Abstract
Multidisciplinary team (MDT) discussions are increasingly recognized as a cornerstone of high-quality prostate cancer (PCa) management. This mini-review explores the growing evidence supporting MDT implementation in PCa care pathways, its impact on treatment planning, and evolving tools to streamline decision-making. Evidence from recent cohort studies and implementation research suggests improved guideline concordance, reduced rates of overtreatment, and enhanced patient engagement when multidisciplinary evaluation is applied, particularly in complex cases or cases where management is uncertain. Future directions include evaluating structured decision-support tools and case complexity scoring systems. The integration of MDTs is a scalable model that should be adapted across healthcare settings.
Keywords
Introduction: why multidisciplinary care matters
Prostate cancer (PCa) is a clinically heterogeneous disease with management options including active surveillance, focal therapy, and radical therapies with or without systemic treatments. Treatment selection is influenced by tumor characteristics, imaging findings, patient comorbidities and preferences, life expectancy, and healthcare system factors. 1
Despite the growing use of active surveillance, substantial overdiagnosis (approximately 20–50%) and overtreatment persist, exposing some patients—particularly those with low-risk disease—to avoidable morbidity with little to no gain on cancer-specific survival. 2 Treatment-decision regret affects 16–20% of men with localized PCa, highlighting the difficulty in aligning oncologic benefit, functional outcomes, and patient expectations. 3
In this context, multidisciplinary team (MDT) discussions have become a cornerstone of modern oncological practice. By integrating the expertise of urologists, radiation and medical oncologists, pathologists, and radiologists, MDTs support individualized, evidence-based, and guideline-concordant recommendations. 4
Several MDT models with varying levels of structure exist and are outlined below. Beyond decision-making, MDTs promote communication, shared responsibility, and patient-centered care.
A conceptual overview of the MDT workflow and its potential clinical impact in PCa care are illustrated in Figure 1.
Multidisciplinary team (MDT) workflow in prostate cancer care. Schematic representation of the five-step MDT clinical pathway, including patient diagnosis, assessment of case complexity, multidisciplinary discussion, integrated treatment recommendation, and patient-centered shared decision-making. The model illustrates how collaboration among urology, radiation oncology, medical oncology, radiology, and pathology supports guideline-concordant care, reduces overtreatment, and facilitates personalized, value-based treatment decisions.
Impact of MDTs on treatment decisions and outcomes
Numerous studies show that multidisciplinary discussions influence treatment planning and improve concordance with clinical guidelines. In PCa—where decisions must balance oncologic control with quality of life—MDTs enhance diagnostic accuracy and enable more refined risk stratification, thereby reducing variability in care.4,5
MDTs are also associated with greater patient satisfaction and trust when treatment options are complex, including focal therapy, clinical trials, or watchful waiting, while incorporating diverse viewpoints that help limit physician bias in settings where financial or procedural incentives may influence recommendations.4,5
Overall, MDTs support more individualized, value-based decisions, 6 for example, by upgrading a patient’s risk category after integrating magnetic resonance imaging findings with adverse pathology features not captured by standard clinical risk stratification.
Key studies evaluating the impact of MDT implementation in PCa and other oncologic settings are summarized in Table 1.
Key studies supporting multidisciplinary team (MDT) implementation in prostate cancer care.
Summary of selected studies evaluating the impact of MDT discussions, structured case selection tools, and multidisciplinary decision-making on treatment planning, guideline concordance, and care delivery in prostate cancer and other oncologic settings.
MDT: multidisciplinary team; PCa: prostate cancer; MeDiC: Measure of Discussion Complexity; VA: Veterans Affairs.
Avoiding overtreatment through MDTs
Overdiagnosis and overtreatment remain major challenges in PCa care, particularly among men with low-risk disease or limited life expectancy. 2 Despite guideline recommendations discouraging radical treatment, many patients still receive therapies that provide minimal survival benefit and unnecessary morbidity. 7 In a cohort of more than 240,000 Veterans Affairs patients, persistent overtreatment—most commonly radiotherapy—was observed among men with intermediate or high-risk tumors and an expected survival of less than 10 years.
By integrating perspectives from multiple specialties and incorporating comorbidity-related considerations, MDTs allow cancer aggressiveness to be contextualized with overall clinical status. This approach facilitates identification of indolent tumors suitable for treatment deferral and ensures that limited life expectancy is appropriately weighed. In the metastatic PCa setting, MDTs play an increasingly important role in guiding treatment strategies, such as limiting systemic therapy or considering metastasis-directed therapy, to reduce toxicity. 4
Overall, MDTs might play a critical role in guiding appropriate treatment, preventing overtreatment—especially in vulnerable patients—and reducing treatment regret.
