Starting in September, President Obama's Affordable Care Act will go into effect. The act mandates free preventative services such as cholesterol or breast cancer screenings and tetanus shots. But the question is, will doctors and patients take advantage of these new preventative services? "Unfortunately, thanks to our American healthcare system, we have been programmed to focus on treatment and not prevention," said Dr. David Samadi, a urologic oncologist specializing in prostate cancer treatment and robotic surgery, who is also the Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York City.
Such a mindset is deeply affecting the makers of Proscar, a medication that has been proven to reduce the risk of prostate cancer. But there is heavy resistance to prescribe this preventative cancer drug, which is categorized as chemoprevention treatment. "Chemoprevention is the act of prescribing drugs to at-risk patients to prevent a certain disease," explained Samadi. "The issue with this is that doctors have to advise healthy patients to take the drug to prevent cancer, which very few patients would consider."
Another issue with chemoprevention is its success is not easily measurable. It's impossible to know if a patient would have developed prostate cancer without Proscar. Therefore the success rate can only be ascertained in a study group. However, a 2003 report compared two groups of men at an average risk of prostate cancer. Over seven years, one group took Proscar and the other didn't. The Proscar group was almost 25% less likely to develop prostate cancer than the other group.
"However, since we, as humans, are programmed to believe only tangible evidence, a preventive medicine does not give us that," explained Dr. Samadi, "Not having cancer is a good thing, but not developing something you didn't have in the first place is hard to comprehend." Samadi believes in the preventative effects of drugs like Avodart or Proscar, which can cut the prostate-specific antigen (PSA) level in half. However, he says, "It's an uphill battle to convince my patients of the benefits."
Proscar causes side effects like hair growth, due to its main ingredient, finasteride. It also causes impotence. "Even though these side effects are unlikely and mild, they matter a lot to patients," said Dr. Samadi, who has performed over 3,000 successful robotic prostatectomy surgeries. "So instead, I try to promote health screenings, but still these are a hard sell especially with conflicting messages on the benefits and costs of expensive diagnostic tests," continued Samadi.
"So now my challenge is just to minimize prostate cancer risks for my patients, as it always has been," said Dr. Samadi. "I will continue to advocate prostate cancer screenings and advise proper nutrition, sleep, exercise, reduction of risk factors such as alcohol and smoking, which can also prevent many other diseases." Samadi advises men over 40 to get an annual digital rectal exam and PSA. "If detected early, the cancer cure rate is excellent," advised Samadi.