Men suffering from prostate cancer get the benefit of receiving care from a unique team approach made possible by the breadth of disciplines offered by the University of Rochester Medical Center (URMC). As a supplement to the care and guidance of their urologist, patients also gain the expertise of an interdisciplinary team of medical oncologists, radiation oncologists, surgical oncologists and pathologists.
The result: designing the right treatment plan that is customized for the patient and for the type of prostate cancer they have.
“The best kind of patient care is multidisciplinary care,” said URMC Department of Urology Chair Jean Joseph, MD. “With our interdisciplinary approach, we are able to care for patients with every type of prostate cancer by examining every case through a comprehensive team with a wide range of backgrounds and perspectives.”
Patients play an integral role in their treatment plan, a core goal of delivering patient-centered care.
A range of treatment options
“Instead of telling our patients, ‘this is the treatment you need to have,’ we provide all the information they need to make an informed decision,” said Thomas P. Frye, DO, associate professor, vice chair of clinical affairs, URMC Department of Urology. “Each type of treatment carries pros and cons that can greatly impact their lives.”
Because prostate cancer is so complex and has many variations, URMC Urology offers a wide range of treatments tailored to the individual patient, including surgical removal, focal therapy, radiation, medications, surveillance or a combination thereof.
“Surgery and radiation have been the gold standard for treating prostate cancer,” said Phillip M. Rappold, MD, PhD, assistant professor, URMC Department of Urology. “Now, with emerging technologies, the goal is to limit over-treatment of the disease. Low-risk cases of prostate cancer often don’t need treatment so it’s important to continually monitor the disease through blood tests, MRIs and biopsies.”
Emerging technologies include focal therapies, and URMC offers the most comprehensive array of these therapies in Upstate and Western New York State. Less invasive than the radiation or surgical whole-gland treatments, focal therapies focus energy on killing cancer cells themselves, leaving the non-cancerous part of the prostate gland alone.
The goal of the treatment – the prostate cancer equivalent of a lumpectomy for breast cancer – is to meet patients’ desire for less morbid options while helping ensure they have a better quality of life.
Various focal therapy techniques available to URMC Urology patients include cryotherapy and high-intensity focused ultrasound (HIFU). URMC is one of only a few academic medical centers in the country offering HIFU as a personalized prostate cancer treatment.
Frye, whose research centers on optimizing the screening, diagnosis and treatment of men with prostate cancer, is currently participating in a focal therapy study to evaluate the efficacy of water vapor therapy used for an enlarged prostate to ablate intermediate-risk prostate cancer.
“With focal therapy, there is a tradeoff as it requires ongoing monitoring of the prostate to make sure the cancer doesn’t come back,” Frye added.
A collaborative team approach
Central to URMC’s approach to prostate cancer care is a collaborative team focused on the patient.
URMC houses a multidisciplinary clinic at its Wilmot Cancer Institute, where a patient can see their care team all in one visit. Patients save time and don’t have to schedule multiple appointments to receive care.
“With this clinic, our prostate cancer patients can see multiple specialists – their urologist and medical or radiation oncologist – on the same day and in the same place,” said Brendan J. Guercio, MD, assistant professor, URMC Department of Medicine, Wilmot Cancer Institute Genitourinary Oncology Program.
The clinic also improves communication among the care team. “Our multidisciplinary clinic not only benefits the patient by saving them time, but it also gives the care team an opportunity to better communicate, sometimes all in the room together, and to reach consensus on a path forward,” Guercio added.
For Rappold, that collaborative approach also includes recommending his patients take advantage of a consultation with a radiation oncologist.
“Men diagnosed with prostate cancer need to learn about all the treatment options, anticipated recovery and possible side effects that can dramatically impact their sexual health and voiding function. To give patients as full a picture as possible, I urge a consultation with a radiation oncologist for every patient.”
One team of urologists and radiation oncologists collaborates to provide high dose brachytherapy to patients, and URMC is among a few hospital systems to offer this treatment in Upstate New York.
That spirit of collaboration extends across the interdisciplinary team, even among what could be competing perspectives, as urologists and radiation oncologists work together to identify a patient’s care plan.
“Treatment for prostate cancer is unique because patients often have a choice between surgery and radiation,” said Michael Andrew Cummings, MD, assistant professor, URMC’s Department of Radiation Oncology (SMD). “Our radiation oncologists and urologists offer the choice without bias, and we work together to make patients feel comfortable with their decision.”
“Our multidisciplinary collaborative approach to cancer care allows constant interactions among our team, and provide a forum to seek solutions to unanswered questions. A number of research collaborations have been developed through these engaging dialogues as we care for our patients,” said Joseph.
Tumor Board for complex cases
URMC’s interdisciplinary approach extends to caring for the most complex cases of prostate cancer as well. For these cases, URMC assembled a group of providers on a Tumor Board to devise the best course of treatment.
The Tumor Board holds weekly, hour-long conferences composed of urologists, oncologists and pathologists to assess a patient’s cancer, discuss treatment options, develop a care plan, and identify patients for participation in latest clinical trials. It provides an open forum where everyone on the care team is posed a clinical question to answer to help determine treatment options.
“Through our Tumor Board conferences, patients suffering from the most complex forms of prostate cancer gain access to the highest possible level of care,” said Frye.
“Every patient is different, and every complex case of cancer is unique, so it’s important that we have a team of specialists working together to share their expertise, evaluate the various options and develop a plan to achieve the best outcomes,” added Guercio.
Held in person before the COVID-19 pandemic, the conferences now take place virtually, making it more convenient for team members at Strong Memorial and affiliate hospitals to participate.
The gateway to care
“Urology serves as the gateway to care for patients with prostate cancer, from diagnosis to treatment and after treatment,” Frye stated. “Whichever therapy option they choose – whether surgery, radiation or focal – patients will continue to see their urologist for guidance and care of the urologic and sexual issues that result.”