Philippa Cheetham, MD, states that the availability of oral hormonal agents such as abiraterone and enzalutamide has expanded the treatment options for patients with metastatic disease. These agents are well tolerated in the majority of patients, and patients can be managed in the urology setting; however, Cheetham stresses the importance of selecting the right medication for the right patient and monitoring patients appropriately.

Abiraterone must be taken with low doses of prednisone; the use of prednisone makes some clinicians nervous, notes Michael Williams, MD. Williams recommends that clinicians implement protocols regarding liver function testing and monitor patients for overall fluid status.

In addition to clinical and safety issues, many urologists may be concerned regarding reimbursement for these medications, comments Cheetham. Oliver Sartor, MD, notes that having office staff or nurses trained to help with reimbursement issues can help streamline the process.