Episode # 3 • 17 Jan 2025
The Basics of Advanced Prostate Cancer Management for Urologists
What does a urologist actually need to know to confidently manage advanced prostate cancer in the clinic? On this episode of BackTable Urology, host Dr. Ruchika Talwar interviews Dr. Kristen Scarpato, director of the advanced prostate cancer clinic at Vanderbilt University Medical Center, and Dr. Jason Hafron, chief medical officer of the Michigan Institute of Urology. They break down how the landscape has shifted, why more patients stay in urology for treatment, and how to select and monitor therapy based on disease state, comorbidities, and patient goals.
Timestamps
00:00 - Introduction
02:41 - Shift to Urology-Led Advanced Prostate Management
07:07 - Sorting Therapies by Disease State
10:33 - Treatment Intensification and Doublet Therapy
17:54 - ARPI Selection and the Four Ps Framework
25:46 - Managing Financial Toxicity
29:30 - Monitoring, Labs, and Imaging
34:11 - Red Flags and Comanagement
36:49 - When to Refer to Medical Oncology
41:11 - Future Directions and Practice Economics
46:33 - Closing Remarks
Resources
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More about this episode
The discussion covers sorting therapies by disease state rather than drug class, doublet and triplet intensification, the nuances of choosing between abiraterone, enzalutamide, apalutamide, and darolutamide, and Dr. Hafron’s “four Ps” framework for drug selection. Dr. Scarpato addresses financial toxicity, surveillance protocols, and red flag symptoms. Both guests share their referral triggers for medical oncology, approaches for oligometastatic disease and metastasis-directed therapy, and practical tips for running an advanced prostate cancer clinic.
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