A Multidisciplinary Prostate Cancer Clinic for Newly Diagnosed Patients

Madsen, Lydia T.; Craig, Catherine; Kuban, Deborah A.

doi:10.1188/09.cjon.305-309

Cited by 11 publications

(9 citation statements)

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“…In the USA, for example, physician assistants have been in place since the 1960s, in an effort to address the national shortage of physicians in primary care as well as in rural areas . Across Europe, there are now approximately 2500 Urology nurse practitioners who belong to the European Association of Urology Nurses , providing a diverse range of urological services such as flexible cystoscopy , lower urinary tract assessment , prostate clinics and sexual dysfunction assessment clinics . Although the physician in charge is ultimately responsible for the care of their patients, it is clear that the role of the NPP has evolved and expanded considerably in recent times.…”

Section: Discussionmentioning

confidence: 99%

Can a trained non‐physician provider perform transrectal ultrasound‐guided prostatic biopsies as effectively as an experienced urologist?

et al. 2012

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What's known on the subject? and What does the study add?• PSA testing has resulted in a large number of patients being referred to urologists for investigation of potential prostate cancer. Despite limited evidence, non-physician providers now perform a number of routine urological procedures such as transrectal ultrasound-guided prostatic biopsies (TRUSP) in a bid to help relieve this increasing workload.• In the largest series to date, we provide evidence that an adequately trained non-physician provider is able to perform TRUSP as effectively as an experienced urologist after an initial learning curve. Objective• To evaluate differences in cancer detection rates between a trained non-physician provider (NPP) and an experienced urologist performing transrectal ultrasound-guided prostatic biopsies (TRUSP) at a single UK institution. Patients and Methods• We retrospectively analysed a prospectively accrued database of patients (n = 440) referred for investigation of an abnormal digital rectal examination and/or a raised age-specific prostate-specific antigen (PSA) value undergoing first-time outpatient prostatic biopsies who were sequentially allocated to either an NPP or a physician-led TRUSP clinic.• Differences in overall and risk-stratified prostate cancer detection rates were evaluated according to TRUSP operator.• Continuous variables were analysed using Mann-Whitney U test whereas categorical variables were analysed using Pearson's chi-squared test. A multivariate binary logistic regression model was fitted for predictors of a positive biopsy. Results• In all, 57.3% (126/220) of patients who underwent physician-led TRUSP were diagnosed with prostate cancer compared with 52.7% (116/220) in the NPP-led clinic (P = 0.338).• Sub-group analysis revealed a lower cancer detection rate in men presenting with a low PSA level (<9.9 ng/mL) during the first 50 independent TRUSP procedures performed by the NPP (P = 0.014). This initial difference was lost with increasing case volume, suggesting the presence of a learning curve.• Multivariate logistic regression analysis revealed age (odds ratio (OR) 1.054, 95% confidence interval (95% CI) 1.025-1.084, P Յ 0.001), presenting PSA level (OR 1.05, 95% CI 1.02-1.081, P = 0.001), prostatic volume (OR 0.969, 95% CI 0.958-0.981, P Յ 0.001) and clinical stage (OR 1.538, 95% CI 1.046-2.261, P = 0.029) to be predictors of a positive prostatic biopsy outcome.• The choice of TRUSP operator was not predictive of a positive prostatic biopsy (OR 0.729, 95% CI 0.464-1.146, P = 0.171). Conclusion• An adequately trained NPP is able to perform TRUSP as effectively as an experienced urologist after an initial learning curve of 50 cases.

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Section: Discussionmentioning

confidence: 99%

Can a trained non‐physician provider perform transrectal ultrasound‐guided prostatic biopsies as effectively as an experienced urologist?

et al. 2012

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“…5 Reports from other multidisciplinary clinics indicate high patient satisfaction similar to the levels at our clinic. 6 In establishing a multidisciplinary clinic, the need for the long-term commitments of all participants and the institution cannot be underestimated. Although the multidisciplinary setting is often viewed as an "inefficient" use of time in terms of the numbers of patients that can be seen by an individual clinician, we have demonstrated that there is a potential outcome benefit to many patients with this approach.…”

Section: Discussionmentioning

confidence: 99%

“…3 Since that time, several other centers have developed similar programs. [4][5][6] Herein we report on findings from our KCC/TJU oncology data to explore the impact of our multidisciplinary efforts over the last 15 years and to describe changes to our original program.…”

