In our first episode of Treating Together, Benjamin Garmezy, MD, and Ralph J. Miller Jr, MD, discuss multidisciplinary prostate cancer care.
In this episode of Treating Together, Benjamin Garmezy, MD, and Ralph J. Miller Jr, MD, discuss the treatment of localized prostate cancer, highlighting the importance of shared decision-making and multidisciplinary collaboration.
0:53 | Differences in Urology vs Medical Oncology Perspectives
1:52 | Localized Prostate Cancer: Active Surveillance vs Treatment
4:50 | Treatment Options: Surgery vs Radiation
8:20 | Multidisciplinary Techniques
15:08 | PSMA PET Imaging and Focal Therapy
20:18 | Genetic Testing in Prostate Cancer
In this conversation, Garmezy and Miller emphasize the critical role of shared decision-making, particularly when discussing treatment options like active surveillance, surgery, or radiation. Miller notes that urologists often initiate the diagnosis and risk stratification, while medical oncologists and radiation oncologists contribute to tailoring therapy based on patient-specific factors, such as Gleason scores and comorbidities. The discussion underscores the need for cohesive messaging across specialties to reduce patient anxiety and improve outcomes.
They also consider newer focal ablative techniques, such as high-intensity focused ultrasound, for select patients with intermediate-risk prostate cancer. Miller explains that these therapies, while lacking long-term data, offer promising quality-of-life benefits. Ideal candidates are those with unilateral, imaging-visible lesions and concordant biopsies. The conversation also touches on the growing role of prostate-specific membrane antigen PET imaging for staging, particularly in intermediate- to high-risk cases, to rule out nodal disease before considering focal therapy.
Both oncologists stress the importance of germline and somatic genetic testing, especially for high-risk or metastatic prostate cancer patients.
“I've been testing everyone with frontline metastatic disease, germline and somatic. In localized prostate cancer, I'm definitely at least sending germline on my patients with Gleason [score of] 8 and above…. The relevant testing here is to get these patients tested now so that we have the information for them and their families,” Garmezy said to Miller when discussing the expanding role of genetic testing in prostate cancer.
The key takeaway is that multidisciplinary communication, patient-centered decision-making, and staying abreast of advancements in diagnostics and therapeutics are essential for improving prostate cancer care.
