BackTable Urology Ep. 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.
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This podcast is supported by
Bayer
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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
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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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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/
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