The best of all worlds for prostate cancer
Date: September 1, 2010
Prostate cancer benefits from multi-disciplinary medicine.
Men diagnosed with prostate cancer traditionally have had to be their own central clearinghouse for treatment that may involve any number of specialists. It’s a situation, says urologist Alan Partin, that has not served them well.
“First, you’ve got the terror of dealing with cancer,” says Partin, who heads Hopkins’ Brady Urological Institute. “You make an appointment and that takes three weeks. Then you decide you want to hear another side, and that takes another five weeks.”
But it isn’t only patients who’ve had to make do with this piecemeal approach. For physicians, trading messages with other specialists often creates a disjointed discussion, especially when examination impressions are far from fresh and test results end up needing to be reviewed and re-reviewed.
At Johns Hopkins, where collaboration has always been a way of life, Partin and his colleagues in the various disciplines that play a role in treating prostate cancer have created a deliberate team protocol to speed up case reviews, make sure all points inform the discussion, and distill what for patients can be a confusing morass of detail.
The prostate cancer clinic, says Ted DeWeese, director of radiation oncology and molecular radiation science, gives everyone—urologists, radiation oncologists, pathologists, medical oncologists, nutritionists, social workers—a seamless, holistic view of each patient. “And because your peers are right there listening to you, you have to be very clear in defending a treatment,” he says. “It really holds everyone’s feet to the fire and keeps us to the highest professional standard.”
Furthermore, DeWeese adds, “when a patient leaves, he has a singular opinion on how to manage his cancer.”
But along with the benefits it offers current patients, the clinic is also improving prospects for those on the horizon. Because the case reviews involve residents, for example, these physicians in training absorb perspectives outside their own specialties as well as the collegial approach to care.
The clinic conferences are also launching new research, particularly with input from experts like cancer immunology and hematopoeisis specialist Charles Drake and prostate carcinogenesis researcher Ted Schaeffer. In one case, says Partin, discussion of a patient’s Gleason score and the aggressiveness of his cancer led to an intriguing question: Could the Gleason score also indicate the likelihood that a cancer has spread further in the prostate, even though it’s undetectable at that time? Study results, now awaiting publication, could lead to an important change in treatment.
Perhaps the strongest glue among the collaborators, Partin says, is the fact that so many are protégées of Donald Coffey, the researcher legendary both within Johns Hopkins and far beyond for his unquenchable curiosity. “That,” says Partin, “is a great link between all of us.”
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