Adherence to oral or parenteral therapies for prostate cancer—or any disease, for that matter—is extremely important. In the last 5 to 6 years, we have seen an algorithmic explosion in oral oncolytic therapies in multiple tumor streams and, particularly, in genitourinary oncology. We have the first oral gonadotropin-releasing hormone antagonist to be approved by the US Food and Drug Administration, 4 oral androgen receptor–targeted therapies, and 2 oral poly (ADP-ribose) polymerase inhibitors. In bladder cancer, we have an oral fibroblast growth factor receptor inhibitor, which is the first oral bladder cancer therapy to be approved. And, of course, in kidney cancer, we have numerous tyrosine kinase inhibitors and other advanced kidney cancer oral therapies. So, this surge in therapies has had a tremendous impact on our patients with genitourinary malignancies. I have yet to meet a patient who would prefer getting a needle in their abdomen or buttock over taking a pill.

Adherence to oral therapies for nononcologic diseases (eg, hypertension, metabolic syndrome, and epilepsy) has long been an important component of treatment success. And now, our urologic oncologic colleagues and our medical oncologic colleagues are entering the world of daily oral therapies. Yes, there are some patients who have swallowing disorders, and yes, there are some patients who have dementia and confusion, but even these individuals can take daily oral medications if they have good caregivers.

One may hear accounts in the field of instances in which patients “just won’t take their pills.” While this has not been my experience, I do think that some cases of nonadherence may be attributed to cost toxicity with the newer oral medications. That must be addressed. Further, it appears that some parts of our health care system encourage the use of parenteral administration over oral administration, depending on the economic model of a particular clinic, and that may need to be evaluated to confirm that it is in the best interest of patient care.

Reports in the literature have indicated that some patients with cancer may ration their medications because of cost concerns, and I believe that, in such cases, patients would not necessarily tell their physician. Additionally, there may be issues with adherence to the indicated dosages or oral medications; some patients may believe that “less is better,” despite their physician counseling them to take the doses as prescribed. I certainly recommend dose reductions and interruptions if patients are having side effects, but it is concerning if they are taking their dosing into their own hands. I think that adherence needs to be regularly reviewed by the entire health care team, with patients and their caregivers.