• Michael Misialek, MD

End The Silent Killer of Men: Take the #SamadiChallenge, Promote Prostate Cancer Awareness

It wasn’t too long ago that men with advanced prostate cancer were commonly seen in the hospital. I remember patients presenting with back pain who upon further workup were found to have widespread prostate cancer to their bones, liver and elsewhere. We didn’t know much about prostate cancer in those days. No way to screen, no way to catch this deadly killer in the early stages when it was curable. Fortunately our understanding has advanced since then. However, many men are still coming in with late stage disease. Perhaps even more disturbing, this silent killer is showing up in younger men. It doesn’t have to be this way.

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As a pathologist, I diagnose cancer all too frequently. I have met many patients and families behind the slides and know the devastating impact upon them. I want to reach the men behind my slides.

Much like the Pap smear and mammogram have transformed cervical and breast cancer detection, the PSA test is doing the same with prostate cancer. PSA is a protein secreted by the prostate and is elevated in many conditions, both benign and cancer. What this means is that it is sensitive for prostate cancer, but not very specific, i.e. there are false positives. This is what makes it a good screening test though. We want to “cast the net wide enough” to catch cancer, but in so doing, we also discover elevations due to benign prostatic hyperplasia (BPH) and inflammation.

Knowing your PSA is the first step. This needs to be combined with age, risk factors, family history, even diet and exercise to determine the next steps. It is a fact that PSA testing has lead to an increase in prostate cancer diagnosis. There are those who question its utility. I ask; what better tests exist? What else should we do; nothing? As one can see, it is a more complex issue. Your doctor can sort through this and offer you an individualized risk assessment of screening.

My diagnosis gives the team valuable information. Prostate cancer is graded by assigning a Gleason grade (1-5) to the tumor cells and combing the two most prevalent patterns to come up with a score. There exists great inter-observer variability in diagnosis. Multiple experts might interpret a cancer differently, i.e. a diagnosis of 3+3, 3+4, 4+3, 4+4, etc. This can have an enormous impact on care. This is just one grey zone in prostate cancer care.

Treatment too has many grey zones. Should a patient pursue “watchful waiting” or active treatment such as surgery, radiation or even chemotherapy? One exciting advance is a recent study presented by researchers from the National Cancer Institute and reported in the Journal of the American Medical Association. It appears that MRI combined with ultrasound was more accurate in identifying high risk cancers over those of lower risk.

Even with watchful waiting we see a 30-40% upstaging at prostatectomy. Clearly there is more to learn about prostate cancer. What makes cancer cells that look the same under my microscope behave so differently? How can we more accurately sample and stage disease?

The best treatment is that of a multidisciplinary team approach. Combining urology, pathology, oncology, radiology and radiation oncology offers patients an effective plan that is individualized to their disease, another example of “Personalized Medicine”. This information can then be taken back to the patient providing a terrific opportunity for them to learn about their disease, to know what questions to ask, to be advocates for their own care.

Dr. David Samadi, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in New York City, a board certified urologic oncologist trained in open, traditional and laparoscopic surgery and an expert in robotic prostate surgery, sat down with me to offer his thoughts.

Dr. Samadi agrees more needs to be done in prostate cancer screening, diagnosis, treatment and care. He states, “We need to better identify high risk vs. low risk cancer. Until we get better screening tests, perhaps through genetics and precision medicine, the PSA test is all we have now.” An additional area that needs attention according to Dr. Samadi is surgical training. “We need to better train surgeons to ensure better outcomes.” His answer is robotic surgery.

Robotics has come a long way in recent years. Dr. Samadi pioneered his own technique, the Samadi Modified Advanced Robotic Technique (SMART) which is a minimally invasive robotic-assisted laparoscopic prostatectomy (RALP). This helps patients recover from prostate cancer and surgery faster and with fewer complications than other techniques.

Dr. Samadi feels women, known for being their own strong advocates, can be a great partner for the men in their lives to get screened. In fact he has launched the #SamadiChallenge urging women and men to take control of their health. It’s not too early to start, and it isn’t just prostate cancer, but also colon, testicular and skin cancer that needs to be screened for. Let’s not forget the biggest killer of both men and women; heart disease. Dr. Samadi offers these suggestions to help maintain the best health possible for men of different ages.

For men in their 20s: -Complete physical every three years -Get blood pressure checked every year

-Cancer screenings every three years particularly for thyroid, testicles, lymph nodes, mouth and skin -Cholesterol test for total, LDL and HDL (the good kind) every three years -Testicular self exam every month

For men in their 30s -Complete physical every 2 years -Get blood pressure checked every year -Cancer screenings for thyroid, testicles, lymph nodes, mouth and skin every three years -Cholesterol test for total LDL, HDL (the good kind) every three years -Testicular self exam every month

For men in their 40s -Get blood pressure checked every year -Cancer screenings for thyroid, testicles, lymph nodes, mouth and skin every three years -Cholesterol test for total LDL, HDL (the good kind) every three years -Testicular self exam every month -Complete physical every 2 years -Baseline prostate-specific antigen (PSA) test and digital rectal exam (DRE) -Stool test (for colon and rectal cancers) every year

For men in their 50s -Get blood pressure checked every year -Cancer screenings for thyroid, testicles, lymph nodes, mouth and skin every three years -Cholesterol test for total LDL, HDL (the good kind) every three years -Testicular self exam every month -A sigmoidoscopy or colonoscopy (for colon cancers) every three to four years or as recommended by your healthcare provider -PSA and DRE exam every year

As we celebrate President’s Day, let’ take the opportunity to promote a greater awareness of prostate cancer understanding. Let’s get the conversation going. I look forward to the day when the morbidity and mortality of this disease becomes a thing of the past. Much like the recent successes in the battle over breast cancer, the same must occur with prostate cancer.

#prostatecancer #drdavidsamadi #samadichallenge #surgery #roboticprostatesurgery

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