Multidisciplinary Care And Management Of Very Low-Risk Prostate Cancer

55 Background: The National Comprehensive Cancer Network (NCCN) recommends active surveillance (AS) as the primary management option for patients with very low-risk prostate cancer (VLRPC) and an expected survival of <20 years. Factors associated with selection of AS are therefore of clinical importance. We hypothesized that care at a multidisciplinary clinic (MC), where multiple physicians simultaneously review each case, will be associated with increased rates of AS in men with VLRPC, including those with limited life expectancy.Of 630 patients with low-risk prostate cancer managed at one of three tertiary care centers in Boston, MA in 2009, 274 (43.5%) had VLRPC. Patients were either seen by one or more individual providers in sequential visits (N=178) or at an MC (N=96), in which concurrent consultation with two or more of the following specialties was obtained: urology, medical oncology, and radiation oncology.Patients seen at an MC were more likely to select AS than those seen by individual providers (64% vs 30%, p<.001), an association which remained significant on multivariable logistic regression (OR=4.16, p<.001), see Table. When the analysis was limited to patients with an expected survival of <20 years based on the 2007 Social Security Life Table, this association remained highly significant (OR=5.19, p<.001).Multidisciplinary care is strongly associated with selection of AS, adherence to NCCN guidelines, and minimization of over-treatment in patients with VLRPC. [Table: see text].