Provider Preferences for Prostate Cancer: Medical Oncologists vs Urologists

February 21, 2021


Ajeet Gajra, FACP, MD, Cardinal Health, Dublin, Ohio, discusses differences in referral patterns and treatment preferences between medical oncologists and urologists for patients with advanced prostate cancer.

This results from this study were presented at the virtual 2021 ASCO Genitourinary Cancers Symposium.


Hello, my name is Ajeet Gajra, and I serve as a senior medical director and vice president here at Cardinal Health. We presented our data titled "Referral Patterns and Treatment Preferences in Patients with Advanced Prostate Cancer: Differences Between Medical Oncologists and Urologists" at the ASCO GU 2021 Virtual Conference.

Here, I'll summarize our key findings. The rationale for the study was that there are now, more than ever before, newer treatment options in the treatment of advanced prostate cancer. We also know that the landscape for the delivery of care has been shifting in the United States, as it pertains to prostate cancer, for several decades now.

By that, I mean that the care is primarily being provided by medical oncologists vs urologists. It is certainly becoming obvious that the urology practices and the urologists are contributing more and more to the care of patients with prostate cancer. This includes all sorts of newer agents and we have multiple hormonal therapies which are now available.

We also have noticed that there was an expansion within many urology practices, with the inclusion of services such as radiation therapy, even immunotherapy, and also various diagnostics.

The purpose of this descriptive study was to assess the differences between medical oncologists and urologists regarding both their referral patterns and treatment decisions in men with advanced prostate cancer.

Our methods included utilizing virtual meetings which were held in August 2020. We threw in a total of four meetings, two for medical oncologists and two for urologists, with representation from diverse geography within the US.

I will highlight that this was all directed towards community‑based oncologists and urologists. We understand that the patterns of care may be different at large academic centers or tertiary care centers.

Because majority of the care for patients with prostate cancers are rendered in the community, that is why the focus of our exploration was limited to urologists and medical oncologists from community practices.

Participants were posed questions and scenarios, both via web‑based surveys prior to the meeting as well as with real‑time polling. All responses were summarized using descriptive statistics. We had a total of 66 oncologists and 69 urologists participate. All of them were in various practice settingsall within the community.

Oncology practice, we had diverse representation from within the US, and most of the participants had been in practice for over 10 years. In fact, half of the urologists had been in practice for over 20 years, so a very experienced group of physicians that we were able to reach out to.

They all had, of course, high patient volumes, with 81% of urologists seeing more than 20 patients a day and over 50% of the oncologists seeing more than 20 patients a day.

Our initial focus was to assess the referral patterns. It appears that 75% of the urologists estimated that less than a quarter of their patients were referred to a medical oncologist, and 75% of the oncologists reported that over half of their patients came from urologists.

We certainly see a shift in dynamic, where urologists are holding on or providing care to their patients for a much longer period of time. In fact, only 9% of them stated that they completely transferred the care of their patient at the time of metastatic disease or later in the course of prostate cancer.

In fact, majority, so 86% of urologists, felt like they viewed medical oncologists as co‑managers in the management of patients with prostate cancer. We also had hypothetical scenarios for the two groups of physicians, in terms of asymptomatic patients with metastatic castrate‑resistant prostate cancer.

The first choice that oncologists had was a secondary hormonal intervention, whereas urologists, or 45% of them, chose sipuleucel‑T as their first option.

Similarly, in terms of a patient who had metastatic CRPC and symptomatic bone metastases, 44% of the medical oncologists chose chemotherapy as their top choice, whereas 47%of the urologists chose radium‑223 as their top choice. We certainly noticed differences in approach and in terms of decision making and choice of therapy between these two groups of physicians.

Ultimately, I would say that urologists refer patients with advanced prostate cancer to oncologists only when there's a need for chemotherapy and that urologists prefer to treat with non‑chemotherapy options when possible and with keen oncologic care for most of the patient's cancer journey.

Very rarely, less than 10% of the time, do they transfer the care completely to oncologists. Why did we pursue this, and what is the significance of these findings? These are, of course, hypothetical possibilities that I present to you.

I think these findings are important for everyone involved. For patients, because whether you are an oncologist, or a urologist, or a family doctor, patients always ask, "Who should be managing my prostate cancer?" We're learning that more and more prostate cancer in the community is being managed by the urologists.

The second part of this is, what about patient outcomes? To the best of my knowledge, we do not have data to understand one group of physician specialists versus another is doing a better job, in terms of patient outcomes with efficacy, controlling toxicity, or even being more cost‑effective. This is certainly an area of future research.

The other part that I would highlight is that with clinical research and various stakeholders involved, be it biopharma, be it the CROs, they need to be aware of where the care is being rendered so that the appropriate research can be brought to the appropriate practice sites.

Last but not the least, we're moving into a brand-new era of therapy treatment in prostate cancer, especially with the advent of nuclear theragnostics. I think the evolution will continue, in terms of where the care is provided as these new, both diagnostic and therapeutic modalities get to the clinic.

I thank you for the opportunity to provide JCP with my summary and thank you again. 

Gajra A, Hime S, Jeune-Smith Y. Referral patterns and treatment preferences in patients with advanced prostate cancer (aPC): Differences between medical oncologists and urologists. Presented at: the virtual 2021 ASCO Genitourinary Cancers Symposium; February 11-13, 2021. Abstract 71.

Dr Gajra reports no relevant financial relationships beyond employment.