Clinical experts do not always agree on the optimal treatment for a particular patient. Patients with prostate cancer are no different.
“Disagreement depends on the issue,” said Jeffrey Holzbeierlein, MD, professor and Chair of Urology at the University of Kansas Medical Center. “The use of MRI [magnetic resonance imaging] is one of the areas on which we will probably see more consensus, whereas operating on patients with advanced disease is a newer idea that is likely to generate more controversy. If you are a practicing urologist, you will see prostate cancer as part of your practice. You may or may not be operating on it, but you need to understand it and you need to be able to work through some of these complex issues.”
Dr. Holzbeierlein is one of four panelists for Friday’s 30-minute Complex Cases: Prostate Cancer presentation, which will begin at 3 pm during the Prime Time plenary program in the Esplanade Ballroom at Moscone South. He will be joined by Shilpa Gupta, MD, assistant professor Hematology, Oncology and Transplantation at the University of Minnesota Medical School; Scott Eggener, MD, professor of Surgery and Radiology, Director of the Prostate Cancer Program, and Director of Translational and Outcomes Research, Section of Urology, at the University of Chicago; and Alexander Gottschalk, MD, PhD, Director of Cyberknife Radiosurgery at the University of California, San Francisco.
The panelists will explore treatment options for a series of complex prostate cancer cases presented by Mark Buyyounouski, MD, MS, associate professor of Radiation Oncology at Stanford University Medical Center. The four panelists will be faced with the familiar scenario of making initial judgements on the fly with less than perfect information.
Some presenters provide the cases in advance, which gives panelists an opportunity to research the alternatives and consider the best next steps. And most presenters offer case reports, history, physical exam results and labs during the discussion. The more complex the case, the more important it becomes to build an experienced clinical team with multiple specialties.
“We are seeing more and more prostate cancers that require a team approach and cannot be appropriately managed by just one person,” Dr. Gupta said. “Even experts specializing in genitourinary cancers are challenged by these complex cases where there may be more than one or two good answers. It will be particularly helpful for community urologists to see how an expert panel might approach some of these more complex cases. The one constant is that there are no easy answers and usually more than one good answer.”
Complex cases are common in most urology practices. Every practicing urologist deals with cases that get more difficult with every look at the data. Picking out the appropriate clues takes skill and experience.
“Sometimes there are nuances radiographically; other times it is pathologic or patient-directed reference that helps guide decision making,” Dr. Eggener said. “It all depends on the case and the patient. Many times it is just acknowledging there are many good answers to treatment questions, not just a single black-and-white choice. Ultimately, it is our role to fairly and comprehensively explain the pros and the cons of each approach to our patients. We will be talking through situations that every urologist who sees prostate cancer patients encounters.”
Sometimes there are no perfect answers in complex cases, and sometimes the answers change with the advent of new data, new concepts and new approaches.
“In 2015 active surveillance might have generated intense debate but is now less controversial because all of us accept the idea and have put it into practice,” Dr. Holzbeierlein said.
Dr. Holzbeierlein added that interest in prostate cancer waned for a few years compared to other areas of urology due to a relative drought of new data and a Grade D recommendation on screening from the U.S. Preventive Services Task Force. However, recent findings have inspired new interest in what remains the single most common cancer seen and treated by urologists.
“We are going to be doing more than just discussing the data on these cases,” Dr. Gupta said. “We will be discussing the practical implications of the data. This will be a good venue to learn about some of the newer approaches in treatment, to understand the risks and benefits of different approaches and to take home some key points one might not have considered initially.”