Cancer screening methods are not perfect: Experts

In a recent New York Times article, the American Cancer Society (ACS) ignited a major controversy over the benefits of cancer screening, specifically with regards to their breast and prostate cancer guidelines. In the article, Dr. Otis Brawley, chief medical officer of the ACS, responded to a study in the current issue of the Journal of the American Medical Association. The study, conducted over the last 20 years of screenings for breast and prostate cancer, concluded that detection of early stage disease nearly doubled for both cancers, but this early detection did not result in more patients being cured.

Dr. Brawley shared his conclusion that current cancer screening methods are not perfect. He further suggested that the advantages of screening guidelines might have been exaggerated. A subsequent clarification from the ACS stated that screening should continue to be done, but patients need to understand that current screening methods are not certain.

While the ACS is continuing to research their cancer screening guidelines, they are not changing them just yet, and neither is Dr. David Samadi, Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology at The Mount Sinai Medical Center. Dr. Samadi's recommendation has and will always be to encourage regular prostate cancer screenings for men over the age of 50. For those men with a family history of prostate cancer, the recommended age drops to 40. "This is no longer an old man's disease," said Dr. Samadi.

Dr. Samadi has long acknowledged that there is no perfect screening method for prostate cancer. And while the ACS does not recommend prostate-specific antigen (PSA) testing for all men, because many studies have determined that the PSA has not been successful in preventing prostate cancer deaths, it does suggest that men make an informed decision about prostate cancer screening with their doctor. Dr. Samadi wholeheartedly agrees with this suggestion, and continues to advocate prostate cancer screening, particularly in men who have known risk factors.

As an oncologist who is also an expert in open, laparoscopic and robotic surgery, Dr. Samadi does not rely on the PSA test alone in making a diagnosis of cancer and prescribing treatment. He conducts an individualized analysis of his patients utilizing a combination of markers, including digital rectal exams and Gleason scores. Even normal scores in these exams can be used as baselines to monitor future fluctuations that can indicate prostate cancer in its early stages.

"Patients who partner with their doctor to monitor these fluctuations and any other risk factors can successfully stay ahead of this disease," said Dr. Samadi, who has successfully performed over 2,100 robotic prostatectomy surgeries. Cancer grows at different rates, but Dr. Samadi believes that a diagnosis of prostate cancer is not necessarily a death sentence. However, he advocates surgery because it is only by removing the prostate that the cancer range, stage and rate can be fully ascertained.

In his own response to the controversial study, Dr. Samadi noted that the study, which took place over the last 20 years, would have a radically different outcome in today's world of cancer treatment. Due to advances in technology and surgical experience, robotic surgery has become the ideal treatment option as it is less invasive than the older modalities, and provides the surgeon a higher level of magnification and mobility. This results in cure rate of over 95%, along with reduced rates of the dreaded side effects of prostate surgery, such as impotence and incontinence.

If left untreated, prostate cancer can spread outside of the gland, making treatment and recovery more complicated and requiring follow-up surgeries. These end up increasing healthcare costs. Dr. Samadi believes in prostate cancer screening and treatment because it's effective. He maintains that there have been definitive decreases in advanced-stage cancers and age-specific prostate cancer mortality rate in the "PSA screening era." This is why Dr. Samadi asks: "Why take a chance with a silent killer when a proactive approach can reduce healthcare costs and save your life?"