title: Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?
abstract: OBJECTIVE
  To determine whether oncological outcomes are improved in prostate cancer patients by using a multidisciplinary strategy as compared with a standard clinic paradigm, and whether time to treatment is delayed when using a multidisciplinary approach.
  
  
  METHODS
  We retrospectively analyzed patients who were evaluated and pursued radical prostatectomy as primary treatment, by the same surgeons, in the prostate cancer multidisciplinary clinic (n = 194) and standard urology clinic (n = 741) at Duke University Medical Center from 2005 to 2009. Comparisons of baseline characteristics were examined using rank sum and χ(2) -tests. Differences in time to radical prostatectomy and oncological outcomes were evaluated using multivariate linear and Cox regression, respectively.
  
  
  RESULTS
  A greater proportion of high-risk patients (D'Amico criteria) were evaluated at the multidisciplinary clinic compared with the urology clinic (23.2% vs 15.6%, P = 0.014). Mean-adjusted time from biopsy to radical prostatectomy was shorter for multidisciplinary clinic patients (85.6 vs 96.8 days, P = 0.006). After a median follow up of 21 months, no significant difference was found between the multidisciplinary clinic and urology clinic in the risk of biochemical recurrence after radical prostatectomy, whether controlling for clinical (hazard ratio 0.71, P = 0.249) or pathological variables (hazard ratio 0.75, P = 0.349).
  
  
  CONCLUSIONS
  Despite higher-risk disease, men evaluated using the multidisciplinary approach have similar oncological outcomes compared with men undergoing standard evaluation. Furthermore, time to radical prostatectomy is not delayed by the multidisciplinary management of these patients.
authors.affiliation: Division of Urology and the Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Stewart
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Bridget F
authors.initials: BF
authors.lastname: Koontz
authors.forename: Cary N
authors.initials: CN
authors.lastname: Robertson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: George
authors.forename: W Robert
authors.initials: WR
authors.lastname: Lee
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Armstrong
authors.forename: Lionel L
authors.initials: LL
authors.lastname: Bañez
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010348:Patient Care Team / Q000592:standards*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: biochemical recurrence; multidisciplinary clinic; outcomes; prostate cancer; prostatectomy