A newly published article in the Journal of Clinical Oncology has reported that men being seen at specialized, multidisciplinary prostate cancer clinics are nearly twice as likely to accept initial active surveillance as men consulting individual practitioners.
The study reported by Aizer et al. was based on data from 701 men, all diagnosed with low-risk prostate cancer and managed at one of three tertiary care hospitals in Boston in 2009. The patients were all seen either at a multidisciplinary prostate cancer clinic (where they were seen by a combination of urologic, radiation, and medical oncologists in a concurrent setting) or they were seen by individual practitioners in sequential settings.
Here are the basic results reported by Aizer et al.:
- Among the men seen at a multidisciplinary clinic, 43 percent selected active surveillance as their first-line form of management.
- Among the men seen by individual practitioners, 22 percent selected active surveillance.
- The proportion of men initially treated with radical prostatectomy or radiation decreased by approximately 30 percent.
- Several specific factors were significantly associated with selection of active surveillance as a first-line management option, including
- Older age (odds ratio [OR] =1.09)
- Unmarried status (OR = 1.66)
- Increased Charlson comorbidity index (OR = 1.37)
- Consultation at a multidisciplinary clinic (OR = 2.15)
While most men are still not being seen at multidisciplinary clinics today, there is a strong potential message here to patients — as well as to the clinical community. Of course it remains a fact that what patients may be told at a multidisciplinary clinic still depends on the knowledge, communication skills, and intent of the participating specialists.