A Multidisciplinary Team Approach for the Optimal Clinical Management of Metastatic Hormone-Refractory Prostate Cancer—Case Study

Patients with prostate cancer often require a multimodal treatment approach and the expertise of a multidisciplinary team for optimal management. This is illustrated by the case study of a 59-yr-old man with a prostate-specific antigen (PSA) level of 11.4 ng/ml, who was otherwise fit and well. He had negative bone scans and transrectal ultrasound-guided biopsies revealed a Gleason score of 8 (4 + 4). The panel identified the patient as having seemingly localised prostate cancer with a high risk of PSA recurrence at 5 yr. Although a potential candidate for radical prostatectomy, the panel recommended that the patient should be informed of the risk of lymph node involvement and exploratory surgery performed. Metastatic disease was detected on lymph node frozen section. Accordingly, the patient did not undergo prostatectomy and received a luteinising hormone-releasing hormone agonist instead. After an initial response, the patient's PSA slowly slipped upwards again, and he then received complete androgen blockade, despite evidence suggesting that the benefit of this approach is minimal. A bone scan and a magnetic resonance imaging scan both revealed metastatic disease, although the patient remained asymptomatic. Data from the TAX 327 study support the use of chemotherapy in asymptomatic patients with metastatic hormone-refractory prostate cancer and therefore docetaxel every 3 wk represents a viable treatment option for this patient. The maintenance of close working relationships between urologists and oncologists will produce a multidisciplinary approach that promises, through the timely use of chemotherapy, to provide patients with the best chance of survival and quality of life.