Neal Shore, MD, begins by saying that there are many different ways to monitor and manage castration-resistant prostate cancer patients. With regard to monitoring patients, a bone health clinic can help to evaluate all of the adverse events caused by androgen deprivation therapy: bone demineralization, risk of fracture, central obesity weight gain, cognitive impairment, and adverse lipid profile. Bone health clinics are data mines, more or less, and provide insight into difference between an androgen-sensitive and a castration-resistant patient.

As data is collected and analyzed, some emphasis must remain on a patient’s age, comorbidities, pace of disease, PSA kinetics, PSA doubling time, and absolute PSA when deciding the frequency of scans. Shore says that there is no room for unnecessary cost, anxiety, and radiation exposure.

In terms of patient management, Shore says that the practice of medicine is heterogeneous between states or even within counties. The ideal setting, with an expert medical oncologist, radiation oncologist, pathologist, nutritionist, physical therapist, and urologist, all part of a multidisciplinary, integrative approach. The keys to making such an arrangement work are communication, education, and dedication.