Coordinated care maximizes advanced prostate cancer outcomes

Chicago-With the evolving definition of advanced prostate cancer that now includes a number of clinical states not previously defined, treatment has also evolved into a multimodal approach. This mandates close cooperation among urologists and medical and radiation oncologists to ensure optimal patient care, according to leading oncologists.

According to Dr. Drecier, medical oncologists need to be involved earlier in the management of patients with prostate cancer. That entails working better and more closely with urologists to provide the multimodal therapy needed to treat the new disease states descriptive of advanced disease.

Communication, trials needed

Nicholas J. Vogelzang, MD, director of the Nevada Cancer Institute in Las Vegas, who is also a medical oncologist, empathizes with urologists, given their substantial workload and the constantly changing recommendations on the treatment of advanced disease.

"The problem for urologists is that treatment for these patients has been a moving target over the last 10 years," he said. "First, urologists were told there was no treatment for patients with positive lymph nodes. Then in 1997, they were told to give them hormonal therapy, and now there is indication that adding chemotherapy and radiation therapy may be useful."

"We do a lot of things, but there are no prospective data to show therapies are effective in this setting," Dr. Dreicer said.

Dr. Vogelzang agrees that clinical trials are critical.

"No clinical trials have yet been completed that provide evidence on the benefit of chemotherapy for locally advanced disease. Furthermore, only this year have data emerged on the benefit of adjuvant radiation therapy," he said. "We need to encourage clinical trials for any stage of disease."

Dr. Vogelzang emphasized that this is a three-way street that includes urologists, medical oncologists, and radiation oncologists.

For Mack Roach, III, MD, a radiation oncologist and professor of radiation oncology and urology at the University of California, San Francisco, critical to improving cooperation among these specialties is recognition that all specialties are involved.