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Urology

Hal & Mary: Another Happy HIFU Story

Posted on HIFU Prostate Services 5/27/2017

If you ask Hal Plimpton, he will tell you that he is a semi-retired, international logistics consultant who has owned and operated his own business for many years.

If his wife, Mary, happens to hear him say he is “semi” retired, she will laugh and probably roll her eyes. “He was supposed to retire 15 years ago, but he’s still working,” said Mary.

However, one thing that Hal and Mary can agree on is that they made a good treatment decision several years ago when Hal was diagnosed with prostate cancer.

“I could tell that he felt really good about HIFU (high intensity focused ultrasound). He had confidence in the technology that it was going to work. I was a little nervous about all the unknowns, but ultimately I knew that if he felt good about it he would have a good experience – so I felt good about it too, “ said Mary.

Hal may have ultimately been confident in HIFU, but it wasn’t a conclusion he came to without doing a lot of research first – and connecting with a lot of people.

Mary and Hal’s prostate cancer journey included ups and downs that finally led them to the right decision for Hal but their experience with diagnosis and research on treatments was extensive – and in some respects, disconcerting.

“I followed my PSA for many years with my family doctor but in February of 2011, he referred me to a urologist for a biopsy,” said Hal. The pathology report indicated that he had prostate cancer with a Gleason score of 7.

“The first urologist we saw outlined several traditional treatments including surgery and radiation; I felt really uncomfortable with what I heard about the potential side effects,” said Hal.

“We were given some brochures and told to read them and decide what we wanted to do,” Mary said. “At that point, we went into research mode

“We saw a handful of doctors and it was not pleasant, informative or reassuring,” said Mary. “The physicians were focused on conventional treatment options, and we felt like each of them was trying to sell us on a specific treatment that they were personally invested in. It was very disheartening.”

“We found one book that had a single page about HIFU. Hal is kind of an ‘early adopter,’ and he was intrigued. But a urologist we spoke with was dismissive.” Mary said.

Coincidentally, Mary and Hal talked to a neighbor who connected them to a friend who had had a successful HIFU procedure some 5 years previously in Canada. Hal was able to talk to him at length and felt a heightened interest in the technique.

Mary was also learning more about HIFU. Curious about this new-to-them technology which she knew was of interest to Hal. She Googled the topic, picked up the phone, and called a company called, USHIFU in North Carolina. She was connected to a nurse, Karen, who was teamed with Dr. Michael Lazar, the then-sole HIFU-trained urologist in northern California.

Karen was wonderful. Our conversation was educational, but more than that she was a sympathetic ear,” said Mary. “She sent me a packet of information and before long we had an appointment to see Dr. Lazar.”

Meeting with Dr. Lazar was very different than their experiences with the other doctors they had seen. “He was so open and empathetic. He answered all our questions and was just very informative,” said Hal.

“He was was not selling any one particular approach. It was a very different kind of appointment from others we’d had,” added Mary.

Hal had HIFU with Dr. Lazar in Puerto Vallarta, Mexico in June of 2011 (HIFU wasn’t available in the U.S. outside of a clinical trial until after October 2015). A couple of friends accompanied them to PV for moral support – and one ended up having HIFU himself a few months later, also with Dr. Lazar.

“I might have opted for something more conventional but I knew this is what HAL WANTED, and, to me, I felt that if he believed in it, that elevated the likelihood of a positive outcome,” said Mary. “I cannot imagine that we could have had a better experience – in all respects – and it worked for us.”

Hal is happy to report that after HIFU, his PSA dropped from 7 to 0.1 and has stayed stable ever since. Almost more importantly, he had no adverse side effects.

“We are believers in HIFU for sure,” said Hal. “HIFU may not be ‘the answer’ for every man, but for families researching their options, we would urge you to consider HIFU. – And we cannot say enough good things about Dr. Lazar.”

By | May 31st, 2017|Dr. Michael Lazar, HIFU, News, Prostate Cancer|0 Comments

New blood test better at predicting prostate cancer risk than PSA

A new blood test known as IsoPSA detects prostate cancer more precisely than current tests in two crucial measures — distinguishing cancer from benign conditions, and identifying patients with high-risk disease. By identifying molecular changes in the PSA protein, the findings of this study suggest that once validated, use of IsoPSA may reduce the need for biopsy, and may lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer.

