Renzulli Joseph F, Collins Jennifer, Mega Anthony
Genitourinary Multidisciplinary Clinic, The Miriam Hospital, Providence, RI, USA.
J Multidiscip Healthc. 2015 Jun 5;8:279-86. doi: 10.2147/JMDH.S81007. eCollection 2015.
Improving options for patients with metastatic castration-resistant prostate cancer (mCRPC) provide latitude in designing treatment plans that meet patients' medical needs and personal goals. The field's rapid evolution opens avenues for contributions by multiple medical specialties and requires considering more options to ensure that each patient receives the most appropriate care. A multidisciplinary clinic (MDC) focusing on patients with cancers of the genitourinary tract demonstrates an efficient and cost-effective means of integrating the diverse professional knowledge and skills needed to develop an optimal patient treatment plan. As a guide to establishing an MDC for patients with mCRPC, this article describes the operation of the Genitourinary MDC at The Miriam Hospital in Providence, RI - specifically, the successful incorporation of radium-223 dichloride (radium-223) into the treatment algorithm for men with mCRPC and symptomatic bone metastases. Radium-223 is a new treatment that, unlike earlier radionuclide therapies, has shown a survival advantage in a large randomized phase 3 trial (ALSYMPCA). The overall survival benefit was comparable to that of newer immuno-and hormonal therapies in similar populations. Radium-223 treatment also delayed onset of symptomatic skeletal events. Both benefits were independent of prior docetaxel therapy or concurrent bisphosphonate use. In our clinic, radium-223 is used primarily to extend patient survival. Patient selection, patient management, and treatment sequencing are discussed here in the context of a multidisciplinary environment.
改善转移性去势抵抗性前列腺癌（mCRPC）患者的治疗选择，为制定满足患者医疗需求和个人目标的治疗方案提供了灵活性。该领域的快速发展为多个医学专科的贡献开辟了道路，并且需要考虑更多选择，以确保每位患者都能获得最合适的治疗。一个专注于泌尿生殖道癌症患者的多学科诊所（MDC），展示了一种高效且具成本效益的方式，来整合制定最佳患者治疗方案所需的各种专业知识和技能。作为为mCRPC患者建立MDC的指南，本文描述了罗德岛州普罗维登斯市米里亚姆医院泌尿生殖多学科诊所的运作情况——具体而言，成功地将二氯化镭-223（镭-223）纳入mCRPC和有症状骨转移男性患者的治疗方案中。镭-223是一种新的治疗方法，与早期的放射性核素疗法不同，它在一项大型随机3期试验（ALSYMPCA）中显示出了生存优势。总体生存获益与类似人群中较新的免疫和激素疗法相当。镭-223治疗还延迟了有症状骨骼事件的发生。这两项获益均独立于先前的多西他赛治疗或同时使用双膦酸盐。在我们的诊所，镭-223主要用于延长患者生存期。本文将在多学科环境的背景下讨论患者选择、患者管理和治疗顺序。
