Shared Decision-Making In Prostate Cancer: Results Of A Nationwide Interdisciplinary Consulting Service

Purpose/Objective: Locally confined prostate cancer can be treated by various treatment options (e.g. radical prostatectomy or radiation therapy) with comparable results but different possible side effects. In Germany referral-practice is mainly dominated by regional and personal preferences leading to a situation best described as a competition between urologists and radiation oncologists in accrual of patients. In 2001 the Charite - Campus Benjamin Franklin (CCBF, Berlin, Germany) established the first interdisciplinary consulting service for prostate cancer patients in Germany. The aim was to offer a comprehensive and neutral consultation on all treatment options and to make treatment recommendations. A total of 700 patients presented to the consulting service since May 2001. We herein report the evaluation of the first 362 patients. Materials/Methods: Between May 2001 and April 2003, 362 patients took part in the interdisciplinary consultation and 92% were completely available. Patients thoughts and expectations as well as their information status were assessed by an extensive questionnaire immediately prior to the consultation and a week later, the latter with assessment of the final treatment decision. Patients were then informed about their disease and the possible modalities and side effects of each therapy by an urologist and a radiation oncologist, both of them present during the entire consultation. Treatment recommendations were not confined to a specific institution. Results: With an average time of 35 minutes consultations were somewhat time-consuming, but 66% of patients found the consultation helpful or very helpful and afterwards 92% felt entirely informed. More than 75% of all patients had made their treatment decision within 2 weeks. 113 patients had stage T1c, PSA < 10 ng/ml and a Gleason sore ≤ 7. In these cases an equivalent recommendation for radical prostatectomy, percutaneous radiotherapy or permanent seed implantation was given. Of these, 49 patients (43,4%) decided on the surgical intervention, 48 patients (42,5%) on a type of radiotherapy and only 18 (15,6%) remained undecided. The histological examination of prostatectomy specimens from patients who had decided to undergo radical surgery at CCBF showed a significant decrease in the rate of extracapsular disease extension (≥ T3) from 38% to 20% during the observation period. Conclusions: Besides the effect of improved patient satisfaction by neutral and precise information from expert consultants there seems to be a trend towards better selection of patients suitable for radical prostatectomy. The ongoing evaluation of this nationwide first interdisciplinary consulting service will be necessary for further validation of these findings.