Role of the urologist in the treatment of castration-resistant prostate cancer in the Czech Republic
Authors:
Milan Hora 1; Marko Babjuk 2; Radim Kočvara 3
Authors‘ workplace:
Urologická klinika LF UK a FN, Plzeň
1; Urologická klinika 2. LF UK a FN Motol, Praha
2; Urologická klinika 1. LF UK a VFN, Praha
3
Published in:
Ces Urol 2013; 17(1): 11-17
Category:
Review article
Overview
The role of the urologist in the treatment of prostate cancer (PC) has been always crucial. Obviously working in close cooperation with physicians of other specialties, the urologist has always been managing the treatment. In certain stages of the disease radiotherapists played and plays important role. However, with the introduction of chemotherapy in prostate cancer treatment (castration-resistant stage) engagement of the clinical oncologists became more important.
A locally advanced and metastatic PC requires care from the perspective local management of the disease (urination, upper urinary tract patency), symptoms (i.a. pain control), treatment of complications (urinary tract infections, cystolithiasis, etc.), and oncological treatment of the underlying disease. During the initial stages, oncological treatment focuses on hormonal therapy, which as a standard is prescribed by the urologist. Until recently only few treatment options (such as estramustine phosphate and β-irradiators) were available for patients with castration-resistant prostate cancer (CRPC); and this treatment was still managed by the urologist. The engagement of a clinical oncologist became more relevant with the introduction of mitoxantrone and, in particular, docetaxel. Second line CRPC therapy, cytostatic agent cabazitaxel, is also in the hands of the oncologist. However, recently have come and keep coming into clinical practice new treatment options (radium-223 chloride, abiraterone acetate, denosumab, enzalutamide, sipuleucel-T) that need not to be for technical reasons administered by the oncologist, so therapy can be returned to the hands of the urologist. For this, though, the urologist must be highly knowledgeable and specialized in this specific treatment segment.
Healthcare payers constitute another important factor in organizing of care for patients with CRCP. Logically, healthcare payers wish to control the new and expensive treatment modalities entering into the clinical practice. And of course, it is easier to control 13 CCCs (Comprehensive Cancer Centers) than over 600 urologists not stratified from the perspective of control of indication and administration of new expensive drugs.
The urologist should continue to play the key role in care for patients with CRCP. It is the urologist who can monitor the patient and manage the therapy in a comprehensive manner; introducing of new mainly oral treatment options into clinical practice also manage the patient in terms of oncological treatment. The patient care although coordinated by the urologist will, of course, depend on cooperation with other specialists, best within the multidisciplinary teams. For this, however, urologist must be highly educated and specialized in this specific treatment segment. The above concept is supported by recently approved and certified oncourology training course, currently under way. Health care payers will be required to set up a model enabling to centralize and thus to effectively control new CRPC treatment modalities with high cost.
Key words:
prostate cancer, castration resistant, hormonal therapy, chemotherapy, abiraterone enzalutamide, radium-223, sipuleucel-T, denosumab.
Sources
1. http://www.uroweb.cz/
2. Heidenrech A, Batian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD, Matveev V, Mottet N, van der Kwast TH, Wiegel T, Zattoni F. Gudelines on Prostate Cancer, European Association of Urology 2012; 163 s., http://www.uroweb.org/gls/pdf/08%20Prostate%20Cancer_LR%20March%2013th%202012.pdf
3. Čapoun O. Novinky v léčbě kastračně rezistentního karcinomu prostaty. Urol. Praxi 2012; 13(3): 101–110.
4. Higano CS. New treatment options for patients with metastatic castration-resistant prostate cancer. Cancer Treat Rev 2012; 38(5): 340–345.
5. Shore ND. Chemotherapy for prostae cancer: when should a urologist refer a patient to a medical oncologist? Prostate Cancer Prostatic Dis 2013; 16(1): 1–6.
6. Suchý D, Hora M, Fínek J. Vývoj a klinické hodnocení nových léčiv. Čes Urol 2009; 13(2): 141–148.
7. Běhounek P, Hora M, Klečka J. Medicína založená na důkazech (Evidence based medicine). Ces Urol 2011; 15(1): 10–14.
8. Tannock IF, Osoba D, Stockler MR, et al. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points. J Clin Oncol 1996; 14: 1756.
