September 2012, Vol 1, No 4
Team Approach Enhances Choice of Observation in Men With Low-Risk Prostate Cancer
Men diagnosed with low-risk prostate cancer are more likely to choose active surveillance as their primary treatment if their care is managed by a multidisciplinary team, according to a recent study published online ahead of print July 30, 2012, in the Journal of Clinical Oncology.
In 2012, about 240,000 men in the United States will be diagnosed with prostate cancer. About 70% will be low risk, but more than 90% of these men will opt for definitive treatment with radiation or radical prostatectomy. Neither of these treatments is superior to active surveillance in reducing prostate cancer–specific mortality. Active surveillance entails observation with monitoring for disease progression and initiating curative therapy at the earliest sign of progression.
“Efforts to prevent unnecessary treatment are crucial from medical, social, and economic standpoints,” wrote the authors.
Multidisciplinary teams provide a balanced view of the risks and benefits of various treatment options, while a single specialist tends to recommend the treatment he or she is trained to deliver, the investigators wrote.
Lead author Jason Efstathiou, MD, Massachusetts General Hospital, Boston, and colleagues analyzed choices made by 701 men with low-risk prostate cancer who were treated at 3 different Boston area hospitals. Low risk was defined as Gleason score of 6 or less, PSA level of 10 ng/mL or less, and clinical stage T1c or T2a.
At baseline, the groups were similar for age, comorbidity score, family history of prostate cancer, race, marital status, and annual income.
One-third were managed by a multidisciplinary team of doctors (urologic, radiologic, and medical oncologists), and 43% of this group opted for active surveillance rather than surgery or radiation. By contrast, only 22% of men seen by individual practitioners opted for active surveillance. The proportion of men treated with radiation or prostatectomy declined by about 30% in the active surveillance group.
In a multivariate analysis, older age, being unmarried, increased comorbidities, fewer positive cores on biopsy, and consultation with a multidisciplinary team were significantly associated with choice of active surveillance.
Efstathiou commented that a visit to a multidisciplinary clinic allowed the patient to hear multiple views about appropriate management choices and for improved informed decision making. He said this was the first study to show that multidisciplinary care may reduce bias of specialists toward the type of care they deliver. —AG
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For men with localized prostate cancer detected by prostate-specific antigen (PSA) level, treatment with radical prostatectomy did not significantly reduce mortality compared with observation, according to overall results of the large, randomized, controlled PIVOT trial (Wilt TJ, et al. N Engl J Med. 2012; 367:203-213). All-cause mortality and prostate-specific mortality [ Read More ]