Ryan Fecteau, MD, PhD, radiation oncologist, genitourinary cancers, Duke Cancer Institute, discusses the benefit of utilizing a multidisciplinary approach in bladder and prostate cancers.

A multidisciplinary approach can be utilized in the treatment of bladder cancer if patients receive chemoradiation following a transurethral resection of the bladder tumor, which requires the aid of a urologist or urologic surgeon to perform the procedure, Fecteau explains. Following surgery, medical oncologists and radiation oncologists must work in tandem to administer chemoradiation, which needs to be coordinated on a proper schedule, Fecteau says.

For patients with prostate cancer, these coordinated efforts remain the same. For patients who have already undergone surgery and experienced a recurrence, a medical oncologist can explore potential treatment hormone therapy, Fecteau continues. A radiation oncologist can also be consulted to explore the pros and cons of radiotherapy for a given patient, Fecteau says.

With the continued advent and emergence of novel treatment strategies and agents for patients with prostate or bladder cancer, patients will have more options presented to them throughout their treatment process. With the growing list of options that could be presented to patients, it is important to think less about trying to convince a patient to pursue one given therapy over another; rather, clinicians need to ensure that patients have all of the necessary information at hand to make the best decisions for themselves, Fecteau continues.

Treatment decisions should can be weighed to consider what option can provide the most benefit and give them best quality of life that aligns with their individual goals for treatment, Fecteau concludes.

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Ryan Fecteau, MD, PhD, discusses the benefit of utilizing a multidisciplinary approach in bladder and prostate cancers.

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Patients with prostate cancer who have undergone radical prostatectomy and have a higher risk of disease recurrence are usually directed towards lymph node sampling or dissection and monitored for high prostate-specific antigen (PSA) levels in peripheral blood, Fecteau begins. Potential recurrence can sometimes be detected with PSMA-PET scans, which have become more routinely incorporated into standard clinical practice, he explains. Although not all patients in this population will present with isolated tumor recurrences, an increasing number are experiencing these failures in the pelvic lymph nodes in recent years, Fecteau states.

Accordingly, identifying the best follow-up treatment for these patients has become an area of focus for clinical practice, Fectau continues. Several combinations of systemic therapy, hormone therapy, and radiation have been identified as potential options for these patients. Hormone therapies such as androgen deprivation therapy (ADT) could be utilized with or without radiation, For example, patients with persistent disease might benefit from targeted radiation therapy without other agents. This could potentially prolong the need for subsequent hormone therapy, Fecteau says.

A limited amount of retrospective data exist in support of each option. More research is needed to determine which treatments are viable and effective in these patients, Fecteau notes. This could be accomplished through a larger, randomized-controlled trial, he suggests.

With this lack of large-scale, comparative data, individual patient factors should be taken into consideration when determining a treatment approach. These include age, personal values, preference for ADT vs radiation therapy, and quality of life, Fecteau concludes.

Ryan Fecteau, MD, PhD, discusses the navigation of salvage treatment options for patients experiencing isolated prostate cancer recurrence.

Ryan Fecteau, MD, PhD

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