The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prostate Cancer form the basis of oncologic practice in the United States (to view the most recent version of these guidelines, visit NCCN. org).1 NCCN Guidelines indicate active surveillance to be a standard option for all men with very-low-risk prostate cancer, and the only option for men with very-low-risk prostate cancer and an expected survival of less than 20 years. Under an active surveillance regimen, immediate treatment for prostate cancer is deferred while patients undergo close monitoring for disease progression, with initiation of curative therapy at the time of convincing evidence of progression.1,2 The NCCN recommendations for patients with very-low-risk prostate cancer reflect both the extremely favorable prognosis for these men and the lack of perceived benefit to immediate, definitive treatment. Based on data from the 2007 Social Security Life Table, which indicates that the life expectancy for an average 61-year-old man is 20.2 years, the NCCN recommendations imply that active surveillance is the optimal option for many patients with very-low-risk prostate cancer aged 61 years or older. Although the incidence of very-low-risk prostate cancer has not been explicitly described, the belief is that approximately 70% of newly diagnosed patients have low-risk prostate cancer,3 and a sizeable proportion of low-risk patients have very-low-risk classification.
Consultation at a multidisciplinary prostate cancer clinic, in which patients meet concurrently with urologists, radiation oncologists, and medical oncologists specializing in prostate cancer, is thought to reduce physician bias and has been associated with increased selection of active surveillance in patients with prostate cancer when compared with sequential consultation with one or more individual providers.4 Whether this association exists in patients with very-low-risk prostate cancer has not been described. Given the improved quality of life3,5 and decreased health care costs6,7 associated with active surveillance as opposed to definitive therapy, factors associated with the pursuit of active surveillance are of clinical and economic importance. In addition, for very-low-risk patients with an expected survival of less than 20 years, active surveillance avoids overtreatment of a disease that is of minimal threat to survival.1,2,8,9
The purpose of this study was to test the hypothesis that multidisciplinary care is associated with selection of active surveillance in men with very-low-risk prostate cancer, and to examine the presence or absence of this association in the subset of men with an expected survival of less than 20 years.
This study was funded by departmental support from the Department of Radiation Oncology at Massachusetts General Hospital. Dr. Efstathiou was supported by a Prostate Cancer Foundation Young Investigator Award. Funding was used to facilitate data collection. The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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