Chemotherapy for prostate cancer: when should a urologist refer a patient to a medical oncologist?

Abstract

The last few years have seen considerable evolution in treatment options and therapeutic strategies for patients with castrate-resistant prostate cancer (CRPC). One major change was the expansion of chemotherapeutic options with the approval of cabazitaxel, representing the first chemotherapeutic therapy after docetaxel to demonstrate improved survival in patients with CRPC. A number of other noncytotoxic therapies have either recently been approved or are in advanced development for treating this patient population. Offering novel mechanisms of action, these new agents make considerably more expansive and complex the decisions regarding when to treat, which agents to use, and the order in which they are administered. A pivotal decision point for urologists who treat patients with advanced prostate cancer has been timing the patient's referral to an oncologist for chemotherapy. Although clinical guidelines regard chemotherapy as only appropriate for prostate cancer patients with symptomatic metastatic disease, increasing evidence points to the possibility that a subgroup of patients may benefit from an earlier introduction of chemotherapy. At the same time, additional treatment options that may either precede chemotherapy or follow initial chemotherapeutic failure mean that urologists must closely monitor their patients' health status to match specific clinical profiles with specific treatment options. With the increase in number and variety of therapeutic approaches, the role of the urologist has been expanded, in part, owing to the opportunity for urologists to administer treatments previously unavailable, and also owing to the growing importance of working cooperatively with oncologists and as a member of a multidisciplinary team.

Current Patterns of Management of Advanced Prostate Cancer in Routine Clinical Practice in Spain

“…With an in-depth understanding of the clinical course and management of CRPC and patient's history, the coordinated care provided by urologists and physicians routinely treating CRPC patients and other relevant professionals is essential to formulate an accurate strategic management plan and provide valuable and consistent advice to the patient [ 25 ]. This concept is reinforced as evidence of benefits from early use of chemotherapy increases [ 26 , 27 ] and newer therapeutics options become more widely adopted [ 12 ].…”

“…As novel and potentially efficacious treatment options for patients with advanced PCa become available, a multidisciplinary management approach is crucial which necessitates shared rather than compartmentalized medical care [ 12 ]. Interaction between different specialties and with supportive physicians can establish a treatment strategy that meets each patient's needs.…”

Prostate Cancer Peripheral Blood NK Cells Show Enhanced CD9, CD49a, CXCR4, CXCL8, MMP-9 Production and Secrete Monocyte-Recruiting and Polarizing Factors

“…Prostate carcinoma (PCa) is the one of most commonly diagnosed cancer in males worldwide (1). Surgery and radiation therapy (2) are still important treatment options, as well as chemotherapy (3) and hormonal therapy (4). Recently, immunotherapy came of age as a possible effective strategy for PCa therapy (5).…”

Evaluation of a multidisciplinary allied health prostate cancer clinic

“…In recent times, there has been considerable evolution in treatment options and therapeutic strategies for men with castrate‐resistant and metastatic prostate cancer, leading to complex decisions about when to treat, which agents to use and in what order they should be used. This highlights the importance of the MDT approach in the care of these men, with urologists, medical and radiation oncologists combining their expertise and services (Shore, ; Rhee et al ., ).…”