Prostate Cancer Units: How and Why


1

PC is a very complex disease, involving diagnostic and therapeutic multidisciplinary decisions

2

Optimal and well-balanced information for PC cases requires a shift from a monodisciplinary to a synergic multidisciplinary approach

3

As Breast Cancer Units for breast cancer, multi-professional Prostate Cancer Units for PC are the best answer to manage patients and the complexity of their disease

4

Prostate Cancer Units offer the patient a complete, simultaneous, unambiguous, polispecialistic counseling on his disease, avoiding him to tour to different physicians

5

An MDT can provide a continuum of care for patients through early diagnosis, treatment planning in all stages of the disease, follow-up, prevention, and management of complications

6

Prostate Cancer Units connect a team whose members have specialist training in PC, spend relevant amount of time in working with PC, and have a high-level scientific qualification on PC

7

In Prostate Cancer Units the MDT can better propose the appropriate management options on the basis of the pathological reports, clinical and biochemical assessments, and the risk benefit evaluation

8

Prostate Cancer Units are in possession of or have easy direct access to all requirements for a complete, adequate, and high-level management of all phases of PC

9

Patients referred to a Prostate Cancer Unit receive more balanced information and decisions obtained in an open and interactive fashion, with all clinical specialists present at the same time

10

Patients referred to a Prostate Cancer Unit experience easier availability, enhanced coordination, and reduced delays to conclude the diagnostic and therapeutic item



Quality cancer care is complex and depends upon careful coordination between multiple treatments and providers and upon technical information exchange and regular communication flow between all those involved in treatment (including patients, specialist physicians, other specialty disciplines, primary care physicians, and support services) [15]. Traditional cancer treatment strategies began with individual consultations initiated by the internist or family practitioner with the relevant cancer specialist and subsequent patient referral to other specialists for specific cancer care treatments. An MDT comprises healthcare professionals from diverse disciplines whose goal of providing optimal patient care is achieved through coordination and communication with one another. Typically, MDT within oncology is disease focused, for example, head and neck, breast, thoracic, or genitourinary. The core disciplines integral to the multidisciplinary approach to cancer care are medical oncology, radiation oncology, surgical oncology, cancer site specialist, primary care, and nursing [16]. This type of structure ensures that the patient is informed and guided during and after treatment, from inpatient status to outpatient status, moving patient care prospectively. The benefits of a multidisciplinary approach to treating cancer may be particularly important in PC where there are so many treatment options available today including surgery, radiotherapy, hormonal therapy, focal therapy, or active surveillance and watchful waiting [17].

As suggested by Valdagni et al., a Prostate Cancer Unit is a place where men can be cared for by specialists in PC working together within a multi-professional team [18].

From October 2010 our hospital accepted the institution of a Prostate Cancer Unit. Our Prostate Unit was established in large size hospital, covering a population of more than 300,000 people.

The main aim of the unit was to provide a continuum of care for patients through early diagnosis, treatment planning in all stages of the disease, follow-up, prevention, and management of complications related to PC. Patients that can be followed by the Prostate Cancer Unit include cases in which the diagnosis is as yet unestablished but whose could benefit for an early diagnosis program; cases in which the diagnosis of PC is confirmed and whose can be considered for treatment planning; cases following primary treatment for discussion of further care; and cases in follow-up after or during treatment.

Following indications from previous experiences [18], we accepted some basic requirements for our Prostate Cancer Unit:

1.

The unit is represented by a core team whose members have a specialist training in prostate disorders, spend a relevant amount of their time working with PC, undertake continuing professional education, and have a high-level scientific production on PC experimental and clinical research.

 

2.

The core team include: two coordinators (one referred for the diagnostic and one for the clinical therapeutic management of PC) from any specialist of the team; urologists (spending 50 % or more of their working time in prostate disease, managing at least 100 PC cases per year, and carrying out at least 25 radical prostatectomies per year and at least one prostate clinic per week); urologist/radiologist dedicated to prostate biopsies (spending more than 70 % of his working time in prostate biopsies and performing more than 400 prostate biopsies per year); uropathologist (spending 30 % or more of his working time in prostate disease and analyzing at least 250 sets of prostate biopsies per year); radiation oncologists (spending 50 % or more of their working time in prostate disease and carrying out radiotherapy on at least 25 PC per year); medical oncologists (spending 30 % or more of their working time in prostate disease and managing at least 50 PC cases per year); and radiologists (with main experience in all aspects of prostate imaging, one using multiparametric magnetic resonance and ultrasonography and one as expert in nuclear medicine, and spending 50 % or more of his working time in prostate disease). Additional professional services also include a sexologist/andrologist, psychologist, palliative care specialist, and a clinical trials coordinator.

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Mar 18, 2017 | Posted by in UROLOGY | Comments Off on Prostate Cancer Units: How and Why

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