Evidence-based PCa care more likely in multidisciplinary setting

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Newly diagnosed low- and high-risk prostate cancer patients seen during the same appointment by a urologist and radiation oncologist were more likely than patients in a nationwide cohort to choose evidence-based care, according to a study by researchers from The University of Texas MD Anderson Cancer Center, Houston.  

MD Anderson and other U.S. cancer centers have developed a multidisciplinary approach to care designed to give prostate cancer patients a balanced presentation of all their treatment options.

Urologists are usually the first to see prostate cancer patients, followed at a later date by radiation oncologists or medical oncologists, according to study author Chad Tang, MD, of The University of Texas MD Anderson Cancer Center.

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“When you have multidisciplinary practice, that means you have two physicians from different specialties at the same time, in the same clinic, seeing the patient either together or back to back,” Dr. Tang said.

The multidisciplinary approach allows simultaneous presentation of therapy choices, facilitating informed decision-making and expediting the time to treatment initiation, according to the study, which was published online ahead of print in Cancer (Nov. 19, 2019).

The authors compared the treatment choices of 4,451 newly diagnosed prostate cancer patients presenting to MD Anderson multidisciplinary prostate cancer clinics from 2004 to 2016 to 392,710 prostate cancer patients nationwide diagnosed between 2004 and 2015 in the Surveillance, Epidemiology and End Results (SEER) database.

The authors found that 74% of men in the MD Anderson multidisciplinary group with low-risk disease received evidence-based nondefinitive therapy compared to 54% in the SEER cohort.

Next: Almost all men treated at MD Anderson multidisciplinary clinics with high-risk disease received definitive treatmentAlmost all men treated at MD Anderson multidisciplinary clinics with high-risk disease received definitive treatment, which is recommended in the National Comprehensive Cancer Network (NCCN) guidelines. Still, nearly 20% of men with high-risk disease in the SEER group chose nondefinitive treatment.

In a finding that suggests the multidisciplinary approach might obviate the influence of race, African-American men older than 70 years of age with low-risk prostate cancer were more likely than older Caucasian men to choose active surveillance in the MD Anderson multidisciplinary care model.

“In all other age and risk groups, African-Americans were more likely to receive definitive treatment. In the SEER cohort, the opposite was found where African-Americans in all risk groups were more likely to receive definitive treatment across age groups,” according to an MD Anderson press release on the study.

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And while previous studies have shown increased use of definitive therapy among Caucasian compared with African-American patients, African-American patients in the MD Anderson multidisciplinary group had higher rates of definitive therapy whether they had high-, intermediate-, and low-risk disease.

The study’s outcomes should motivate urologists, radiation oncologists, and medical oncologists to offer prostate cancer patients multidisciplinary clinical care when possible, according to Dr. Tang.

Urologists in all settings, when possible, should partner with radiation oncologists and medical oncologists to offer these “one-stop clinics,” even if they practice in different parts of town, he said.

Among the study’s limitations: The SEER database contains data through 2015, whereas the MD Anderson database offered mature data through 2016, and SEER data lacks details about systemic therapy and whether patients were treated with active surveillance, watchful waiting, hormones only, or “benign neglect,” the authors wrote.