Defining which cases benefit most from MDT review
While MDT benefits are well recognized, universal case review is not feasible in many settings due to increasing cancer incidence, time limitations, and resource constraints. Identifying patients who derive the greatest value from multidisciplinary input has therefore become a key focus of implementation research.
Case-complexity tools such as the Measure of Discussion Complexity (MeDiC) 8 provide a structured approach to guide case selection. Developed and validated in the United Kingdom and recently adapted for PCa in Sweden, MeDiC scores clinical and logistical factors—including tumor stage, comorbidities, and diagnostic uncertainty—to identify cases most suited for interdisciplinary evaluation. Wihl et al. 9 demonstrated that MeDiC scores aligned closely with clinician-led referrals and streamlined workflow without compromising quality.
Not all patients with low-risk or straightforward cases require full MDT review. Hybrid strategies—such as selective MDT referral, standard care pathways, or mini-MDTs for routine cases—are increasingly adopted in both academic and community settings. Prioritizing case complexity allows efficient use of MDT resources while maintaining high standards of personalized PCa care.
Current models and future directions
The evolution of MDTs has led to diverse models tailored to institutional resources and patient needs, including traditional in-person tumor boards, virtual tumor boards leveraging telemedicine, and joint multidisciplinary clinics in which patients are evaluated by multiple specialists during a single visit. Structured MDT documentation further supports coordination and accountability. 3
Looking ahead, innovations may further enhance MDT efficiency. Artificial intelligence (AI)-assisted decision-support tools could help standardize case triage, flag high-risk features, and integrate imaging, pathology, and genomic data. 10 Cross-institutional MDTs and real-world data registries may facilitate broader collaboration and benchmarking.
Together, these developments signal a shift toward a more dynamic and collaborative model of PCa care, in which MDTs function not only as decision-making forums but also as continuous engines of quality improvement.
From good to great: management lessons for MDTs
High-performing MDTs may rely on leadership characterized by quiet determination and humility—qualities that foster trust and long-term commitment. Establishing a strong MDT begins with engaging professionals across disciplines around shared values and a common purpose, followed by strategic direction. Over time, repeated, structured case-based collaboration and adherence to shared clinical standards foster mutual respect and drive meaningful transformation in care delivery. Within this framework, the urologist serves a central role as both procedural specialist and strategic clinician with an integrative vision of PCa management. 4
Affordability and feasibility of MDT implementation
Concerns regarding cost, time, and resource allocation are frequently cited as barriers to MDT implementation, particularly outside large academic centers. Emerging evidence suggests that MDTs may be cost-neutral or cost-saving by reducing unnecessary treatments, avoiding duplicative testing, and improving adherence to evidence-based pathways. 5
MDTs align closely with value-based healthcare principles by prioritizing appropriate treatment intensity, reducing overtreatment-related morbidity, and supporting shared decision-making, particularly when scalable and context-adapted models are adopted. 7 When strategically implemented, multidisciplinary care represents an investment in quality, efficiency, and patient-centered outcomes.
Conclusion
Multidisciplinary care is no longer optional—it is essential for delivering high-quality, individualized treatment in PCa. MDT discussions enhance guideline adherence, reduce overtreatment, and improve patient experience through shared decision-making. Even in resource-limited settings, scalable MDT models supported by structured decision tools can be implemented. The future of PCa management lies in collaborative, personalized, and evidence-based care.
Footnotes
Acknowledgements
None.
Conflicting interests
All authors declare no competing interests except H.U.A., who reports the following disclosures: H.U.A. receives core funding from the UK NIHR Imperial BRC and Imperial NIHR/Cancer Research UK Experimental Cancer Medicine Centre (ECMC); receives research funding from the Wellcome Trust, UK Medical Research Council, Cancer Research UK, Prostate Cancer UK, UK NIHR, and Imperial Health Charity for trials in prostate cancer; is a paid proctor for HIFU (Sonablate Corp), cryotherapy (Boston Scientific), and Rezūm (Boston Scientific); is a paid scientific advisory board member for Francis Medical; has given lectures for Boston Scientific, Ipsen, and Janssen; has received funding to attend scientific conferences from Janssen; and is on a medical advisory board for Janssen.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethics approval
Not applicable.
Informed consent
Not applicable. This article does not contain any individual patient data.
Consent to participate
This article is a perspective and does not report studies involving human participants, human data, or human tissue.
Consent for publication
Not applicable. This manuscript does not contain any individual patient data.
Data availability statement
All data supporting this work are derived from previously published studies and are appropriately cited within the article.
Guarantor
R.R.-T. is the guarantor of this work and takes responsibility for the integrity of the manuscript.
Contributorship
All authors contributed to the conceptual development of this perspective, reflecting multidisciplinary expertise in prostate cancer care. R.R.-T. led the drafting of the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version prior to submission.
