When it comes to the prostate cancer, the disease known as the "silent killer" because it often exhibits no symptoms, to be forewarned is to be forearmed. It is the second leading cancer killer in men, just behind lung cancer. Every year, more than 218,000 men are diagnosed with prostate cancer in the United States, claiming about 28,000 lives. Regular prostate-specific antigen (PSA) tests are encouraged for men over the age of 50; for those with a family history of prostate cancer, the recommended age drops to 40. However, an upcoming report in the Journal of the National Cancer Institute debates that PSA testing is excessive and has resulted in many patients being over-diagnosed.
The study, conducted by H. Gilbert Welch of the VA Outcomes Group in Vermont, analyzed the correlation of cancer and PSA testing between 1986 and 2005. The PSA, which measures a protein in the blood produced by the prostate gland, started being used routinely around 1987 to detect early prostate cancer. The study showed that over 1 million men had been diagnosed with prostate cancer and underwent treatment. However, because prostate cancer grows so slowly and silently, many do not need treatment and die from other causes. The study estimated that for every one patient who benefited from PSA testing, at least 20 were treated unnecessarily and left with side effects for a disease that may never have been fatal for them.
PSA testing has also resulted in men being diagnosed younger than in the past. According to the study, diagnosis in men ages 50 to 59 has more than tripled since 1986 and grown more than 7 times in men under age 50. At a time when health care reform is focused on controlling unnecessary spending, the American Cancer Society said the study highlights the need to only treat prostate cancer in patients who truly require it.
Dr. David B. Samadi, Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York City, believes that a diagnosis of prostate cancer is not necessarily a death sentence. Samadi utilizes the PSA as just one part of his individualized analysis of his patients. The PSA, digital rectal exams (DRE) and Gleason scores are used as baselines to monitor fluctuations that can help detect 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.
PSA testing is vital in assessing the rate of the progression of the cancer. A notable fluctuation indicates that cancer is growing at a substantial rate, at which point treatment is recommended. Dr. Samadi has successfully treated over 2,000 patients with robotic prostatectomy. It is only by removing the prostate that the doctor can ascertain if the cancer is organ-contained, the type and the stage of the cancer.
Because it is minimally invasive, robotic surgery can salvage the delicate nerves surrounding the gland and preserve sexual function and continence, shorten hospital stays and recovery, and reduce costs. But most importantly, if caught early enough, the cure rate could be over 95%. If left untreated, the disease spreads, treatment and recovery become complicated, and revision techniques might be needed, running up healthcare costs. 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?"
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