alexa Communication on the Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease | Open Access Journals
ISSN: 2472-4971
Journal of Medical & Surgical Pathology
Like us on:
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Communication on the Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease

Andrew Leone1*, Gregory Diorio1, Anthony Mega2 and Joseph Renzulli II2

1Department of Urologic Oncology, Moffitt Cancer Center, Tampa, Florida, USA

2Division of Urology, The Warren Alpert Medical School of Brown University, Florida, USA

Corresponding Author:
Andrew Leone
Department of Urologic Oncology
Moffitt Cancer Center, Tampa Florida, USA
E-mail: [email protected]

Received Date: April 05, 2016; Accepted Date: May 03, 2016; Published Date: May 09, 2016

Citation: Leone A,Diorio G, Mega A, Renzulli II J (2016) Communication on the Impact of Multidisciplinary Care in a Large Volume Robot- Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease. J Med Surg Pathol 1:123. doi: 10.4172/jmsp.1000123

Copyright: © 2016 Leone A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Medical & Surgical Pathology

Short Communication

The authors of this manuscript present the effect of successful implementation of a multidisciplinary genitourinary oncology clinic (MDC). The clinic includes coordinated patient visits with medical oncology, urologic oncology, and radiation oncology. At The Miriam Hospital MDC in Providence, Rhode Island (major affiliate of Brown University), individual patients meet with members of the medical oncology, radiation oncology, and urologic oncology teams to discuss their diagnosis, prognosis and potential treatment options [1]. Each specialty has the ability to put forth treatment recommendations based on the patient’s comorbidities, clinical stage and appropriate risk stratification (NCCN).

The widespread adoption of robotic prostatectomy and the capital investment in robotic systems nationwide has led many to anticipate more surgery for low risk prostate cancer. However, at roughly the same time the USPSTF recommendations for reduction in prostate cancer screening and the adoption of active surveillance for very low and low risk prostate cancer surfaced.

Contrary to what was expected, we found that our patients, seen at the MDC, undergoing surgery were more likely to have higher risk and stage prostate cancer and that overtreatment of potentially indolent prostate cancer was not seen. With the aggressive adoption of active surveillance surgery for Gleason 3+3 diseases dropped to less than 10% (Unpublished Data The Miriam Hospital MDC 2015).

Finally, it is difficult to determine causation from association and the specific effect of a MDC on pathological upstaging. The implementation of a MDC at other institutions has been associated with changes in disease risk classification. Sundi et al. found patients were up-classified 5.7% of the time and were down-classified 2.9% of the time as a result of a MDC appointment [2]. While much emphasis has been placed on treatment modalities that are selected after patients are seen in a MDC, it is clear that the proper assignment of risk stratification is essential to optimizing care.

Recent research and emphasis on multidisciplinary care for high risk and locally advanced disease has led to an increased adoption of surgery [3]. The Mayo Clinic recently summarized their surgical experience with high risk prostate cancer. They discussed the advantages of surgery including accurate pathological staging, durable local control, and excellent long term cancer specific survival [3]. Further, proper pathological staging may limit associated negative effects of long term androgen deprivation therapy (ADT) (cardiac, cognitive, bone health, mood, etc.) and radiotherapy. In addition, many studies suggest that the morbidity associated with radical prostatectomy (specifically the robotic approach) is similar between high risk and lower risk disease [4] and therefore surgery is more tolerable than a decade ago. One well established MDC clinic reported improved survival in high stage patients (stage III,IV) treated at their MDC when compared to the SEER national database [5].

High risk prostate cancer patients are increasingly seen as candidates for surgical intervention with extended lymph node dissection [3]. The adoption of the extended lymph node dissection has improved pathologic staging and decision making for adjuvant therapies. The appropriate integration of adjuvant or salvage radiation therapies have improved local control and possibly increased disease specific and overall survival (SWOG). In addition, a myriad of new systemic therapies for metastatic castration resistant disease has extended overall survival and reduced skeletal related events, thus improving patient’s longevity and quality of life.

With an increase in surgery as the preferred modality in selected patients with high risk prostate cancer, extended pelvic lymph node dissection has been adopted my many academic groups (Mayo, MSSKCC, MD Anderson). The definition of extended pelvic lymph node dissection (ePLND) remains somewhat undefined. The majority of surgeons agree that ePLND must include obturator and external iliac and hypogastria but the inclusion of presacral, common iliac, and presciatic nodes is not agreed upon [6]. Recent evidence from Abdollah et al. suggests that more extensive PLND improves survival in patients with node positive prostate cancer [7]. However, this study is limited by its retrospective design and lack of central pathological review.

Finally, while operative time is increased when performing ePLND, studies to date have failed to demonstrate a significant increased complication rate compared to standard PLND [6]. The lack of level one evidence and difficulty in performing randomized prospective trials has limited guideline adoption of ePLND. Determining which patients with high risk prostate cancer would benefit most from surgery remains elusive and despite attempts to develop preoperative nomograms further research is needed [8].

In conclusion, we are confident that a multidisciplinary approach to address high risk prostate cancer has optimized and improved our patients’ outcomes and experiences. With reduced screening for prostate cancer, high risk and locally advanced disease will be diagnosed more frequently [9]. USPSTF increase risk high risk prostate cancer Since the USPSTF recommendation against prostate cancer screening in 2012, there has already been an increase in high risk disease diagnosis (approximately 3% per year) Thus, the development of a MDC at cancer centres around America that incorporate surgery into the treatment algorithm for properly selected patients with high risk disease will become of paramount importance.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Recommended Conferences

Article Usage

  • Total views: 8075
  • [From(publication date):
    July-2016 - Oct 23, 2017]
  • Breakdown by view type
  • HTML page views : 8012
  • PDF downloads :63
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords