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Multi-Disciplinary Approach to Newly Diagnosed Prostate Cancer: A New Paradigm
Thomas E Novak1, Jane L Hudak*2, Jennifer Cullen*3, Mary McGarvey*2, David G McLeod2
1Malcolm Grow Medical Center, Andrews Air Force Base, MD;2Center for Prostate Disease Research, Washington, DC;3Center for Prostate Disease Research, Rockville, MD
Introduction:
There are relatively equivalent treatment alternatives for local therapy for prostate cancer (CaP) from which patients must choose. The authors investigated the impact of multi-disciplinary counseling on treatment decisions of patients with newly diagnosed CaP.
Methods:
In a single day, patients meet individually with a urologist, radiation oncologist, psychologist, nurse educator and nurse coordinator. Each treatment alternative is discussed. A collaborative meeting culminates in a treatment recommendation, or when appropriate, the decision is left to the patient. The authors reviewed patient characteristics and treatment decisions of the first 421 patients evaluated in this setting over 2-years (2003-2005) and compared them to a cohort of similar patients from the CPDR Database who made the same decision after conventional counseling (2001-2003).
Results:
A total of 421 patients attended the multi-disciplinary clinic in the study period. Mean patient age was 62.6 years (range 35-91). The majority had PSA < 10 ng/dl (84%) and Gleason ≤ 6 (86%). Of the 404 (96%) patients in which a treatment decision was available, 43% had surgery and 43% radiation. In contrast, of the 1322 patients in the database, 51% had surgery and 20% radiation. The decreased number of patients opting for surgery was significant (p<0.0001). Subset analysis comparing men (age ≤70, PSA ≤10, and Gleason ≤6) demonstrated a similar finding (p<0.0001).
Conclusions:
Multi-disciplinary counseling of patients with newly diagnosed CaP resulted in a more balanced number of patients electing surgery and radiation therapy. Collaborative multi-disciplinary counseling empowers patients to make confident, informed treatment decisions.
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