Detecting High-Risk Prostate Cancer Factors Can Inform Referral Strategies

Video

An expert from Dana-Farber Cancer Institute indicates that urologists should refer patients with prostate cancer who present with multiple high-risk factors at surgery to a radiation and medical oncologist.

Before a patient’s prostate-specific antigen (PSA) level can rise, urologists should refer them for additional treatment if they present with a high-risk factor at radical prostatectomy, according to Anthony V. D’Amico, MD, PhD.

D’Amico, a professor and chair of genitourinary radiation oncology at Brigham and Women’s Hospital and Dana-Farber Cancer Institute, spoke with CancerNetwork® at the 16th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies, hosted by Physicians’ Education Resource®, LLC (PER®) regarding the necessity of multidisciplinary treatment referrals for certain patients with prostate cancer.

According to D’Amico, urologists should refer patients to a radiation and medical oncologist if they have at most 1 high-risk factor at surgery before their PSA level reaches 0.25 ng/mL. Data suggest that initiating salvage radiotherapy above the 0.25 ng/mL PSA threshold correlated with an increased risk of mortality.

Transcript:

My colleagues in urology, they [should] refer patients to a radiation and medical oncologist if they have a high-risk factor at radical prostatectomy before the PSA gets to 0.25. If [patients] have multiple high-risk factors, [urologists should] refer them after surgery, even if the PSA is undetectable.

I believe the radiation oncology community knows that allowing patients to regain maximal urinary continence, particularly by doing physical therapy with a pelvic muscle floor physical therapist, including Kegel exercises, is very important. We don't like to start radiation until that happens; that typically can be several months, in most cases.

But nonetheless, getting the referrals established so the communication and conversation can occur and people know if you have multiple high-risk factors, adjuvant [therapy] appears better than early salvage, and if you have one [high-risk factor], you've got until the PSA gets to 0.25 before the potential for increased risk of recurrence, metastasis, and death can happen.

Reference

Tilki D, Chen M, Wu J, et al. Prostate-specific antigen level at the time of salvage therapy after radical prostatectomy for prostate cancer and the risk of death. J Clin Oncol. Published online March 1, 2023. doi:10.1200/JCO.22.02489

Related Videos
Patients with NSCLC who have comorbidities or frailty may also be able to receive treatment with fewer toxicities via proton beam radiotherapy.
Terrence T. Sio, MD, MS, emphasizes multidisciplinary collaboration for treating patients with NSCLC who may require more than 1 type of therapy.
Collaboration among nurses, social workers, and others may help in safely administering outpatient bispecific T-cell engager therapy to patients.
Immunotherapy may be an “elegant” method of managing colorectal cancer, says Gregory Charak, MD.
D. Ross Camidge, MD, PhD, spoke about how the approval of alectinib is the beginning of multiple other approvals for patients with ALK-positive NSCLC.
Nurses should be educated on cranial nerve impairment that may affect those with multiple myeloma who receive cilta-cel, says Leslie Bennett, MSN, RN.
Treatment with cilta-cel may give patients with multiple myeloma “more time,” according to Ishmael Applewhite, BSN, RN-BC, OCN.
Nurses may need to help patients with multiple myeloma adjust to walking differently in the event of peripheral neuropathy following cilta-cel.
Administering neoadjuvant therapy to patients with colorectal cancer may help surgical oncologists attain a negative-margin resection.
Increasing screening for younger individuals who are at risk of colorectal cancer may help mitigate the rising early incidence of this disease.
Related Content