U.S. Panel Says No to Prostate Screening for Healthy Men
Dr. David Samadi, Leading Prostate Cancer Expert, Deeply Concerned by Impending PSA Test Recommendation From U.S. Preventative Task Force
NEW YORK, NY--(Marketwire - Oct 7, 2011)
- "Today, it feels we are taking a huge medical leap backward," says Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center. Dr. Samadi's comment comes on the heels of front page news in the New York Times that the U.S. Preventative Services Task Force (USPSTF) intends to release official guidelines next week against the use of the PSA blood test for healthy men of any age. "For many urologists and prostate cancer treatment experts worldwide, it's shocking," says Dr. Samadi. "We've worked tirelessly to teach men how important this test is."
The PSA, prostate-specific antigen test, is currently recommended on an annual basis for men beginning at age 50; for high-risk men, African Americans or those with a family history, it's age 40. "The test is our single best tool for detecting prostate cancer," stresses Dr. Samadi. "It is not perfect, but without it we have nothing. There is significant evidence that early prostate cancer detection and treatment saves lives, particularly in younger men." Dr. Samadi also believes that the PSA velocity, the trend of a man's PSA level over the years, is the best tool for evaluating the cause of PSA level spikes.
The USPSTF is basing its recommendation on five clinical trials, stating that PSA screening does not save lives and leads to further testing and treatments resulting in negative side effects such as impotence and incontinence. These trials, however, are not without controversy. The Prostate, Lung, Colorectal, and Ovarian screening trial, a large American based study, failed to demonstrate a significant benefit in reducing prostate cancer mortality. This study's results were published prematurely without the sufficient follow up needed to demonstrate a benefit. Furthermore, over 50% of participants in the control group were screened during the study period, most likely obscuring differences between the study groups. A similar study was conducted in Europe, which followed over 200,000 men for a longer period. The European study observed a 20% reduction in prostate specific deaths in the screening group compared to the control. While the panel's recommendation will not immediately impact insurance or Medicare coverage of the test, it could in the future.
The panel appears to be in agreement with the test's success in detecting prostate cancer, but believes that information is useless without distinguishing between slow-growing, benign cancer and more advanced prostate cancer. Dr. Samadi thinks they're creating a dangerous proposition for healthy men. "Prostate cancer is a mostly asymptomatic disease. If we tell men not to get screened we're essentially saying, 'Yes, you may very well get prostate cancer and, yes, it might become painfully metastatic, but wouldn't it just be easier not knowing?' I doubt many men would go for such an offer," he says.
As a robotic prostatectomy expert, Dr. Samadi specializes in robotic-assisted removal of cancerous prostates. "To use treatment side effects as justification for not testing is illogical," Dr. Samadi says. "Sexual potency and urinary control are not guaranteed victims of prostate cancer treatment." Through robotic surgery, Dr. Samadi is able to take advantage of greatly enhanced vision and dissection precision that allows him to spare the nerve bundles that control these two important functions. For some men, the recovery period involves short-term sexual and urinary issues, but with early detection robotic surgery can cure men of their prostate cancer. For Dr. Samadi's patients that cure rate is 97 percent.
Dr. Samadi's position is supported by the American Urological Association, which released a statement today against the panel's impending recommendation, using phrases such as "great disservice" and "more harm than good." The USPSTF is the same group that caused a great stir two years ago by recommending that women under 50 not undergo annual mammograms.
"More than 32,000 U.S. men died from prostate cancer last year. Without this test, we rob men of their window for a cure and that number will surely increase," cautions Dr. Samadi.
More can be seen from prostate cancer expert, Dr. Samadi, on YouTube/roboticoncology
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