Three is a very important number to Dr. David Samadi, Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center. Considered a mystical number, Samadi has incorporated this number in his robotic prostatectomy practice. Having performed 3,000 successful prostate cancer treatments in his work, Samadi’s experience is unparalleled. Thanks to three fellowships, he is not only an accomplished robotic surgeon, he is also expertly trained in open and laparoscopic surgery. Samadi refers to himself as "three surgeons in one head," which is crucial in surgery, if he needed to switch from one type of surgery to another.
Prostate Cancer Treatment Options
When determining prostate cancer treatment for his patients, Dr. Samadi uses a three-pronged approach, taking into consideration their prostate specific antigen (PSA) level, digital rectal exam (DRE) and Gleason scores. This information is used as a baseline monitor, along with other risk factors such as lifestyle and family history, to help successfully treat this disease.
Currently, the most popular treatment options for prostate cancer are radiation, active surveillance and prostatectomy. Radiation uses high-energy rays or seeds to kill cancer cells. It is ideal for low-grade, prostate-confined cancer and recurrent cancer cases. Active surveillance, also known as "watchful waiting," means waiting until the cancer exhibits symptoms before starting treatment. In other cases, it involves closely monitoring the patient’s tests, exams and ultrasounds to ascertain the cancer’s growth. The third option is a radical prostatectomy, whereby the entire prostate gland is removed, which can be done traditionally (via open surgery), laparoscopically, or robotically.
In choosing a treatment, understandably Dr. Samadi stands behind the viability of a radical prostatectomy. It is, in Samadi’s opinion, the "gold standard" for completely eliminating prostate cancer that is organ-confined. Understandably, he advocates a robotic prostatectomy, via the da Vinci robot, as the most effective way of treating prostate cancer. "It is only by removing the prostate that I can ascertain three things: if the cancer is organ-contained, the type of cancer, and the stage of the cancer," explained Samadi.
The "Triple Play" Philosophy
In keeping with his "triple play philosophy," Dr. Samadi believes that with the experience of open prostate surgery and laparoscopic prostatectomy, robotic surgery can offer his patients the best cure (with post-operative long-term PSA levels undetectable), retention of sexual function, and continence (see charts). "All three factors are equally important to my patients, and my experience with robotic surgery has consistently provided these to them," continued Samadi.
Dr. Samadi envisions promising advancements in the arena of prostate cancer research. He cites the possibility of gene therapy, whereby prostate cancer cells are infected with genes that prevent them from multiplying. Another hopeful treatment includes immunotherapy, which stimulates the body’s own immune system to attack cancer cells. And finally, there are many potential vaccines being researched to prevent prostate cancer from developing in the first place.
"Choosing robotic surgery is a no-brainer. Choosing the right surgeon who performs a large volume of these cases and is also a trained oncologist is most important," says Dr. Samadi. "I have increased visibility, magnification, and dexterity with no tremors. The patient’s time in surgery is reduced to 1-2 hours. The incisions are smaller, with minimal blood loss. They are discharged within 24 hours. Recovery is faster and side effects are practically eliminated." Samadi is confident in his trifecta approach to prostate cancer and robotic surgery as the most effective treatment option available.