Prostate

Deciding to Use HIFU for Prostate Cancer Treatment

According to the American Cancer Society, prostate cancer is the most common cancer among men, after skin cancer and there will be 161,360 new diagnoses this year alone. With that in mind, I thought I’d share my story. At a routine check-up, my physician ran a battery of tests and noticed my PSA (prostate-specific antigen) count was elevated, and sent me to a urologist.

Finding out I Had Prostate Cancer

At the urology appointment, my PSA count was higher still. Looking at records of past check-ups, my PSA had been steadily rising and was cause for concern. The doctor ordered an MRI which unfortunately indicated a high probability of cancer. The urologist suggested I consider prostatectomy—removing the entire prostate. I was in a state of shock and uncertain about what to do.

My urologist recommended I see Dr. Arieh Shalhav at UChicago Medicine (UCM) because he is considered a leader in the field of minimally invasive urologic surgery. So I made an appointment.

Dr. Shalhav discussed the various conventional treatments. First, I needed to have a biopsy to better understand what was actually there. My MRI was used to guide the biopsy, which confirmed the cancer. Fortunately it was confined to one side of the prostate, meaning it had not spread beyond that. But it needed to be addressed.

Learning My Treatment Options

Dr Shalhav told me about robotic prostatectomy, as opposed to the conventional open surgery, but also mentioned that UCM had installed a medical device called Ablatherm HIFU, which applies high intensity focused ultrasound energy to heat and destroy diseased or damaged prostate tissue.

He said HIFU had been practiced in Europe and Asia for a number of years with more than 45,000 successful cases. He thought I was a good candidate for HIFU because the cancer was localized in my prostate. I was grateful that HIFU was becoming an available option in the US. Many American men have gone to Canada and Mexico to have this procedure and had to pay for hospitalization and treatment out of pocket.

Second and Third Opinions: The Doctors Didn’t Mention HIFU

Like most patients who first receive a cancer diagnosis, I wanted more opinions about best treatment for me. I went to a doctor at Rush University Medical Center, also in Chicago, where I learned about cryotherapy. It initially sounded attractive to me because I was enamored with the idea that something would be able to locate and kill the cancerous parts and preserve the rest of the prostate. I wanted to avoid surgery to remove the prostate because it could leave me impotent and incontinent.

I also talked to a doctor at Northwestern University, who was impressive. He was strong on robotic prostatectomy and recommended it for me. Based on his advice, and what I had read about survival and complication statistics, I was about ready to do the full prostatectomy — the radical nerve-sparing procedure. I went ahead and scheduled the robotic prostatectomy for the middle of June 2017.

Second Thoughts about Prostatectomy Side Effects

But the idea of cutting out the entire prostate and the urethra, and all that goes with that kind of surgery continued to nag at me. I spent more time on the Internet researching treatments and got more confused about what to do. Until one day I saw that Medicare had approved partial coverage of the HIFU procedure. Just two days before the scheduled surgery I called Dr. Shalhav and confirmed that I would go ahead with HIFU instead. I would be UCM’s first patient.

I chose HIFU because when I looked at the statistics for this procedure versus a radical prostatectomy it just seemed HIFU was the way to go and would give me a better quality of life. Unlike some of the other technologies, if they weren’t able to remove all the cancer with HIFU I could repeat the procedure, and if, in the end, the only answer becomes a prostatectomy I still had that option.

I know too many people who have, in fear of the worst disease outcomes, gone to extremes for treatment. The side effects of the treatment had a lot of other negative consequences. So it appealed to me to start with something that’s not quite so dramatic and HIFU seemed to be the answer.

HIFU Procedure and Outcome

I was confident going into the outpatient procedure. I showed up at 5:30 am. While I was under anesthesia, Dr. Shalhav inserted an ultrasound probe into my rectum and focused the beams of sound waves on the cancerous portions of my prostate. I woke up in a recovery area about three hours later. After the anesthetic wore off by 12:30 pm, I was on my feet and discharged. I haven’t had any issues, except for wearing a catheter that was removed one week after the procedure.

I’m sure there are thousands of guys across the country who are in the exact position I was in. It’s important they know that HIFU is available in the U.S. and more accessible than ever because of partial Medicare reimbursement. HIFU enables people like me to use something more appropriate for treatment rather than the more intrusive, extensive surgery like prostatectomy.

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Author: Charles Barriball

Charles Barriball was diagnosed with prostate cancer in 2016, at age 66. He lives in Porter, IN, and recently retired from his job as quality director at a major international steel company, after 43 years. The last time he was in a hospital was for a hernia operation, nearly 40 years ago.

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