Establishing a prostate cancer referral pathway between urology and medical oncology at Lyndon B. Johnson Hospital.

Abstract

60 Background: Treatment for biochemically recurrent (bcr) and metastatic prostate cancer (pc) is evolving, making multidisciplinary evaluation a critical need. Our center, a community public hospital, lacked clear referral criteria between the Urology (Uro) and Medical Oncology (Onc) clinics, resulting in inconsistent care. We aimed to improve multidisciplinary communication and the rate of patient (pt) referrals by establishing standardized referral criteria for pc pts between Uro and Onc. Methods: Referral criteria were based on the presence or concern for primary refractory, bcr, castrate resistant (cr), or metastatic pc, as established by the PCWG3 and RTOG-ASTRO Phoenix consensuses. Primary refractory pc was defined as a failure of the PSA to fall to undetectable levels after radical prostatectomy (rp). Bcr pc was defined as two consecutive PSA values ≥ 0.2ng/mL after rp, or a rise in PSA 2ng/mL above post-treatment nadir after radiation therapy. Cr pc was defined as radiographic (progressive measurable disease) or chemical (two rising PSA levels 6-12 weeks apart) progression despite castrate levels of testosterone (T), defined as a serum T < 50ng/dL. Metastatic pc was defined as the development of bone lesion(s), organ involvement, or lymphadenopathy above the bifurcation of common iliac vessels. The referral criteria were organized into a chart and visibly displayed, discussed during multidisciplinary meetings, and distributed during educational sessions with Uro Residents and Onc Fellows in January 2019. Referral rate was collected from July 2018 through December 2018, and collection of post-intervention referral rate is planned from January 2019 through June 2019. Results: Pre-intervention, 39% (23/59 pts) of the pts that met referral criteria were referred to Onc. Preliminary data from January through April 2019 demonstrated a referral rate of 60% (9/15 pts). Conclusions: In 4 months, our intervention improved the referral rate by 21%. These criteria continue to be reinforced during multidisciplinary meetings and more educational sessions are planned as new personnel establish in the clinics. Ultimately, more time and pts are required to determine the full impact of this project.