A Call to Arms in Urology

Raoul S. Concepcion, MD, FACS
Published: Sunday, Mar 04, 2018
Raoul S. Concepcion, MD, FACS

Raoul S. Concepcion, MD, FACS
I hope that many of you took notice of the recent estimates for 2018 by the American Cancer Society in the latest Cancer Facts & Figures 2018. At first glance, the trends really have not changed: Prostate cancer continues to be the most common newly diagnosed solid tumor in men over 50 years and the second leading cause of cancerspecific mortality.

As we have articulated many times in this publication, it is incumbent on us as specialists to be the recognized leaders and experts in the diagnosis and management of prostate cancer and not cede that mantle to any of our colleagues. So, what are the areas that require our complete and thorough understanding so that we can better serve our patients, especially in this world of value-based medicine:
  1. Which patients need an initial biopsy to diagnose significant prostate cancer, and what tests are available to aid in that decision?
  2. Which patients with an initial negative biopsy require a repeat biopsy?
  3. When is active treatment/intervention needed versus active surveillance for localized prostate cancer?
  4. In the setting of a patient definitively treated but who has a biochemical recurrence, when is it appropriate to start androgen deprivation therapy (ADT)?
  5. Early identification of metastatic disease in the patient with castration-resistant prostate cancer (CRPC).
  6. Understanding of the various therapeutic options for patients with hormone-naïve and metastatic CRPC, as well as the adverse effect profiles of these agents, including ADT.
  7. Understanding the role of molecular and hereditary testing for patient management and family counseling.
  8. Understanding the utilization of new imaging technology.
As we are well aware, the rapid proliferation of new data in all of these areas can be quite daunting and can make it difficult to stay current, especially for individual practitioners or even those with well-established large group practices where there is an element of sub-specialization to some degree. That is no excuse for us to not take the opportunity to go out and educate our referring doctors and the public on how the urology community manages these complex issues. If we fail in these endeavors, we will become nothing more than dancing monkeys, relegated to perform when instructed to do so by our referring physicians who will view us as nothing more than noncognitive proceduralists. We cannot allow that to happen, given our responsibilities to our patients and the training of our future urologists.
American Cancer Society. Cancer facts and figures 2018. ACS website. cancer.org/ research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html. Published 2018. Accessed January 12, 2018.

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