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PSA Testing and Robotic Surgery Take on Prostate Cancer

NEW YORK, Jan. 13, 2012 /PRNewswire/ -- The New Year brings hope for the fight against prostate cancer. While the American Cancer Society (ACS) predicts another 240,000 U.S. men will receive this unfortunate diagnosis in 2012, numbers also indicate that it's a battle we are winning. Prostate cancer-specific deaths dropped 39 percent since the 1990s. The widespread adaptation of PSA screening and improved surgical treatment, in the form of robotic prostatectomy, is leading the charge.

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As Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, Dr. Samadi stresses the importance of early detection through the PSA, despite recent government guidelines to the contrary. Several large population based studies have in fact demonstrated a survival advantage from routine PSA screening. The government chose to focus on the results from the Prostate, Lung, Colorectal, and Ovarian Cancer trial, which failed to demonstrate any benefit. The study, however, was flawed in its design, with a majority of the control group receiving PSA screening.

Currently, an estimated 85 percent of prostatectomy surgeries performed in the U.S. are done so with the surgeon-guided assistance of robotic technology. "Undoubtedly, robotic surgery is part of our success in reducing prostate cancer deaths," says Dr. Samadi. As a robotic prostatectomy expert, he continues to share his knowledge both domestically and abroad to improve surgical success rates by strengthening surgeon expertise. "It's the surgeon's ability rather than the machine. The robot allows for a less invasive, quicker surgery, however, the surgeon behind the console is what truly determines outcomes and education of these physicians is of paramount importance."

Media reports and skeptical researchers may disagree and, as such, repeatedly ask us to question the benefits and validity of robotic surgery. Incontinence and sexual functioning are the two primary concerns men grapple with when electing to have prostatectomy surgery, either traditionally or robotically. Accusations of robotic surgery's comparable results in these areas, paired with its elevated expense, leave prostate cancer patients with even more complex treatment decisions.

One such study, led by researchers from Massachusetts General Hospital, consisted of a five-month review of Medicare prostate cancer surgery patients to assess side effect variances between robotic prostatectomy surgery and traditional, open prostatectomy surgery.

Surveys sent to a sample size of less than 700 asked men to rate their continence and sexual potency issues 14 months post-surgery. As reported in this month's Journal of Clinical Oncology, the data showed no statistical significance with regard to severity or incidence of sexual and urinary issues with robotic prostatectomy surgery.    

"The media can make it tough for patients," worries Dr. Samadi. "Research is reported and taken for fact; patients have to really dig deep to understand how conclusions are drawn before letting them play a role in their personal decision making. What kind of volume did the surgeons have? What was the patients' overall health? How were patient expectations managed pre-op? We need these answers for the total picture."

First and foremost, Dr. Samadi believes one must explore the issue of surgeon expertise. Having performed over 3,600 successful robotic prostatectomy procedures, he is well aware of the role that experience plays. "Robotic prostatectomy success comes from years of experience; that's really the X-factor that's excluded from this and many other studies," asserts Dr. Samadi.

Combining his traditional and laparoscopic surgical training with oncologic principles, Dr. Samadi designed his SMART (Samadi Modified Advanced Robotic Technique) Surgery with unique surgical methodology to improve robotic prostatectomy outcomes. "My expertise, combined with the precision of the robot, helps us achieve continence rates of 97 percent and potency rates of 81 percent one-year post surgery," he states. Further, Dr. Samadi reminds patients that robotic prostatectomy is a minimally invasive procedure. The "keyhole" incisions results in very little blood loss, shorter hospital stays and faster recovery.

While Dr. Samadi is a firm believer in the surgical, oncologic, and lifelong benefits of robotic prostatectomy he knows that without surgical experts at the helm we are no better off. "I would never suggest a patient choose robotic prostatectomy for the technology alone; they have to seek the right surgeon with the right experience."



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