gms | German Medical Science

Introduction: Locally confined prostate cancer (PCa) can be treated for cure by various treatment options (radical prostatectomy or radiation therapy) with comparable results but different possible side effects. Therefore, treatment recommending can vary between urologists and radiation oncologists. In 2001 the Charité, Campus Benjamin Franklin (CBF, Berlin), 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. The study examines what benefits may be derived from this type of consultation.

Material & Methods: 970 patients presented to the consulting service between May 2001 and October 2005. Two questionnaires were used. The first one contained epidemiological questions as well as questions covering information already available on the PCa. It also examined feelings and fears about the disease and possible treatment options. The second questionnaire was given two weeks after the consultation to evaluate the treatment decision, determine the patient’s satisfaction with the consultation and trace the development of feelings and fears.

Results: 890 patients (91,7 %) were completely assessable. All patients had already obtained information about the disease and possible treatment options and wished to be involved in the decision-making process through objective and neutral consultation. Nearly all of them had a great fear of the possible side effects of therapy. Such a comprehensive consultation is time-consuming (average of 35 minutes) but largely received a very positive assessment in that a total of 60% found it helpful (181, 20%) or very helpful (357, 40%). Patients felt they had been completely informed in 92% of the cases. Only 86 (9.7%) had still failed to make a decision after 2 weeks. In 65% (347/534) of Patients who had stage T1c, PSA < 10 ng/ml and Gleason Score ≤7 was given an equivalent recommendation for a radical prostatectomy, a percutaneous radiotheraypy or a permanent seed implantation. 153 (44%) decided on the surgical intervention and 147 (42,5%) on a type of radiotherapy. Only 54 (15,6%) remained undecided. The histological examination of radical prostatectomy specimens of the patients who had decided to undergo radical surgery at CBF showed a significant decrease in the rate of extracapsular disease extension (≥T3) from 38% to 20% during the observation period.

Conclusion: The interdisciplinary approach has made the process of deciding on an appropriate treatment much easier for the patient. The time-consuming consultation enables better selection of individual treatment modalities and their possible side effects from the point of view of both the patients and the attending physicians. In this study, patients chose either radical surgery or radiotherapy with equal frequency.