Introduction and Overview of CRPC Treatment Challenges

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Moderator, Raoul S. Concepcion, MD, introduces a panel discussion focused on treatment challenges and practice management issues faced by oncologists and urologists who care for patients with prostate cancer. This discussion includes expert perspectives from Leonard G. Gomella, MD, Lawrence I. Karsh, MD, Mark C. Scholz, MD, and Evan Y. Yu, MD.

The recent approval of new treatments for men with castration-resistant prostate cancer (CRPC) has created fresh challenges for urologists at academic centers, Gomella notes. With the rapidly changing treatment environment, it remains important for physicians to stay proactive. However, Gomella admits, some senior urologists are overwhelmed by this influx of new agents, specifically when it comes to understanding where they fit into the management of patients.

In addition to the rapidly expanding number of available treatments, new challenges are arising, such as the rising cost of healthcare and insurance restrictions, Yu suggests. Newer oral therapies, such as abiraterone acetate (Zytiga) and enzalutamide (Xtandi), are more expensive than traditional treatments and, as a result reimbursement may not always be available. Inversely, Scholz was surprised at how quickly and readily insurance companies paid for these newer agents, particularly when considering their high cost. Additionally, he adds, specialty pharmacies have been able to help track down co-pay programs, when applicable. More often than not, Scholz says, patients are able to receive these agents.

In this new era of treatment for patients with advanced prostate cancer, Karsh believes the overall lack of data will cause several challenges, particularly relating to sequencing these agents. Until evidence-based guidelines and biomarkers are available, it is likely that patients will receive several of these agents, Karsh remarks. Additionally, he adds, this process will remain challenging as managed care systems begin to further restrict certain procedures.

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