By Dr. Sperling

Many historic trends in medical practice have been influenced by patient need and desire. Women’s health offers a case in point: the advancement of the breast lumpectomy as an alternative to radical mastectomy (removal of the breast, nearby lymph nodes and significant muscle tissue.) Breast surgeons were reluctant to deviate from this “gold standard.” It was not until a significant number of women and their innovative surgeons chose lumpectomy and post-surgery radiation that the results were unarguable: lumpectomy for appropriate women is as successful in cancer control as radical removal.

Prostate cancer (PCa) treatment is now at a similar stage. Thanks to the media, especially the internet, men at risk of PCa, or recently diagnosed, are aware of two important facts:

1. All whole-gland PCa treatments (surgery, radiation, ablation) carry a risk of side effects that can diminish quality of life, even if only temporarily.
2. Technology is moving quickly toward less invasive surgery (robotics), more targeted radiation (IMRT, proton beam), and focal ablation (cryotherapy, HIFU, laser ablation, phototherapy) for qualified patients.

The patient quest for post-treatment preservation of continence and potency presents a golden opportunity for a new cooperative trend in clinical practice: the interdisciplinary team. Several years ago, a group of authors in the United Kingdom contributed an editorial piece on the merits of a multidisciplinary team in urologic oncology, the branch of urology devoted to the treatment of urologic cancers. They noted, “Recently, in the UK it was recommended that improvements in cancer outcomes can be achieved through major organizational changes in cancer care by reorganizing cancer services into ‘cancer networks’ and adopting significant changes in professional practice through the promotion of specialization by individual consultants, a multidisciplinary approach and shared clinical protocols.”i Specifically regarding urologic oncology, a multidisciplinary team approach was emphasized. The article shares the authors’ positive experience and enhanced quality of care for patients under the team method.

Increasingly, urologists and radiologists are collaborating in PCa diagnosis, decisionmaking, treatment and follow up. Working together, they can combine diagnostic techniques (imaging and biopsy), review pathology analyses, and work with the patient to tailor treatment recommendations to the patient’s clinical profile, life expectancy and lifestyle wishes. Especially with the growing interest in minimally invasive and less-thanradical ablative technologies, the thoroughness brought by the team approach increases confidence that even a targeted treatment assures successful cancer control—the most important treatment criterion.

Prior to biopsy, it may be worthwhile for potential PCa patients desiring access to truly comprehensive diagnostic and treatment options seek a medical team that includes at least a urologist and radiologist working together.