Impact Of Multidisciplinary Counseling On Awareness Of Prostate Cancer Treatment Options

Men with localized prostate cancer (PCa) may be unaware of their treatment options which could restrict their ability to make an informed treatment choice. We hypothesized patient counseling in a multidisciplinary clinic by a radiation oncologist in addition to a urologist will raise awareness of radiation therapy as a treatment option and could change treatment choice. 417 men with localized PCa seen in a multidisciplinary PCa clinic by a urologist and a radiation oncologist were enrolled in a prospective trial from 10/2016 to 7/2018. Men completed a questionnaire about information sources used to learn about PCa, their understanding of treatment options, and their overall health and disease-specific function prior to visit. Men completed a second questionnaire after they made a treatment decision that assessed their understanding of treatment options, why a specific treatment was selected, and their satisfaction with the decision making process. The survey questions were piloted in men with prostate cancer and contained validated instruments. Descriptive statistics characterized the study cohort. Chi-square statistic evaluated categorical variables. The 303 men who reported meeting with and discussing PCa treatment with only a urologist (not a radiation oncologist) prior to the clinic visit were the basis of this analysis. We report the results of the 231 men who completed the post visit, post decision, questionnaire (76% response rate). Median age was 62, 85% of men were white, and 23% had low-risk disease. After the visit, more men reported radiation therapy (RT) were treatment options for their PCa: intensity modulated radiation therapy (IMRT 41% post vs. 33% pre visit; p=0.07), proton beam therapy (PBT 31% vs. 7%; p<0.001), and brachytherapy (BT 24% vs. 9%; p<0.001). The multidisciplinary visit changed treatment choice for 19% of men. 74% of men reported the visit made them more certain of their choice and 4% reported it had no impact on treatment choice. After the clinic visit, 25% preferred AS, 45% RP, and 30% RT (12% IMRT, 9% PBT, and 9% BT). 62% of men reported they made the final decision, 1% that their doctor made the final decision and 36% that they shared equally in the decision. 96% of men felt they made an informed choice, 86% knew the benefits of each option, and 85% knew the risks and side effects of each option. Counseling in a multidisciplinary PCa clinic by a radiation oncologist in addition to a urologist increased awareness of radiation treatment options, helped patients make an informed treatment choice, and changed treatment choice for 19% of patients. Men with localized PCa should be seen in multidisciplinary setting to facilitate informed treatment decision making.