Raoul D. Concepcion, MD, begins the discussion by posing the question as to what sorts of models or protocols are being put into place to evaluate and manage patients with regards to sequencing different types of therapies (immunotherapy, oral therapy, cytotoxic chemotherapy).

Daniel R. Saltzstein, MD, says that a multidisciplinary approach works best for his practice where a radiation oncologist is involved with a medical oncologist. Though he can offer his patients clinical trials, few trials have actually been completed to determine appropriate drug combinations and sequencing.

Bryan Mehlhaff, MD, stresses that every community will have a slightly different setup, depending on what a urologist feels comfortable with. It remains important, Mehlhaff says, to keep patients in the loop and provide them with options every step of the way.

Though his practice has 20 physicians, Steve Dobbs, FACHE, has not looked into bringing a full-time medical oncologist in. As drugs are approved, urology as a business will have to adjust to reimbursement with regards to disease management and episodic care.

Concepcion wraps up the discussion by emphasizing the need to change practice models in urology to avoid marginalizing itself as reimbursement changes.