James L. Mohler, MD, Chair of the National Comprehensive Cancer Network (NCCN) Prostate Panel, discusses approaches for urologists dealing with insurance coverage denial for patients who do not fit within NCCN guidelines for prostate cancer. He outlines the iterative, bias-free process of creating the guidelines, which allows for a quick response to the latest research. Dr. Mohler further details how the guidelines value efficacy, quantity/quality of evidence, consistency of evidence, and safety above affordability, and how this can lead to denial of coverage. He then outlines talking points for overcoming guideline-based reasons for rejection from insurance providers.Read More
James L. Mohler, MD
Roswell Park Comprehesive Cancer Center
Buffalo, New York
I have been engaged in translational research for 32 years. My activities have focused upon the role of the androgen receptor (AR) in prostate cancer (CaP) recurrence after androgen deprivation therapy (ADT), as well as racial differences in CaP aggressiveness. These research activities have been supported primarily by a Program Project that ended on 03/31/2017 after 17 years: “Prostate Cancer: Transition to Androgen-Independence” and the DOD Prostate Cancer Research Program-funded “North Carolina-Louisiana Prostate Cancer Project (PCaP),” the largest population-based CaP study ever conducted (2258 men with newly diagnosed CaP; involved 11 institutions). PCaP sought to compartmentalize the reasons for increased CaP mortality in African Americans. Thus far, racial differences in interactions between African-American CaP patients and the American Healthcare System seem to outweigh the impact of racial differences in CaP biology and both the host’s environment (diet) and genetics. PCaP has produced a total of 44 manuscripts thus far and 16 grants have been awarded to continue the interrogation of its data and biorepository. Our P01 demonstrated that tissue levels of dihydrotestosterone (DHT) in CaP that recurs during ADT are sufficient for AR activation, which lead to the re-purposing of abiraterone to treat castration-recurrent CaP. My focus on AR and ADT continues with 2 grants to support the characterization of the 3 pathways for intracrine metabolism of testosterone and DHT, as well as a novel therapeutic against DHT production. My focus on racial disparities in CaP continues with a new grant to study financial distress.
Articles by James L. Mohler, MD
Posted by James L. Mohler, MD | Jan 2020
James L. Mohler, MD, discusses the rationale and development of the 2019 NCCN guideline recommendations on genetic testing for prostate cancer. He details the workflow for developing these guidelines and changes for 2019, outlines a new decision-making algorithm for how and when men should be tested, and lays out the panel’s goals and challenges for improving genetic testing.Read More