ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 December;71(6):576-82

DOI: 10.23736/S0393-2249.19.03231-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Prostate cancer management at an Italian tertiary referral center: does multidisciplinary team meeting influence diagnostic and therapeutic decision-making process? A snapshot of the everyday clinical practice

Stefano DE LUCA ^{1, 2} ✉, Cristian FIORI ^{1, 2}, Marcello TUCCI ^{2, 3}, Massimiliano POGGIO ^{1, 2}, Simona ALLIS ^{2, 4}, Enrico BOLLITO ^{2, 5}, Federica SOLITRO ^{2, 6}, Roberto PASSERA ^{7, 8}, Consuelo BUTTIGLIERO ^{2, 3}, Francesco PORPIGLIA ^{1, 2}

¹ Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; ² Department of Oncology, University of Turin, Turin, Italy; ³ Division of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; ⁴ Division of Radiation Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; ⁵ Division of Pathology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; ⁶ Division of Radiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; ⁷ Division of Nuclear Medicine, San Giovanni Battista Hospital, Turin, Italy; ⁸ Department of Medical Sciences, University of Turin, Turin, Italy

BACKGROUND: Multidisciplinary team (MDT) management decision-making process appears as an interesting tool to answer most aspects of prostate cancer (PCa) diagnosis and treatment, allowing a fairer choice of therapies. The aim of this study to prospectively investigate the impact on prostate cancer clinical management of the uro-oncology MDT meeting at an Italian tertiary referral center.
METHODS: All cases discussed over an 18-months period at San Luigi Hospital uro-oncology MDT were prospectively evaluated for the impact of the MDT discussion on PCa clinical decision-making. Dilemma and management plan in the monodisciplinary visit before and/or after primary treatment were recorded. Subsequently, the MDT discussed the case and reached a consensus decision, which was also recorded. Changes in diagnostic assessment and patient management from pre- to post-MDT meeting were evaluated by a consultant urologist.
RESULTS: Overall, 201 patients, of which 99, 81 and 21 with local, advanced and metastatic disease respectively, were selected for MDT evaluation. The most frequent reasons for MDT approach after either PCa diagnosis or primary treatment were metastatic disease or locally advanced disease/positive surgical margins/biochemical recurrence, respectively. Patients with local, advanced and metastatic disease had a significative change of diagnostic/therapeutic management in 23.2%, 46.9% and 33.4%, respectively (P<0.001). Multimodal treatment was recommended in 25.3%.
CONCLUSIONS: The uro-oncology MDT meeting alters management plans in at least one-quarter of patients reaching almost 50% of cases in locally advanced disease.

KEY WORDS: Prostatic neoplasms; Interdisciplinary studies; Decision making; Radiation oncology