical oncology practices to treat and manage prostate, kidney, and bladder cancer patients.

This collaboration with medical oncology practices enhances the continuity of care that is so important for patients on their cancer journey.

In discussing the use of MRI-guided biopsies in prostate cancer, Tareen called these advances “practice changing” because of the greater accuracy MRI-guided technology provides over traditional ultrasound-guided modalities. In addition, the greater use of robotic technology to hone the surgical skills of urologists when performing cystectomies or nephrectomies adds to their expertise.

In this month’s issue, we also bring you coverage from the New York GU™: 9th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies held on March 19 in New York City. The congress is an intensive, interactive, one-day educational program that brings together renowned national experts in the fields of genitourinary malignancies treatment.

Daniel P. Petrylak, MD, a leading expert in the field, provided a broad overview of the development of new therapies to treat patients with bladder cancer, which has been lagging behind other genitourinary malignancies for at least 30 years. In particular, Petrylak focused on the PD-1/ PD-L1 pathway highlighting clinical trial results involving atezolizumab, pembrolizumab, nivolumab, and durvalumab, and even explored the potential preclinical research involving the vascular endothelial growth factor (VEGF). In particular, Petrylak reported results of a three-arm phase II study that evaluated docetaxel with or without ramucirumab or icrucumab, a VEGFR-1—targeting agent, among 139 patients with urothelial transitional cell carcinoma following progression on or after first-line platinum-based therapy.

Also during the conference, Robert Dreicer, MD, MS, associate director for Clinical Research and deputy director of the University of Virginia Cancer Center, discussed androgentargeting strategies in metastatic prostate cancer. Although some recently approved agents have improved outcomes for men with metastatic castration-resistant prostate cancer (mCRPC), significant questions linger about how to tackle resistance to the therapies, whether there is cross-resistance in sequential paradigms, and what predictive biomarkers can be identified. Read all about these topics—and more—in this month’s Urologists in Cancer Care.