Section: Introductionmentioning

confidence: 99%

Enhancing Prostate Cancer Care Through the Multidisciplinary Clinic Approach: A 15-Year Experience

Gomella

Lin

Hoffman-Censits

et al. 2010

JOP

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Our long-term experience suggests a benefit of the multidisciplinary clinic approach to prostate cancer, most pronounced for high-risk, locally advanced disease. A high level of satisfaction with this patient-centered model is seen. The multidisciplinary clinic approach to prostate cancer may enhance outcomes and possibly reduce treatment regret through a coordinated presentation of all therapeutic options. This clinic model serves as an interdisciplinary educational tool for patients, their families, and our trainees and supports clinical trial participation.

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“…2,21 In addition, reports from other MDCs indicate high patient satisfaction with this approach. 22 Of the 224 patients with high or very high risk, 13 (5.8%) and 42 (18.8%) were also managed conservatively or with primary ADT. While these numbers are not large, multiple randomized, controlled trials have shown that compared to RT and ADT, patients have an increased risk of PCa-related and overall mortality [23][24][25] and combined modality treatment should be offered.…”

Section: %)mentioning

confidence: 99%

Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

Guy

Ghanem

Loblaw

et al. 2016

CUAJ

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Introduction: We aimed to report on data from the multidisciplinary diagnostic assessment program (DAP) at the Gale and Graham Wright Prostate Centre (GGWPC) at North York General Hospital (NYGH). We assessed referral, diagnosis, and treatment decisions for newly diagnosed prostate cancer (PCa) patients as seen over time, risk stratification, and clinic type to establish a deeper understanding of current decision-making trends. Methods: From June 2007 to April 2012, 1277 patients who were diagnosed with PCa at the GGWPC were included in this study. Data was collected and reviewed retrospectively using electronic patient records. Results: 1031 of 1260 patients (81.8%) were seen in a multidisciplinary clinic (MDC). Over time, a decrease in low-risk (LR) diagnoses and an increase intermediate-risk (IR) diagnoses was observed (p<0.0001). With respect to overall treatment decisions 474 (37.1%) of patients received primary radiotherapy, 340 (26.6%) received surgical therapy, and 426 (33.4%) had conservative management; 57% of patients who were candidates for active surveillance were managed this way. No significant treatment trends were observed over time (p=0.8440). Significantly, different management decisions were made in those who attended the MDC compared to those who only saw a urologist (p<0.0001). Conclusions: In our DAP, the vast majority of patients presented with screen-detected disease, but there was a gradual shift from low-to intermediate-risk disease over time. Timely multidisciplinary consultation was achievable in over 80% of patients and was associated with different management decisions. We recommend that all patients at risk for prostate cancer be worked up in a multidisciplinary DAP. IntroductionIn 2015, an estimated 24 000 men in Canada will be diagnosed with prostate cancer (PCa) and will need to decide between a variety of management options.1 For many, this can be distressing and lead to post-treatment regret and worse quality of life.2,3 Most commonly, a patient diagnosed with PCa will meet with their urologist to learn about management options. Sometimes a referral for consultation with a radiation oncologist is made. The literature has reported that each specialist is more likely to recommend treatment that they provide. 4 In anticipation for an increase in the number of PCa diagnoses in the coming years, an understanding of the decision-making process is exceedingly important. 1,5 In 2007, the Gale and Graham Wright Prostate Centre (GGWPC), in collaboration with the Odette Cancer Centre (OCC), was established at North York General Hospital (NYGH). As a diagnostic assessment program (DAP), the goal is to improve timely access and the quality of care provided to men with PCa. Our group has already shown that wait times from suspicion to radiation treatment is, on average, two months shorter in the GGWPC vs. standard community practice (183 vs. 138 days, p=0.046). 6Patients are referred from general practitioners or community urologists if they have an elevated prostate-specific antig...

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A Multidisciplinary Prostate Cancer Clinic for Newly Diagnosed Patients

Cited by 11 publications

References 0 publications

Can a trained non‐physician provider perform transrectal ultrasound‐guided prostatic biopsies as effectively as an experienced urologist?

Can a trained non‐physician provider perform transrectal ultrasound‐guided prostatic biopsies as effectively as an experienced urologist?

Enhancing Prostate Cancer Care Through the Multidisciplinary Clinic Approach: A 15-Year Experience

Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

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