(UroToday.com) The 2024 American Urological Association (AUA) Annual Meeting held in San Antonio, TX between May 3rd and 6th, 2024 was host to an advanced prostate cancer podium session. Dr. Kassem Faraj presented the results of an analysis evaluating whether the quality of treatment with targeted therapies for advanced prostate cancer differed by the treating specialist.
Advanced prostate cancer accounts for approximately 35,000 deaths annually. The treatment paradigm has shifted over more recent years with a decreased reliance on cytotoxic chemotherapy and increased utilization of oral targeted therapies, which have excellent oncologic efficacy with fewer life-threatening toxicities.
The care model is thus evolving whereby these oral targeted therapies, which are convenient and well-tolerated, are being increasingly prescribed by urologists, as illustrated in the graph below. Potential advantages of increased prescription of these drugs by urologists include enhanced continuity of care. However, there are concerns that such prescription patterns may fall outside the scope of practice of urologists and whether this mandates increased resource utilization from a urologist standpoint.
This study evaluated outcomes among men with advanced prostate cancer started on an oral targeted drug by a treating specialist using data from the National Medicare claims database (2011 – 2019). The primary outcome was a composite of cardiometabolic adverse events. Secondary outcomes included:
- Monthly out-of-pocket costs in those with low-income subsidies
- Treatment adherence
Subgroup analyses by drug type (abiraterone versus other androgen receptor inhibitors) were performed.
There were no significant differences in the frequency of adverse events, both composite and individually, between patients treated by urologists versus medical oncologists.
When stratified by drug type (abiraterone versus other androgen receptor inhibitor), there were again no differences in safety events among patients treated by urologists versus medical oncologists.
No differences by treating specialist were observed in monthly out-of-pocket costs or treatment adherence.
Dr. Faraj concluded that:
- Specialty-prescribing physician was not associated with
- Safety
- Out-of-pocket costs
- Adherence
- Reassurance regarding the growing role of the urologist
- Considerations for urologists
- Medical oncology referral
- Optimal therapy duration
Presented by: Kassem Faraj, MD, Society of Urologic Oncology Fellow, Department of Medicine, University of Michigan, Ann Arbor, MI
Written by: Rashid Sayyid, MD, MSc - Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, May 3rd - 6th, 2024