This particular topic may be the most important. A few have tried to put the discussion about its importance on the table (ref. this document published by the AUA back in 2005), but perhaps old habits die hard?

General cancer conferences are mandated by the Commission on Cancer (CoC). You can’t be a community cancer center without offering this service to your local medical community…

And… you can’t be a Breast Cancer Center of Excellence without offering a multidisciplinary breast conference to your local medical community!!! This is not only listed as criteria, but specifically referenced in two other sections listing guidelines for being a Breast Center of Excellence:

Standard 1.2 Interdisciplinary Breast Cancer Conference
The BPL establishes, monitors, and evaluates the interdisciplinary breast cancer conference frequency, multidisciplinary and individual attendance, prospective case presentation, and total case presentation annually, including AJCC staging and discussion of nationally accepted guidelines.

Standard 5.1 Breast Center Staff Education
Professionally certified/credentialed members of the breast center participate in local (in addition to breast cancer conference attendance), state, regional, or national breast-specific educational programs annually.

Standard 6.1 Quality and Outcomes
Each year the breast program leadership conducts or participates in two or more studies that measure quality and/or outcomes and the findings are communicated and discussed with the breast center staff, participants of the interdisciplinary conference, or the cancer committee, where applicable.

This particular guideline is a hinge for supporting excellent care…

Multidisciplinary care can take various forms, from the (usually day long) multidisciplinary clinic experience now commonly seen at most National Cancer Institute (NCI) accredited research centers to the community cancer conference. The NCI clinic model is difficult (though not impossible) to translate into a community cancer center environment: http://www.presbyterian.org/_media/local/docs/services/accc_prostate.pdf

The challenge is that most urologists are private practice MDs, though frequently using their local community cancer centers for surgical space for performing radical prostatectomies and the like. Surgery in many cases has become the “de facto” front line, and sometimes surgery as a primary treatment is clearly the right option… but important questions need to be asked in order to know this for sure – and these questions almost always benefit from discussions that involve a radiation oncologist, medical oncologist, pathologist, radiologist, and even (and often most importantly) the man’s primary care doctor.

A couple of years ago a pilot for establishing a “grassroots” parallel to the STANDARD CoC breast conference was initiated out of this meeting: http://www2.nbc17.com/lifestyles/2009/sep/10/prostate_cancer_coalition_of_nc___social_changes_i-ar-284910/

This model is incredibly simple, and it works…
Monthly, Rex Cancer center hosts a genitourinary (GU) multidisciplinary conference at the same time that the local anesthesiologists meet (you can’t perform a prostatectomy on a conscious patient :)). Prostate cancer cases are most predominantly discussed, though there is often enthusiastic discussion to support care of patients with testicular cancer, renal cell carcinoma, etc. (within a community cancer center, the same team of doctors that treat a prostate cancer patient treats these other forms of cancer, so the GU model is much more adoptable in a community cancer center environment).

So the question is… as advocates… would it make sense to join forces with advocates of other types of GU cancer to see if we can’t get some GU Center of Excellence guidelines established by the Commission on Cancer?