In this review, we examined major innovations in PC management, considered how MDTs should adapt to these developments, and discussed the value that MDTs provide in addressing challenging clinical scenarios from diagnosis to end of life.
New diagnostic technologies (e.g., next-generation nuclear medicine imaging techniques, genetic testing, and artificial intelligence) are transforming the management of PC and impacting the evolution of the MDT. As these diagnostic technologies help inform patient selection for precision medicine in PC (e.g., radioligand therapy and PARP inhibitors), it is increasingly essential for patient access to cutting-edge care that MDTs include members with the requisite expertise to interpret the results from these tests in a timely and accurate manner. The urgency is magnified when considering the increasing use of precision medicine in advanced PC and the potential move to earlier lines of therapy with larger patient populations.
MDTs with broad and specialized expertise are well positioned to address contemporary challenges in PC. For example, rapid advances in diagnostics have also created gray areas of care in which questions produced by information from novel diagnostic technologies outpace the answers provided by clinical guidelines and trials. A key challenge in modern PC management is how to integrate novel information with established risk factors to produce tailored strategies for individual patients in the absence of level 1 evidence or consensus criteria. In our review, we provided 2 specific examples of this challenge: 1) a patient considered low risk by established risk factors (e.g., Gleason 3+3 [GG1]) but considered higher risk for disease progression according to genetic testing (e.g., BRCA2 mutation) and 2) a patient considered high risk by established risk factors but who is negative for high-risk disease via nuclear medicine imaging and has a favorable genetic profile. MDTs have the specialized expertise to guide clinical decision-making in these complex and challenging scenarios. For example, MDT nuclear medicine and genetic experts can advise on the value of additional testing. MDTs can also quickly disseminate emerging data and best practices amongst members. Finally, MDTs can help set evidence-based institutional guidelines and pathways that incorporate information from novel diagnostic tests.
In addition to helping address clinical challenges, the use of MDTs may also help overcome nonclinical barriers to optimal PC management, such as race and geography. Our review highlighted several lines of evidence suggesting that MDTs can minimize disparities in care. For example, a recent study by Tang et al. revealed that MDT use obviated racial differences in PC treatment.2 The expanding role of telehealth and virtual meetings may further democratize evidence-based care to rural and community settings. However, the role of MDTs for disadvantaged populations remains an understudied topic, and additional studies are warranted.
Our review identified other gaps in the literature, including frameworks for determining the success of MDTs and payment models for MDTs. It will become important to fill these and other gaps, as the importance of MDTs in PC will only increase with the continued rapid evolution of the PC landscape. We also encourage successful MDTs to share and publish their specific workflows and execution pathways in order to serve as examples for institutions aiming to initiate or improve their own MDT programs for PC.
Written by:
- Neal D. Shore, MD, FACS, Chief Medical Officer, Surgery/Urology, for GenesisCare and the Medical Director for the Carolina Urologic Research Center, Myrtle Beach, South Carolina
- Alicia K. Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana Farber Cancer Institute, Boston, Massachusetts
- Ghassan El-Haddad, MD, Associate Professor, Moffitt Cancer Center, Tampa, Florida
- Sandy Srinivas, MD, Professor of Medicine/Oncology, Stanford University, Stanford, CA, USA
- Matthew Abramowitz, MD, MS, Associate Professor in the Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Lowrance WT, Breau RH, Chou R, et al. Advanced prostate cancer: AUA/ASTRO/SUO guideline PART II. J Urol. 2021;205(1):14-21.
- Tang C, Hoffman KE, Allen PK, et al. Contemporary prostate cancer treatment choices in multidisciplinary clinics referenced to national trends. Cancer. 2020;126(3):506-514.