Patterns of management and multidisciplinary care in high/very high and intermediate risk localized prostate cancer: A population-based study in Ontario, Canada.

Abstract

333 Background: Patients with high- or very high-risk (H/vHR) localized prostate cancer (LPC) are at significantly increased risk of recurrence, metastasis, and mortality than those with intermediate risk (IR) LPC. Multidisciplinary management involving urologists, radiation oncologists, and medical oncologists is vital to optimize treatment outcomes. Understanding real-world care patterns is essential to identify gaps and guide improvement in care delivery. This study aims to characterize current management practices and multidisciplinary care patterns among patients with H/vHR and IR LPC in Ontario, Canada. The focus is on evaluating consultation rates, treatment approaches, and coordination of care during the initial diagnosis and the first-year post-diagnosis. Methods: A retrospective, population-based cohort study was conducted using province-wide linked administrative data from Ontario. The study included 12,939 patients diagnosed with H/vHR PCa and 16,650 with IR disease between 2010 and 2021. Descriptive analyses summarized consultation patterns with urology, radiation oncology, and medical oncology, both prior to treatment and within the first year after diagnosis. Comparisons between groups were performed using standardized differences and p-values. Results: Most patients in both groups visited a urologist (H/vHR: 97.8%; IR: 94%; p<0.001). However, fewer high-risk patients had radiation oncology consultations before treatment (H/vHR: 41.2%; IR: 62.5%; p<0.001). Among those undergoing radical prostatectomy, about 40% had prior radiation oncologist consultations, with no significant difference across risk groups. Medical oncology consultations were rare (~2%) in both groups. Within the first year, approximately one-third of patients were seen only by a urologist, whereas over 65% consulted both urologists and radiation oncologists. Notably, multidisciplinary care involving all three specialties was uncommon (H/vHR: 40%; IR: 32%). Conclusions: Despite the recognized importance of multidisciplinary management, significant gaps remain in the coordination of care for prostate cancer patients, especially among high-risk groups. Strengthening collaborative approaches is crucial to enhance treatment decision-making and improve clinical outcomes. Future efforts should prioritize optimizing multidisciplinary pathways to ensure comprehensive, patient-centered care.