STRATEGICAL IMPLICATIONS OF THE INTRODUCTION OF AN ALTERNATIVE TREATMENT MODALITY (HIGH INTENSITY FOCUS ULTRASOUND) IN A PROSTATE CANCER UNIT IN THE CONTEXT OF MULTIDISCIPLINARY TEAM

Carmen Maccagnano1, Matteo Corinti1, Antonello Paulesu1, Patrizio Armeni2, Lorenzo Fenech2, Francesca Lecci2, GIARIO NATALE CONTI1
  • 1 ASST Lariana Ospedale Sant'Anna (San Fermo della Battaglia)
  • 2 SDA Bocconi School of Management (Milano)

Objective

The critical evaluation of a new modality of treatment which employs a new technology has to be considered in the context of “Health Technology Assessment” (HTA). This analysis lead to documents whose utility is essential both for National Health System and the stakeholders, i.e. subjects who are interested in the technology itslef and who can judge it from different point of view, varying from costs to clinical references. We considered the introduction of an alternative treatment modality, i.e. High Intensity Focused Ultrasound (HIFU) in the context of the Prostate Cancer Unit (PCU) in Our centre.
PCU is a multi-disciplinary team (MDT) constituted by an Urologist, a Medical Oncologist and a Radiation Oncologist, who manage almost 100 case of prostate cancer (PCa) per year, according to the position paper of European School of Oncology. The capacity of offering to the patients the ordinary therapies and also alternatives, due to clinical experience of the Centre, plays a fundamental role for the correct management of PCa. The aim of the present study was to contextualize the results of the analysis among the strategies of MTD, also evaluating the social impact.

Materials and Methods

We analyzed the patients affected by prostate cancer, who were all evaluated by MTD in 2015.
For the purpose of the study, we considered only low risk patients, according to Epstein’s criteria. The available therapeutic alternatives in Our Centre were: radical prostatectomy (open or robotic) (RRP), radiation therapy (RT), active surveillance (AS) and HIFU.
We compared our experience with those reported in literature, searching for the key words: “multidisciplinary team”, “ prostate cancer “ and “High Intensity Focused Ultrasound”.

Results

In our Centre 360 patients with PCa were evaluated by PCU in 2015.
During the same year we executed 500 prostate biopsy, among these 146 pts were affected by low risk Pca
The partion of patients according to chosen treatment modality is described in table 1.

Discussions

SEE RESULTS AND TABLE 1

Conclusion

Different treatment modalities may be offered to the patients after the diagnosis of PCa; obviously, every alternative may have both physical and psychological side-effects, all significantly impact on the quality of life. The management of the patient in the context of MDT may change, especially regarding therapy itself; this is due to the fact the decisions of the MTD are applicable and reproducible, according to the internal guide-lines followed by all the members. Our MTD follows data literature, especially regarding the orientation towards AS and RT. Additionally, patients tend to chose RT during the PCU visits.
There are no available data about the impact of MTD on survival, or about a correlation between the MTD and a improvement of the outcome of the patients. Nevertheless, a clear idea about the overall survival of the single treatment modality may lead to a more simple choose by the patients. In this context, we could not have certainties, because of the too recent follow up as well as the recent introduction of PCU in Our Center.

Reference

1. Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, Crowe J, Costello AJ. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev 2016; 42:56-72.

2. Valdagni R.. Multidisciplinary Team Meetings in Cancer Care: We Could and Should do Better Than This. Clin Oncol (R Coll Radiol) 2016;28(12):799-800

3. Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MD, Jayakody S, MacLennan G, Fraser C, MacLennan S, Brazzelli M, N'Dow J, Pickard R, Robertson C, Rothnie K, Rushton SP, Vale L, Lam TB. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2015 19(49):1-490.

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