Robotic Prostatectomy Expert Dr. David Samadi, MD Discusses Prostate Cancer Staging and Prostate Cancer Recurrence Study

A new study in the journal Cancer shows that staging prostate cancer that has not metastasized beyond the prostate gland does predict the outcome, prognosis or risk of cancer recurrence after a radical prostatectomy. “This study confirms what many prostate cancer treatment surgeons have thought about staging – it’s irrelevant after prostate cancer surgery – something I strongly disagree with,” said Dr. David Samadi, a robotic surgery expert, as well as the Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York City.

The study, which emanated from the University of California, San Francisco, was designed to prove how reliable the staging system was as well as what could account for the inaccuracy of prostate cancer staging when determining prognosis. It was found that in 35 percent of the nearly 4,000 cases, clinical stages of prostate cancer were assigned incorrectly, mostly due to overlooked results from prostate tests such as the transrectal ultrasound tests and biopsy results which were incorrectly measured in the staging process. However, even after these errors were resolved, researchers found no link between the stage and outcome after prostate removal surgery.

The study indicated that the PSA, Gleason score and other variables are more powerful prostate cancer screening indicators of recurrence than clinical staging. Researchers believe that these factors should be emphasized more heavily than clinical stage data. This information pleased Dr. Samadi, who uses a three-pronged diagnostic approach in prostate cancer treatment: the prostate-specific antigen (PSA), the digital rectal exam (DRE) and the Gleason score. Samadi, a prostate surgeon who is also a urologic oncologist, trained in open prostatectomy and laparoscopic prostatectomy, added, “I go above and beyond to consider the biopsy, the patient’s individual family history and risk factors.”

Pre-operative staging is not as accurate as the post-operative staging

Dr. Samadi strongly believes that a prostatectomy, specifically a robotic prostatectomy, remains the best way to determine the grade and stage of the disease as well as post-surgical prostate cancer treatment options. “Pre-operative staging is not as accurate as the post-operative staging, which is why the only treatment that gives me the most accurate and final staging picture is complete removal of the prostate,” explained Samadi.

Dr. Samadi provided a clinical example of a patient with a low Gleason volume of 6, who would be a good candidate for watchful waiting (active surveillance) or seed implant. However, when the prostate is removed, half of the gland has a Gleason score of 7. The reason for this is because random biopsies are not accurate cannot image the entire prostate well enough to give doctors accurate staging. “This is important information that a lot of patients are not aware of,” explained Samadi, “Usually, there is a 40 percent upgrading of the disease after the prostate removal.”

However, the clinical stage is still necessary for cancer of the prostate that has spread beyond the prostate gland. “Currently, what science lacks right now is an accurate prostate cancer imaging system and genetic screening test” said Samadi, “Which is why I rely on so many different indicators to make my prostate cancer treatment assessments.”