“It’s actually an exciting time for patients who have metastatic urothelial cancers and prostate cancers or advanced prostate cancers because there are a lot more products on the way, like the newer hormone agents for prostate cancer and the new immunologic agents like PARP inhibitors for different types of cancers," says one urologist.
Urology Times reached out to three urologists (selected randomly) and asked them each the following question: What advances in urology do you hope to see in 2020?
“It’s actually an exciting time for patients who have metastatic urothelial cancers and prostate cancers or advanced prostate cancers because there are a lot more products on the way, like the newer hormone agents for prostate cancer and the new immunologic agents like PARP inhibitors for different types of cancers. Those are all really interesting developments. I’d like to see more results in that sense. I think we will have more coming along there, and it will be good to see.
I think it will definitely help patients who have these diseases to have their lives prolonged. There will be changes in the treatments for prostate cancer. As the PARP inhibitors continue to be refined, they really will address advanced prostate cancer with more targeted therapies. Those are really interesting.
Then, in terms of immunotherapies for bladder cancers, some of those products like checkpoint inhibitors, which are drugs that allow T cells to stop tumors from growing in advanced bladder cancers, can hopefully prolong patients’ lives. So that too will be a good thing.
I really expect to see some big advancement in treatments for prostate cancer patients.”
Donald Sonn, MD
Next: “I hope the government continues to look at site-neutral payments for groups and practices"“I hope the government continues to look at site-neutral payments for groups and practices because a lot of the integrated groups are doing a lot to control costs. The fact is, hospital systems get paid more than independent practices when we have the best interests of our patients at heart and provide good quality care. That’s one thing.
Another hope is that we continue to see progression with the prostate cancer care for our patients. There’s been a lot of innovation in treatment for advanced prostate cancer, as well as early prostate cancer in active surveillance. I hope the progression continues there like it has the past couple years. We’re in an exciting time for that.
We’re beginning to identify patients at risk and stratify patients better. With the genomic sequencing and genetic profiling coming along, we’re developing more personalized treatment plans for them, understanding more of the pathways-who are the people at higher risk and who are at lower risk-and extending life with the new therapies that have come out, especially with advanced prostate cancer. With the trials and new drugs coming out, I think we’ll continue accruing information and learning how to use it.
Also see: What’s your opinion of Medicare for All?
My hope is that, at some point, we actually find a cure. I don’t think that’s in 2020, but we’re at least making it more of a long-term disease for guys with more advanced prostate cancer.”
David Wilhelm, MD
Next:"AUA guidelines for multiparametric MRIs are going to change care for prostate cancer"“I see two things coming down the pipeline. First, AUA guidelines for multiparametric MRIs are going to change care for prostate cancer. If people have not been doing MRIs prior to biopsy, that’s now going to become the standard. MRIs prior to biopsies are going to become commonplace with patients demanding them. Those will be a real game changer in the way we diagnose prostate cancer.
The cost is something we’re going to have to deal with on the public health side, but if clinically speaking, it’s better for the patient or is something we can recommend as a group, I think we’ll have to find a best practice way of doing that. It will be a balance between the cost of health care and treating our patients with the latest technology.
I hesitate to say it will reduce the number of biopsies performed because the negative predictive value of MRIs isn’t super high, but it increases the ability to detect cancer with an eventual fusion biopsy. Biopsies would be better targeted, and if prostate cancer and grading are more accurately diagnosed with MRI, your treatment should be better. We’ll see what happens with outcomes, but that’s something it may help down the line.
Secondly, in this age of smart phones, Internet, and instant communication, we will see a shift in patient care from traditional and expensive office visits-which have added burdens to the patient, physicians, and the environment-to telemedicine, which Kaiser Permanente has integrated in our system for years. Through telephone visits, real-time video visits, and the ability to show images and results through technology, we have been able to improve patient satisfaction, decrease costs, and streamline urologic care for our members. I see many others adopting telemedicine in the upcoming year due to increasing costs of medical care but, more importantly, patient demand.”
Michael Choi, MD
Santa Clara, CA
Your turn - what are your hopes for urology in 2020? Let us know at email@example.com