MDT (multi-disciplinary team) guidance for managing prostate cancer

Approach within the MDT
Key questions for the MDT
• TNM stage?
• Gleason grade?
• Prostate-specific antigen (PSA) concentration?
• Risk group (according to National Comprehensive Cancer Network [NCCN] guidelines)?
• Age/co-morbidity/life expectancy?
• Symptoms:
o International Prostate Symptom Score (IPSS), bowel, urinary?
• Sexual function?
• Bone pain?
• Osteoporosis risk?
• Family history?
• Clinical trials?
• The MDT is an essential part of cancer management. However, there are often difficulties in
knowing which patients to discuss, ensuring that their details and diagnoses are available,
and keeping a record of decisions made at the meetings.
• MDTs have repeatedly been endorsed as the principal mechanism for ensuring that all relevant
disciplines and professional groups contribute to, and participate in, decisions regarding the
clinical management of patients. 2
• MDT-working is positively related to a range of measures of effectiveness, including the quality
of clinical care.
• It is important to emphasise the distinction between management and administration.
• A central concept of integrated care is to reinforce the role of the MDT (working as a single unit),
but with enough clinical freedom to tailor management strategies to the needs of individual
patients.
• Treatment strategies are influenced by the stage of disease and by an interaction between
the risk of disease progression, survival and key patient characteristics, such as age, lifestyle
and general health. The discussion of these factors is of crucial importance in determining the
most appropriate way forward. For example, age and the presence of co-morbidities may be a
restrictive factor when considering surgery.
• The case notes, pathology reports, test results and radiology for each patient must be available
to be discussed at the meeting. The MDT must also ensure that the patient has the fullest possible
role in determining treatment − the importance of this cannot be overstated. Patient preference
should be discussed within the MDT. Although the majority of men with prostate cancer want to
be involved in treatment decisions, an estimated one in five of all patients does not raise, or really
understand, the potential issues and associated side-effects of treatments and alternatives that
may be available to them. 3
• The possibility of including a patient in a relevant clinical trial should not be forgotten.
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