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The evolution of prostate cancer management within a specialist MDT

Bennett, Adam 2019. The evolution of prostate cancer management within a specialist MDT. MD Thesis, Cardiff University.
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The use of multidisciplinary team (MDT) meetings have proven benefits in cancer care. In this thesis, prospectively collected data for men with new diagnosis prostate cancer discussed at a single specialist MDT over a 20-year period is analysed to address several clinically relevant questions in the pathway of prostate cancer management. This study has not shown any significant association between symptomatic men and more aggressive disease but did show that they were less likely to have radical treatment. It also reports that men with a positive family history are more likely to present with low risk disease and are more likely to have radical treatment. Isotope bone scanning for the staging of metastatic disease remains the most commonly used imaging modality. However, guidelines for use in men with intermediate risk disease are inconsistent. This study represents the largest UK study to date of bone scan positivity rates and supports its use in men with high risk disease and men with intermediate risk disease with ISUP grade group 3. The role of MRI imaging in prostate cancer spans diagnostics, staging, and disease surveillance. This study has shown that changes in MRI protocol and technology has not decreased the rate of upstaging following radical prostatectomy and established markers of biochemical recurrence remain superior to MRI staging at predicting disease relapse. The use of MRI in active surveillance regimes remains an area of debate. In this study, a normal bi-parametric restaging MRI in the absence of other clinical markers of progression conveys a very low risk of disease progression and the possibility of avoiding repeat prostate biopsies.

Item Type: Thesis (MD)
Date Type: Completion
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 22 January 2020
Last Modified: 11 Dec 2020 02:22

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