9. Sartor AO, Fitzpatrick JM. Urologists and oncologists: adapting to a new treatment paradigm in castration-resistant prostate cancer (CRPC). BJU Int. 2012; 110(3): 328–335.
10. Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, Oudard S, Théodore C, James ND, Turesson I, Rosenthal MA, Eisenberger MA; TAX 327 Investigators. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004; 351(15): 1502–1512.
11. De Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels JP, Kocak I, Gravis G, Bodrogi I, Mackenzie MJ, Shen L, Roessner M, Gupta S, Sartor AO; TROPIC Investigators. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet 2010; 376: 1147–1154.
12. Vyzula R. a kol. Modrá kniha České onkologické společnosti, 15. vydání. Brno: Masarykův onkologický ústav 2012; 250.
13. Berthold DR, Pond GR, Soban F, de Wit R, Eisenberger M, Tannock IF. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer: updated survival in the TAX 327 study. J Clin Oncol 2008; 26(2): 242–245.
14. Cheetham PJ, Petrylak DP. Alpha particles as radiopharmaceuticals in the treatment of bone metastases: mechanism of action of radium-223 chloride (Alpharadin) and radiation protection. Oncology (Williston Park) 2012; 26(4): 330–337, 341.
15. De Bono JS, Logothetis CJ, Molina A, Fizazi K, North S, Chu L, Chi KN, Jones RJ, Goodman OB Jr, Saad F, Staffurth JN, Mainwaring P, Harland S, Flaig TW, Hutson TE, Cheng T, Patterson H, Hainsworth JD, Ryan CJ, Sternberg CN, Ellard SL, Fléchon A, Saleh M, Scholz M, Efstathiou E, Zivi A, Bianchini D, Loriot Y, Chieffo N, Kheoh T, Haqq CM, Scher HI; COU-AA-301 Investigators. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med 2011; 364(21): 1995–2005.
16. Ryan CJ, Smith MR, de Bono JS, Molina A, Logothetis CJ, de Souza P, Fizazi K, Mainwaring P, Piulats JM, Ng S, Carles J, Mulders PF, Basch E, Small EJ, Saad F, Schrijvers D, Van Poppel H, Mukherjee SD, Suttmann H, Gerritsen WR, Flaig TW, George DJ, Yu EY, Efstathiou E, Pantuck A, Winquist E, Higano CS, Taplin ME, Park Y, Kheoh T, Griffin T, Scher HI, Rathkopf DE; COU-AA-302 Investigators. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med 2013; 368(2): 138–148.
17. Scher HI, Fizazi K, Saad F, Taplin ME, Sternberg CN, Miller K, de Wit R, Mulders P, Chi KN, Shore ND, Armstrong AJ, Flaig TW, Fléchon A, Mainwaring P, Fleming M, Hainsworth JD, Hirmand M, Selby B, Seely L, de Bono JS; AFFIRM Investigators. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med 2012; 367(13): 1187–1197.
18. Fizazi K, Carducci M, Smith M, Damião R, Brown J, Karsh L, Milecki P, Shore N, Rader M, Wang H, Jiang Q, Tadros S, Dansey R, Goessl C. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. Lancet 2011; 377(9768): 813–822.
19. Kantoff PW, Higano CS, Shore ND, Berger ER, Small EJ, Penson DF, Redfern CH, Ferrari AC, Dreicer R, Sims RB, Xu Y, Frohlich MW, Schellhammer PF; IMPACT Study Investigators. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med 2010; 363(5): 411–422.
20. Kočvara R, Dvořáček J. Postgraduální vzdělávání v urologii – současný stav. Čes Urol 2008; 12(1): 55–61.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2013 Issue 1
Most read in this issue
- Diagnosing adrenal disease – most significant clinical syndromes, biochemical testing and role of imaging methods
- Self-inserting foreign bodies in urogenital tract for the purpose of sexual stimulation
- Life-threatening bleeding into the peritoneal cavity due to spontaneous rupture of angiomyolipoma
- Kidney morcellation after laparoscopic nephrectomy