Judd W. Moul, MD
New clinical models are emerging for the delivery of prostate cancer care. Some large urology group practices are expanding to offer cancer care and instituting bone health clinics to treat patients throughout the entire course of their disease. In some academic settings, the concept of multidisciplinary prostate cancer care has been adopted, in line with a model that has become routine in breast and lung cancer assessment. In both the academic and group practice settings, new drugs are offering efficacy along with good tolerability, and the promise for a significant impact on patient care may be close at hand.
In a conversation with Urologists in Cancer Care
, Judd W. Moul, MD, professor of Surgery and director of the Duke Prostate Center, Duke Cancer Institute, Durham, North Carolina, commented on practice trends in urologic cancer care and the advantages and disadvantages of his institution’s multidisciplinary prostate cancer clinic. He highlighted a few of the new treatments on the horizon for prostate cancer, and elaborated on the rationale behind the urology community’s disagreement with the recent US Preventive Services Task Force (USPSTF) recommendation against PSAbased prostate cancer screening.Urologists in Cancer Care: Some urology practices, especially large groups, are expanding to provide cancer care, and establishing additional onsite services such as bone clinics. Could you reflect on this trend from an academic medical center perspective?
I think this offers a great opportunity for some of the large urology groups to find at least one partner or one member of the group who has a special interest in advanced prostate cancer. There are a number of new agents, either available now or in the pipeline. If urology groups do not embrace some of the new prostate cancer treatments, I am afraid they are going to lose out to medical oncology and some of the academic centers that are offering these services and treatments.It has been said that the availability of more prostate cancer drugs with good tolerability and easy regimens such as oral administration also helps to make the case for urology practices to provide ongoing prostate cancer care.
I completely embrace urologists’ maintaining their role as the key physicians for men with prostate cancer—early and advanced. While I am enthusiastic about our continued role in pushing the technology envelope with early-stage prostate cancer, I am worried that many young urologists have focused so much on early-stage technology, such as the robot, and have not kept up or embraced the equally exciting new treatments for advanced prostate cancer.
Many LUGPA [Large Urology Group Practice Association] groups have adopted subspecialty expertise, such as having only one or two partners per group as robotic surgeons. In the same vein, I feel these groups need to embrace one or two partners as champions for new therapy for advanced disease—such as sipuleucel- T infusions, abiraterone use, or denosumab expertise. Urology remains a wonderful specialty because we can be surgeons and also be medical experts in our key diseases.MDV3100 (enzalutamide) has been described as a “gamechanger” in the treatment of prostate cancer, having shown a significant survival benefit in men with prostate cancer post-docetaxel. Can you comment on these results and whether you agree with the claims about this oral drug’s potential?
MDV3100 has to be placed in the context of other products that have been FDA-approved in the last year or two years, such as sipuleucel-T, which is another treatment that large urology groups should embrace because of its low side-effect profile and evidence for increased survival in advanced prostate cancer. An advantage to MDV3100 is that it is an oral agent with a low sideeffect profile. It does not have to be administered with steroid medications and does not seem to have as many toxicities as some of the other oral agents that are currently being utilized.You are an author of a recent paper that reports phase III results for zibotentan (ZD4054), an endothelin A receptor antagonist, in patients with castration-resistant prostate cancer [CRPC] that has metastasized to bone.1 Can you comment on the results and the drug’s possible future in the expanding treatment armamentarium for CRPC?