Multidisciplinary Care Increases Active Surveillance in Prostate Cancer
“To our knowledge, this is the first description of such an association. Interestingly, the number of physicians and specialties seen was significantly associated with the choice of active surveillance on univariate, but not multivariate, analysis suggesting that the multidisciplinary clinic itself, and not merely the number or type of physicians seen, is important to the shared decision making process for selection of active surveillance,” wrote Ayal Aizer, MD, MHS, of the Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, MA, and colleagues.
The study examined 701 men with low-risk prostate cancer who were being managed at three tertiary care centers in 2009. “Patients either obtained consultation at a multidisciplinary prostate cancer clinic, at which 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,” they noted.
Active surveillance, the primary outcome, was selected by 22% of patients seen by individual practitioners and 43% of those seen at a multidisciplinary clinic, which decreased selection of prostatectomy by 24%, external-beam radiation therapy by 41%, and brachytherapy by 30% (all P<0.001). On multivariate logistic regression, in addition to receiving care in a multidisciplinary care clinic, older age, unmarried status, increased Charlson comorbidity index, and fewer positive cores were all significantly associated with choosing active surveillance.
The investigators noted that “although active surveillance has become a reasonable option for men with low-risk prostate cancer, its safety remains controversial and continues to be investigated. Ongoing randomized trials will further inform this important management decision. The ProtecT trial, a trial based in the United Kingdom that randomly assigns men with lower-risk prostate cancer to active surveillance, radical prostatectomy, or radical radiotherapy, is expected to report preliminary results in 2015.”