Impact of interdisciplinary tumor boards (ITB) and personalized treatment on survival outcomes in metastatic castration-resistant prostate cancer.

Abstract

Purpose: Interdisciplinary tumor boards (ITB) are essential in optimizing treatment recommendations for metastatic castration-resistant prostate cancer (mCRPC) by incorporating oncology guidelines, clinical trials, and patient-specific factors to ensure individualized care. This study examines clinical parameters that influence ITB recommendations, evaluates their adherence to guidelines, and assesses their impact on patient survival.

Methods: In a retrospective analysis, data from 187 mCRPC patients discussed at an ITB in a tertiary care center in 2018 were evaluated. Patient- and disease-specific factors were correlated with adherence to National Comprehensive Cancer Network^® (NCCN^®) guidelines and overall survival (OS). The impact of clinical parameters on survival outcomes was assessed through univariate and multivariate analyses.

Results: The median patient age was 72.8 years, with a median prostate-specific antigen (PSA) level of 65.0 ng/ml. Guideline-compliant recommendations were given in 42.9% of cases, while 57.1% received individualized recommendations. Clinical trial eligibility was noted in 24.8% of patients. Individualized ITB recommendations were associated with significantly longer OS (38.3 vs. 21.2 months, p = 0.03). Shorter OS correlated with renal impairment (p = 0.007), symptomatic metastases (p < 0.0001), and visceral metastases (p < 0.0001). Limitations include the retrospective design, lack of follow-up on therapy adherence, and absence of progression-free survival (PFS) data.

Conclusion: ITB discussions improve survival in mCRPC patients, mainly due to personalized approaches and better access to clinical trials. Visceral and symptomatic metastases as well as renal impairment are risk factors for reduced OS, emphasizing the need for careful management of these high-risk patients. The results support the expanded use of ITB to improve mCRPC treatment outcomes.