Thursday, January 23, 2014

Prostate Cancer Multidisciplinary Clinic

Multidisciplinary clinics are a relatively new trend in medicine.  The clinics offer patients the opportunity to meet, on the same day, experts from a number of fields within medicine and surgery.  For patients with cancer, this often is an opportunity to have records reviewed by expert pathologists and radiologists and to meet with a surgeon, radiation oncologist and medical oncologist in the same setting.  It prevents the patient from having to schedule multiple appointments with multiple experts in the field, creates a forum for conversation between experts in a variety of fields (rather than relying on interdepartmental consultations and discussions) and, in doing so, can streamline care.  For prostate cancer, multidisciplinary clinics from around the country demonstrate improved compliance with national guidelines, excellent oncologic outcomes and high patient satisfaction. [1,2]

Edward M. Schaeffer, MD, PhD
The Prostate Cancer Multidisciplinary Consultation (PCMDC) at Johns Hopkins has been offering this service since 2008.  Over the past 5 years, over 1,000 men with prostate cancer have been seen in the PCMDC.  Nearly 60% stay at Hopkins for their treatment: approximately 25% elect surgery, 25% radiation therapy, 10% active surveillance and 5% androgen deprivation treatment for advanced cancer.  All medical records are obtained, collated and reviewed by our experts prior to the PCMDC clinic appointment.  All prostate cancer slides obtained from the biopsy are reviewed by our expert urological pathologists and any imaging is reviewed by dedicated genitourinary radiologists.  A panel including these pathologists, radiologists, urologic oncology surgeons, radiation and medical oncologists then meet to review a patient's case.

Debasish Sundi, MD
Often changes are made, diagnoses can be adjusted and management options tweaked to best fit that patient's needs.  Under the tutelage of Edward M. Schaeffer, Associate Professor of Urology, Oncology and Pathology, and Co-Director of the PCMDC; Debasish Sundi (a senior resident at the Brady) will present data at American Society for Clinical Oncology (ASCO) Genitourinary Cancers Symposium demonstrating that nearly 30% of patients who present to the PCMDC will have a change in their risk category or stage.  For example, 3% of men were down classified to very -low risk prostate cancer and became eligible for active surveillance; 6% of men were upstaged to metastatic disease and had systemic therapy initiated rather than undergoing localized treatment. [3]

In addition, the PCMDC offers a unique opportunity for research.  For instance, many patients speak favorably about their experience at PCMDC, however little data exists validating these perceptions.  Over the next several months, we will be evaluating the patient-centered experience at the Johns Hopkins PCMDC by prospectively evaluating quality of life, satisfaction with care, and illness uncertainty among patients coping with a new diagnosis of prostate cancer.  The study is conducted entirely online and is administered through the NIH-funded tool for online clinical research: Assessment Center ( Patients complete online questionnaires before and after their clinic appointment and can access their personalized study webpage from their personal computers, tablets, or smart phones.  By focusing on patient-reported outcomes, our goal is to show a positive impact of multidisciplinary cancer care on the quality of life of men with newly diagnosed prostate cancer.  In addition, research opportunities exist to track cancer and functional outcomes following surgery and radiation treatments.  Novel therapies including gene-based vaccinations are offered to appropriate candidate patients.  Patients with advanced malignancies who have failed traditional therapies are offered the newest and latest options from Johns Hopkins experts.

If you are a patient with prostate cancer who would like a second opinion, or if you are a physician with a patient who you would like seen at PCMDC please call 410-955-6100.

1. Aizer AA, Paly JJ, Zietman AL, et al. Multidisciplinary care and pursuit of active surveillance in low-risk prostate cancer.  J Clin Oncol. 2012 Sep 1;30(25):3071-6. doi: 10.1200/JCO.2012.42.8466. Epub 2012 Jul 30.

  • 2.  Gomella LG
  • Lin J
  • Hoffman-Censits J
  • et al. 
  • Enhancing prostate cancer care through the multidisciplinary clinic approach: A 15-year experienceJ Oncol Pract 2010 6:e5e10.

    3. Sundi D, Cohen JE, Cole AP, Neuman BP, Cooper J, Faisal FA, Raben MG, Song DY, Drake CG, Netto GJ, Macura KJ, DeWeese TL, Partin AW, Bivalacqua TJ, Ross AE, Schaeffer EM. Multidisciplinary clinic evaluation changes prostate cancer stage and risk stratification.  To be presented at GU-ASCO, January 30-February 1, 2014; San Francisco, California.

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