Multidisciplinary clinic evaluation changes prostate cancer stage and risk stratification.

Abstract

91 Background: The use of multidisciplinary clinics (MDCs) for outpatient cancer evaluation is increasing. Data on whether MDCs improve prostate cancer (PCa) care are limited. We studied the frequency of changes in PCa grade and stage upon MDC evaluation. Methods: Between May 2008 and December 2012, 887 consecutive patients underwent consultation for newly diagnosed prostate cancer at the Johns Hopkins Hospital (JHH) MDC, which features real-time collaboration among urologists, radiation oncologists, and medical oncologists. Retrospective chart review identified presenting tumor characteristics, based on outside assessment (medical records sent upon referral to MDC), as compared with disease stage and grade as determined at MDC evaluation. All outside biopsy slides were reviewed by JHH pathologists, and all outside imaging (CT, MRI, bone scan) was reviewed by JHH radiologists. Results: The three most chosen treatments after MDC evaluation were external beam radiotherapy +/- androgen deprivation (39.3%), radical prostatectomy (32.0%) and active surveillance/expectant management (12.9%). Using the NCCN guidelines as a benchmark, many men were found to have undergone non-indicated imaging (bone scan 23.9%, CT/MRI 47.4%). Overall, 186/647 (28.7%) had a change in their NCCN risk classification or N or M stage. For example, 2.9% of men were down-classified as very-low-risk, rendering them eligible for active surveillance. 5.7% of men thought to have localized cancer were up-classified as metastatic, thus prompting systemic management approaches. Conclusions: Comprehensive evaluation of prostate cancer patients in a MDC is associated with critical changes in presenting disease classification from baseline in over one in four men. While questions about the long term costs and benefits of MDCs remain, these results lend credence to the growing belief that MDCs may dramatically impact management for a large number of men with prostate cancer. [Table: see text]