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Prostate Cancer Treatment Expert Dr. David Samadi, MD Speaks Out

American Cancer Society's New Screening Guidelines

Just a few months after the American Cancer Society (ACS) recommended against regular mammograms for women, the ACS has now changed its recommendations regarding prostate cancer screening. The recommendations call for healthy men with no risk factors for prostate cancer to commence screening at the age of 50. For those patients with higher risk, such as African-Americans and those with family history, the recommended screening age is now 40 or 45, depending on the level of risk.

These "new" guidelines recommend that the patient make an informed decision on his own treatment or have their doctor make a determination. "I have always advocated individualized treatment in a strong doctor-patient partnership," Dr. Samadi, Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology at The Mount Sinai Medical Center in New York, "Treatments are not 'one size fits all' and even the ACS guidelines are not ideal for all men evenly across the board."

The ACS also recommends that men who have no symptoms of prostate cancer and are not expected to live more than 10 years (due to age or declining health) should not undergo prostate cancer screening because the risks likely outweigh the benefits. This recommendation greatly concerns Dr. Samadi, who has successfully performed over 2,250 da Vinci robotic prostatectomy surgeries in his practice. "This information is contrary to what we know to be true of robotic surgery, which has a high cure rate as well as success in preserving sexual function and continence," he said, "Why would anyone deny themselves a quality of life based on this recommendation? Who makes this determination that one is not expected to live more than 10 years? If a cure would probably lengthen their life, so why wouldn't they choose that option?"

Additionally, the guidelines make the digital rectal exam (DRE) optional and extend the time between screenings for men with low PSA levels. Dr. Samadi understandably disagrees. "I use the DRE, and the PSA, along with Gleason scores and other testing factors to make an individualized decision on treatment for my patients," explained Samadi. "By eliminating one marker, I can't see the whole picture."

Dr. Samadi feels that extending the time between prostate cancer screenings is dangerous. "I look for fluctuations in my patient's Gleason scores, and I can't properly monitor these fluctuations if the screenings are done infrequently or too spaced apart," he said, "Time makes a big difference when you are dealing with a 'silent killer' such as prostate cancer, that often exhibits no symptoms."

Dr. Samadi's recommendation has always encouraged regular prostate cancer screenings for men over the age of 50. For those men with a family history of prostate cancer, he recommends testing from the age to 40. "Prostate cancer is no longer an old man's disease," said Samadi, "I've seen it in patients as young as 39, and the earlier we intervene, the better the chances for a cure." He believes that there have been definitive decreases in advanced-stage cancers and age-specific prostate cancer mortality rate in this "PSA screening era." "Cancer grows at different rates. If left untreated, prostate cancer can spread outside of the gland, making treatment and recovery more complicated and requiring follow-up surgeries, which can increase healthcare costs," said Samadi, "I believe in prostate cancer screening and treatment because it's effective."