Specialty: Urologic Oncology
Practice: NewYork-Presbyterian Medical Group, Westchester
Hospital: NewYork-Presbyterian/Lawrence Hospital
In 1990, when Mitchell Benson, MD, first developed the innovative concept of PSA density testing (a more accurate way to determine the cause of elevated levels of the prostate-specific antigen that can indicate prostate cancer), he earned a reputation as one of the leading doctors in his field. As the current director of Urologic Oncology at NewYork-Presbyterian/Lawrence Hospital, and emeritus chairman of the Department of Urology at Columbia University, he works on the most complex cases out there — including all of the most complicated cases involving ill and injured NYPD officers. “I am an honorary police surgeon for the City of New York, appointed by former commissioner Ray Kelly. So anytime there is a police officer who is injured who needs urologic care, I take care of them, taking whatever the police insurance covers, and giving them VIP treatment,” Benson says. “I would be more than honored to do the same thing for the Westchester police departments, too.”
As the doctor who first created the concept of PSA density, do you think today’s PSA tests are useful and accurate in diagnosing prostate cancer?
Prior to PSA testing, the most common presentation for a man with prostate cancer was ‘Doctor, my back hurts.’ The reason his back hurt was that the cancer had already spread to his spine. Then the prostate-specific antigen (PSA) blood test was developed. Once PSA testing became widespread, we went from metastatic cancer of the spine being very common to being very rare. But there was a price to be paid: We were finding and treating prostate cancers that probably never needed to be treated because they have such low potential for harm. We were over-treating some men.
How often do you suggest not treating a patient’s prostate cancer in your own practice?
About 60 percent of the patients coming to me with newly diagnosed prostate cancers don’t need immediate treatment. They go on active surveillance. This doesn’t mean no treatment ever, but it means no treatment now. It means we can safely delay treatment — and for the majority of these men, treatment will never become necessary. If a doctor tells you that all prostate cancers need to be treated and he will treat all prostate cancers, walk out the door because that is just not true.
What is the most important thing someone with a new cancer diagnosis should know?
There is nothing more important than a second opinion. This is a serious illness, and you should get a second opinion. If the first two doctors don’t agree, go for a third opinion to break the tie. You have to be able to reach consensus. I tell my patients, ‘I am so certain of what I am telling you that if someone is telling you something different, you need to go for a third opinion.’
What’s the one issue on which you’d like to better educate Westchester residents?
When serious illness is involved, choosing the wrong doctor can be the greatest risk to your health. It’s the hands that you end up in — the doctor and not the location — that makes the biggest difference to your treatment and recovery. There is a misconception here in Westchester that in order to get the latest treatment and the best care, you have to go into the city. That just is not true! You don’t need to go into the city to get the best treatments or to get the best and the brightest doctors.
What will the future of urologic oncology look like?
Today, I do 100 percent of my prostate cancer and much of my kidney surgery robotically, and this technology is continuing to evolve at lightning speed. What was considered minimally invasive yesterday will be obsolete tomorrow.
Another evolving area…we are moving to the point where, based upon analysis of an individual’s genetic profile, we can tell if a drug will work or not for each of our patients based on their tumor’s unique characteristics. In other words, we are eliminating trial and error because we know how successful the drugs will be before we even write the prescription.
