title: Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program.
abstract: BACKGROUND
  We aimed to report on data from the multidisciplinary diagnostic assessment program (DAP) at the Gale and Graham Wright Prostate Centre (GGWPC) at North York General Hospital (NYGH). We assessed referral, diagnosis, and treatment decisions for newly diagnosed prostate cancer (PCa) patients as seen over time, risk stratification, and clinic type to establish a deeper understanding of current decision-making trends.
  
  
  METHODS
  From June 2007 to April 2012, 1277 patients who were diagnosed with PCa at the GGWPC were included in this study. Data was collected and reviewed retrospectively using electronic patient records.
  
  
  RESULTS
  1031 of 1260 patients (81.8%) were seen in a multidisciplinary clinic (MDC). Over time, a decrease in low-risk (LR) diagnoses and an increase intermediate-risk (IR) diagnoses was observed (p<0.0001). With respect to overall treatment decisions 474 (37.1%) of patients received primary radiotherapy, 340 (26.6%) received surgical therapy, and 426 (33.4%) had conservative management; 57% of patients who were candidates for active surveillance were managed this way. No significant treatment trends were observed over time (p=0.8440). Significantly, different management decisions were made in those who attended the MDC compared to those who only saw a urologist (p<0.0001).
  
  
  CONCLUSIONS
  In our DAP, the vast majority of patients presented with screen-detected disease, but there was a gradual shift from low- to intermediate-risk disease over time. Timely multidisciplinary consultation was achievable in over 80% of patients and was associated with different management decisions. We recommend that all patients at risk for prostate cancer be worked up in a multi-disciplinary DAP.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;
authors.forename: David
authors.initials: D
authors.lastname: Guy
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ghanem
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;; Department of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, ON, Canada;; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;
authors.forename: Andrew
authors.initials: A
authors.lastname: Loblaw
authors.affiliation: Division of Urology, North York General Hospital, Toronto, ON, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Buckley
authors.affiliation: Division of Urology, North York General Hospital, Toronto, ON, Canada.
authors.forename: Beverly
authors.initials: B
authors.lastname: Persaud
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;
authors.forename: Patrick
authors.initials: P
authors.lastname: Cheung
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;
authors.forename: Hans
authors.initials: H
authors.lastname: Chung
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;
authors.forename: Gerard
authors.initials: G
authors.lastname: Morton
authors.affiliation: Division of Urology, North York General Hospital, Toronto, ON, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Noakes
authors.affiliation: Division of Urology, North York General Hospital, Toronto, ON, Canada.
authors.forename: Les
authors.initials: L
authors.lastname: Spevack
authors.affiliation: Division of Urology, North York General Hospital, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hajek
authors.affiliation: Division of Urology, North York General Hospital, Toronto, ON, Canada.
authors.forename: Stanley
authors.initials: S
authors.lastname: Flax