Practice-specific Comprehensive Approach in the Management of mCRPC Patient Populations  


Christopher M. Pieczonka, MD and Jose De La Cerda, MD, MPH share their expertise in managing metastatic castration-resistant prostate cancer (mCRPC), focusing on the demographics in their distinct clinical practices and unique challenges they encounter nuances of treatment.  


Christopher M. Pieczonka, MD: Hello everybody, I'm Dr. Christopher Pieczonka, and I'm joined by my esteemed colleague, Dr. Jose De La Cerda. We're excited to talk about a Urology Times interview today, focusing on a comprehensive and insightful discussion about abiraterone formulations for metastatic castration-resistant prostate cancer (mCRPC). We'll concentrate on patient assessment and factors guiding the selection of appropriate treatment choices for special populations. Additionally, we'll share our clinical practice management considerations and insights into the diverse needs of patients with mCRPC. So, I'll now hand it over and thank our audience for joining us in this brief vignette.

Jose De La Cerda, MD, MPH: Thank you, Dr. Pieczonka. I appreciate the opportunity to be here today for this engaging discussion. My name is Jose De La Cerda, and I'm a urologist at U of Urology San Antonio, a large urology group practice association where I co-direct Urology San Antonio clinical trials. I also manage our advanced prostate cancer clinic, treating a variety of diseases, including locally advanced disease, metastatic castrate-sensitive disease, and metastatic castrate-resistant prostate cancer. Annually, I see approximately 50 to 60 mCRPC patients, focusing on minority populations, particularly Hispanic and Spanish-speaking men.

Christopher M. Pieczonka, MD: Thanks for that overview. My practice is quite similar. At the Associate of Medical Professionals, a division of the United States Urology Partners, I lead our Advanced Prostate Cancer Clinic in Syracuse, New York. Additionally, I am the CEO of our organization. Our practice is unique in its patient diversity: approximately 80 to 85% Caucasian, 15 to 18% African American, with the remainder being a mix. This diversity is interesting when approaching mCRPC patients, as some may benefit more from certain therapies based on race. Our practices are comparable in size, with a similar number of patients. One aspect I'd like to explore is the referral process in your practice. Are referrals mandated, and do you have a navigator? I think our audience would be interested in understanding how you receive patients.

Jose De La Cerda, MD, MPH: Absolutely. San Antonio is an incredibly diverse city, with about 70% of our population being Hispanic. Our practice, the largest in San Antonio, covers a wide area, extending approximately 30 miles from one clinic to the next. Our referrals primarily come from community practices and physicians. While there is a small academic program here, prostate cancer treatment is predominantly handled by oncology. In our practice, we conduct prostate biopsies and PET scans, allowing us to identify advanced diseases and keep these patients within our care. Once identified, we refer them to advanced prostate cancer specialists. We're spread across the city to engage patients from all areas, ensuring comprehensive care from diagnosis to treatment. I imagine your practice operates similarly.

Christopher M. Pieczonka, MD: Yes, our practice has a similar setup. We've decided to internalize PSMA PET scans on our campus due to availability issues. Previously, our patients experienced long waits at external PET facilities, sometimes spanning weeks or months. This change has significantly improved our practice, allowing us to use PET scans more frequently while reducing reliance on CAT scans and bone scans. As someone involved in many trials, it's challenging to reconcile the trial literature, which often relies on CAT scans and bone scans, with the newer approaches using PET scans. This creates a discordance in how we equate studies started years ago with current practices.

Video transcript AI-generated and reviewed by Urology Times® editorial staff.

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