Oncologists' role in early prostate cancer remains unclear

Chicago-For men diagnosed with early prostate cancer or localized disease, the roles of the urologist, surgical oncologist, and radiation oncologist have been fairly well defined. The role of medical oncologists in managing patients in the early stages of the disease is less clear.

Speaking to a group of urologists, radiation oncologists, and medical oncologists at the Perspectives in Prostate Cancer conference here, Dr. Carducci said that even though some centers have multidisciplinary clinics where cancer care is more closely managed by all three specialties, "whether every patient with local disease should see a medical oncologist is by no means standard."

"It is not that better coordination is needed between urologists and oncologists," said Nicholas J. Vogelzang, MD, director of the Nevada Cancer Institute in Las Vegas, "but that we need to do clinical trials to gather evidence on which to base treatment."

The need for more clinical trials in prostate cancer was echoed by Mack Roach, III, MD, professor of radiation oncology and urology at the University of California, San Francisco, who emphasized that without adequate input from all specialties involved with prostate cancer care, "you will have studies designed that will fail and will not answer the appropriate questions."

"I do agree that there should be better communication among the radiation therapist, the urologist, and the medical oncologist," Dr. Roach said. "I think that sometimes if one specialty designs a trial, then they do it without discussing it with other specialties and there is a chance that they may do something that is not in the best interests of the patient."

Dr. Carducci agreed.

"Certainly we should include urology and radiation oncology earlier to help design trials that fit into individual practices," he said, "but the role of medical oncologists once the trial is up and running is to add their level of expertise to the conduct of the trial and to encourage patient participation."

For Dr. Carducci, clinical trials are a way to build relationships between the specialties. Specific types of trials for early-stage disease that may benefit from input with a medical oncologist may be trials on perioperative strategies and a rising PSA after local therapy. In terms of perioperative strategies, issues that medical oncologists and urologists would need to discuss would include patient flow and timing of procedures, he said.

Experts agree that improving coordination among urologists, radiation oncologists, and medical oncologists in early-stage prostate cancer appears to hinge on performing more clinical trials in which all specialties have a voice in designing the trials, are knowledgeable about trials under way, and have access to the trials to encourage patient participation.