Editors’ Note

Dr. Peter Scardino specializes in early detection, prognosis, and surgical treatment of prostate cancer. Dr. Scardino’s position at Memorial Sloan-Kettering includes appointments as Head of the Prostate Cancer Program and as the incumbent of the David H. Koch Chair. He is also a Professor in the Department of Urology at Weill Cornell Medical College and at SUNY Downstate Medical Center. Dr. Scardino edited the Comprehensive Textbook of Genitourinary Oncology, and in 2010, with Judith Kelman, wrote Dr. Peter Scardino’s Prostate Book: The Complete Guide to Overcoming Prostate Cancer, Prostatitis and BPH. He serves as Editor-in-Chief of Nature Reviews Urology and is an editorial board member and reviewer for several peer-reviewed journals. He is also a Fellow of the American College of Surgeons and was elected to membership in the National Academies’ Institute of Medicine in 1995. Dr. Scardino received his M.D. from Duke University School of Medicine and completed residencies at Massachusetts General Hospital and the University of California, Los Angeles, School of Medicine

Organization Brief

Memorial Sloan-Kettering Cancer Center (www.mskcc.org) is one of the world’s premier cancer centers committed to exceptional patient care, leading-edge research, and superb educational programs. At Sloan-Kettering Institute, state-of-the-art science research flourishes side by side with clinical investigation and treatment at Memorial Hospital, the nation’s oldest cancer hospital. Sloan-Kettering is also one of 40 National Cancer Institute-designated Comprehensive Cancer Centers.

What can men approaching their 40s do to protect themselves against prostrate cancer?

This is a particularly scary disease, because it’s cancer and we’re all afraid of the connotations of that word.

But this particular cancer occurs at the intersection of key functions that men who get prostate cancer have taken for granted all their lives: urinary, sexual, and bowel function. Prostate cancer and its treatment can often lead to disruption and problems with those functions.

The most important fact about prostate cancer is that in the United States today, the chances of dying of prostate cancer are almost half what they were just 20 years ago, largely because of effective testing, early detection, and treatment of prostate cancer when it’s necessary.

How to treat prostate cancer is complicated by the fact that men, beginning at age 50, start to develop cancer cells in their prostate far more often than they develop the disease prostate cancer, and the older they get, the more common these cells are. If you get tested and have a biopsy, your doctor may incidentally find some of these cells, diagnose you with prostate cancer, and subject you to treatment that has some unpleasant side effects for no great benefit.

So you can’t say, “If it is cancer, get treated.” You can say, get tested, but be thoughtful before you decide to have treatment. Make certain you have a cancer that needs to be treated and that the treatment you’re choosing is appropriate to your life expectancy, your health, the side effects you’re concerned with, and the nature of your cancer.

What is the best test for prostate cancer?

The most widely known tests for prostate cancer are the PSA test, which is a simple blood test, and the digital rectal exam, which is a physical exam where the doctor uses his finger to feel the prostate gland, searching for nodules. The blood test is by far the most important.

Studies show that a single PSA blood test at age 45 to 50 predicts with a high level of accuracy whether you will ever get prostate cancer at all or develop a serious life-threatening prostate cancer. The PSA test at age 60 has more than 90 percent accuracy in predicting who will die of prostate cancer. So this is a very powerful tool for sorting out men at risk.

If you have it and you have to be treated, what options can patients benefit from?

The good news is there are a number of very effective ways to treat prostate cancer, depending upon you, your health, your concerns, and the nature of your cancer. Those include surgical techniques – robotic surgery is the newest and has generated a lot of interest; it is a form of laproscopic surgery. There is also open surgery and external beam radiation, radioactive seed implants, and combinations of these. And there are new things coming down the road all the time.

So you need to address the pros and cons of each patient, and get the right doctor to carry out the treatment. That is the part of the equation I would most emphasize. The truth is, which treatment you choose is probably less important than who you choose to give it to you, because the quality of treatment varies enormously.

How do you find the right doctor?

We don’t have a Moody’s or Standard & Poor’s rating service for doctors that compares them objectively. The Best Doctors in America is a place to start. At least those are votes from other doctors on who they would go to or send patients to. Castle Connolly is also a reputable group that attempts to identify the most qualified doctors in the field.

Second, if you have a family doctor or a friend who is in the medical field, ask who they’d go to, who has experience, and who is known to have good results.

Then meet the doctor face to face and determine if this feels like someone you want to trust your health to. In prostate cancer, it’s particularly important to select the right doctor because the treatment is not a formula.

How have you achieved such status in the prostate cancer field?

Prostate cancer has been my field of special interest over the past 30 years. One reason I’ve become a leader in the field is that I am able to distill a great deal of complicated information into the essential knowledge that is important for decision-making about an issue that is vital to the health of men over the age of 40.

I wrote Dr. Peter Scardino’s Prostate Book to help people understand prostate cancer better than listening to a 30-second sound bite on the evening news. When you’re in your 40s, begin thinking about your prostate; and by 45, get your first test.•