BackTable UrologyEp. 332 The Basics of Advanced Prostate Cancer Management for Urologists with Dr. Kristen Scarpato and Dr. Jason Hafron
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. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Bayer https://www.bayer.com --- 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 --- 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. --- Resources Advanced Prostate Cancer: AUA/SUO Guideline https://www.auanet.org/guidelines-and-quality/guidelines/advanced-prostate-cancer Trial Design and Objectives for Patients With Prostate Cancer: Recommendations From the Prostate Cancer Working Group 4 (JCO) https://ascopubs.org/doi/10.1200/JCO-25-02834 ARACOG (AFT-47): Darolutamide vs Enzalutamide and Cognitive Function, ClinicalTrials.gov NCT04335682 https://clinicaltrials.gov/study/NCT04335682 ARASENS: Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer (NEJM) https://www.nejm.org/doi/full/10.1056/NEJMoa2119115 PSMAddition: 177Lu-PSMA-617 Plus Standard of Care in mHSPC, ClinicalTrials.gov NCT04720157 https://clinicaltrials.gov/study/NCT04720157 Medicare Plan Finder, referenced on air for comparing Part D out-of-pocket drug costs https://www.medicare.gov/plan-compare/ --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app
