Urologists Prescribing More Oral Targeted Therapies for Advanced Prostate Cancer as Comanagement Declines

Urologists accounted for a growing share of oral targeted therapy prescriptions for men with advanced prostate cancer from 2013 to 2021, while comanagement between urologists and medical oncologists declined, according to a cross-sectional study published as a research letter in JAMA Network Open.

The investigators noted that men with advanced prostate cancer often require the expertise of both urologists and medical oncologists. Unlike chemotherapy, oral targeted therapies may be prescribed by physicians other than medical oncologists, namely urologists. Using a 100% sample of Medicare beneficiaries, the investigators examined patient volume and comanagement by prescribing specialty among men older than 66 years who initiated an oral targeted therapy between 2013 and 2021.

The analysis included 15,639 men (mean age, 76.5 years). Of these, 33.9% received their prescription from a urologist and 66.1% from a medical oncologist. The number of men receiving these therapies increased from 487 in 2013 to 2854 in 2021, and the proportion prescribed by urologists rose from 14.0% to 41.0%. Comanagement was defined as at least 1 evaluation and management visit with the nonprescribing specialist within 12 months after the first prescription fill.

Comanagement declined over the study period regardless of prescribing specialty. The decline was more pronounced among patients whose prescriptions came from urologists, falling from 44.1% in 2013 to 23.9% in 2021. The authors said the shift is likely due to the growing number of oral treatment options and the expansion of indications to earlier stages of disease. They added that the profitability of dispensing these therapies may further disincentivize comanagement.

The authors noted several limitations. Medicare claims lack cancer severity characteristics, such as volume of metastatic disease or local symptoms. Selection based on prescribing specialty is possible. The comanagement definition required only 1 visit, which limited the investigators’ ability to characterize the degree of collaboration. The authors concluded that the data support a growing role for urologists in prescribing these therapies, with a concurrent decline in comanagement regardless of prescribing specialty.

Source: Srivastava A, Sun A, Caram MEV, Shahinian VB, Hollenbeck BK. Oral targeted therapies and clinician comanagement among men with advanced prostate cancer. JAMA Netw Open. 2026;9(10):e2639853. doi:10.1001/jamanetworkopen.2026.39853