Advanced PCa now in urologists’ hands

Dr. Thrasher, a Urology Times editorial consultant, is professor and chair of urology, University of Kansas Medical Center, Kansas City.

I’ve always felt that the AUA’s guideline process is the crown jewel of a multitude of benefits for the practicing urologist. The recent completion of the AUA’s Guideline on Castration-Resistant Prostate Cancer (CRPC) was not only timely but also very important for those of us treating these patients.

The guideline assembled experts in both urologic and medical oncology, who completed a very thorough review of available articles on the subject, from 1996 to February 2013. They took advantage of the fact that, since the approval of docetaxel (Taxotere) for this group of patients in 2004, five additional agents (enzalutamide [Xtandi], abiraterone [ZYTIGA], sipuleucel-T [Provenge], and cabazitaxel [Jevtana], and radium Ra 223 dichloride [Xofigo]) have been FDA approved on the basis of randomized trials that showed a survival benefit. (Radium Ra 223 dichloride was approved after the completion of the new guideline.)

My interest in this document was piqued for a variety of reasons. First, the guidelines’ statements were developed for six index patients that represent common scenarios encountered in many clinical practices. Second, the panel provided a very thorough, user-friendly algorithm that takes the clinician through the most appropriate use and sequencing of these drugs, based on the available data. The algorithms will be available in both a pocket guide and web-based format for easy access.

Finally, the ease of administration of several of these new compounds puts them into the hands of the urologist. In the past, agents requiring infusion centers were generally not in the purview of the urologist, but required a referral to our medical oncology colleagues. Since most of these patients start by receiving their care from a urologist, it’s nice to now have options for continuity of care in the face of castration-resistant disease.

All urologists who care for men with advanced prostate cancer should familiarize themselves with this guideline. Further, the AUA and the Society of Urologic Oncology (SUO) have partnered to provide five regional courses in 2013-2014 on the use of these new agents. The 2014 annual meeting will provide an even larger multidisciplinary collaboration between the SUO and the AUA on the use and sequencing of these agents. This is truly good news for the urologist, our medical oncology colleagues, and most important, our patients.UT