Tags: Cancer | prostate cancer | treatments | surgery | incontinence | sexual dysfunction | Dr. David Samadi

Prostate Cancer: Is the Cure Worse Than the Disease?

By John Bachman and Donna Scaglione   |   Thursday, 28 Mar 2013 08:45 AM

A study on prostate cancer patients, most of whom had problems having sex 15 years after being treated with surgery or radiation, underscores the importance for men to carefully weigh treatment options for early-stage disease, Dr. David Samadi, one of the nation’s top prostate cancer authorities, tells Newsmax Health.

While the study results, which were published in the New England Journal of Medicine earlier this year, sound discouraging, Dr. Samadi notes that the surgical procedure used was conventional and “open” — involving an open wound with a lot of blood and requiring surgeons to distinguish nerves through touch rather than sight. When nerves are damaged during prostate surgery the result can be sexual dysfunction and incontinence.

“Since then there have been a lot of advances in the field of prostate cancer,” says Dr. Samadi, vice chairman of the Department of Urology and chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York City. “We have taken the experience of open surgery, we have built up the laparoscopic experience from France, and now we’ve done well over 4,000-plus robotic cases. And there are a lot of skilled robotic surgeons out there who know how to save the nerves.”

Dr. Samadi and other surgeons use a robotic, nerve-sparing technique that separates the prostate gland from the nerves in an effort to preserve critical urinary and sexual function.

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“This way the entire skeleton of the nerves and the sphincter, and surrounding tissues are untouched,” he explains. “And now we’re seeing about 97 percent continence, we see about 85 percent sexual function, and the patients are basically leaving the hospital in 24 hours. What that tells you is that it’s not just the robotic technology, it’s the experience of the surgeon behind it.”

While advances have occurred in prostate surgery, the diagnostic tools used to detect prostate cancer — the biopsy and prostate-specific antigen (PSA) test — can be imprecise and lead to overtreatment, Dr. Samadi notes. Other conditions beside prostate cancer, such as a recent sexual encounter, can elevate PSA levels, and biopsies are random.

“Your doctor is taking certain samples of your prostate from different parts of it,” Dr. Samadi says. “Now if you get the same biopsy a week after or two weeks after you may end up with a completely different result.”

Because of this patients may be getting surgery for low-risk cancer that they might not necessarily need.

[When] the day comes that we have better imaging and better diagnostic tools, I think those numbers will go down,” he says. “There’s also a lot of studies coming in in genetics trying to find out who is really at high risk and who is not. Then we can really decide who should get the surgery or not.

“But in general, I think that it’s important for people to know that when you remove the prostate, unlike [with] radiation, you get a very accurate staging, you will find out how much cancer you have, what type of prostate cancer. And other treatments … won’t give you that kind of answer.”
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