For patients with castration-resistant prostate cancer (CRPC), a therapeutic framework should involve an integrated approach, with joint management by a urologist and medical oncologist, researchers reported online ahead of print in Urologic Oncology.
Noting that the therapeutic landscape in CRPC has evolved rapidly in recent years, with five new systemic agents available, Ralph de Vere White, MD, and Primo N. Lara Jr., MD, from the University of California Davis Comprehensive Cancer Center in Sacramento, propose a framework for urology and medical oncology interaction to optimize treatment.
The authors note that all caregivers should be involved in an integrated and comprehensive approach, which requires joint management of CRPC by a urologist and a medical oncologist, from initial manifestations of castration resistance to the end of life. This partnership should involve the establishment of common management guidelines, which identify available therapeutic options and define treatment goals and responsibilities of each provider. The partnership could be used to develop and pursue clinical studies that would allow testing of different models of integrated patient management. Potential barriers to integrated care include financial considerations as well as logistical and regulatory barriers.
“The patient with CRPC deserves no better than an integrated care team that includes both urologic and medical oncology specialties, rather than being managed by a temporal sequence of specialists separated in time and space,” the authors wrote.