A team of researchers from Cleveland Clinic, Louis Stokes Cleveland VA Medical Center, Kaiser Permanente Northwest, and other clinical sites have demonstrated that a new blood test known as IsoPSA detects prostate cancer more precisely than current tests in two crucial measures — distinguishing cancer from benign conditions, and identifying patients with high-risk disease.

By identifying molecular changes in the prostate specific antigen (PSA) protein, the findings, published online last month by European Urology, suggest that once validated, use of IsoPSA may substantially reduce the need for biopsy, and may thus lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer.

The research team, led by Cleveland Clinic’s Eric Klein, M.D., conducted a multi center prospective study of 261 men scheduled for prostate biopsy at five academic and community centers in the U.S. enrolled between August 2015 and December 2016.

“Despite criticism, PSA has transformed the landscape of early detection, screening, and management of prostate cancer in the last few decades,” said Dr. Klein, chair of Cleveland Clinic’s Glickman Urological & Kidney Institute. “Unfortunately, PSA is tissue-specific but not cancer-specific, leading to overdiagnosis and overtreatment of biologically insignificant cancers, which is widely recognized as a key limitation in its clinical utility.”

The study directly compared the clinical performance of a new test based on PSA, called IsoPSA, to PSA itself with patients already scheduled for prostate biopsy. IsoPSA proved significantly superior to PSA in two key indications: discriminating between prostate cancer and benign conditions; and identifying patients with high-grade disease. The former indication is potentially useful for using IsoPSA for screening by primary care physicians, while the second is helpful for urologists in identifying patients who would benefit from curative intent therapy and other applications.

The results show that if validated and adopted clinically, IsoPSA could significantly reduce the rate of unnecessary biopsies by almost 50 percent. “The methodology used in the IsoPSA assay represents a significant departure from conventional ways to define biomarkers in blood, and may be applicable to improving other cancer biomarkers,” said Dr. Klein.

“Due to its inherent simplicity, requiring only a blood draw and presenting information to the physician in familiar context using a single number — just like PSA itself — we are quite hopeful in IsoPSA’s future utility after further validation studies,” said Mark Stovsky, M.D., co-author and staff member, Cleveland Clinic Glickman Urological & Kidney Institute.


Story Source: Materials provided by Cleveland Clinic.

Journal Reference: Eric A. Klein, Arnon Chait, Jason M. Hafron, Kenneth M. Kernen, Kannan Manickam, Andrew J. Stephenson, Mathew Wagner, Hui Zhu, Aimee Kestranek, Boris Zaslavsky, Mark Stovsky. The Single-parameter, Structure-based IsoPSA Assay Demonstrates Improved Diagnostic Accuracy for Detection of Any Prostate Cancer and High-grade Prostate Cancer Compared to a Concentration-based Assay of Total Prostate-specific Antigen: A Preliminary Repo. European Urology, 2017; DOI: 10.1016/j.eururo.2017.03.025

Read this article on Science Daily. “New blood test is more accurate in predicting prostate cancer risk than PSA: IsoPSA assay can help in determining the need for prostate biopsy for patients.” ScienceDaily. ScienceDaily, 15 May 2017. www.sciencedaily.com/releases/2017/05/170515122149.htm.

By | May 16th, 2017|Dr. Michael Lazar, HIFU, News, Prostate Cancer|0 Comments

Common Prostate Cancer Therapy May Trigger Dementia

A new analysis of patients who have undergone treatment for prostate cancer shows a connection between androgen deprivation therapy (ADT) — a testosterone-lowering therapy and a common treatment for the disease — and dementia, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. Their previous studies have shown men who undergo ADT may be at an increased risk of dementia, including Alzheimer’s disease, compared to men who were not treated with the therapy.

This new analysis — the largest of its kind ever performed on this topic — shows that all existing studies taken together support the link to dementia and show a possible link to Alzheimer’s. The findings are published this week in Prostate Cancer and Prostatic Diseases. “Since publishing our initial findings, there has been a lot of other research on this topic, and we wanted to see what that research was saying,” said the study’s lead author Kevin Nead, MD, MPhil, a resident in Radiation Oncology at Penn. “This analysis tells us that the composite message of existing studies is that androgen deprivation therapy is associated with dementia.”

The team compiled data from four different global databases looking at studies on ADT patients and dementia and Alzheimer’s. An analysis of more than 50,000 patients worldwide showed a consistent statistical link between men who underwent ADT for prostate cancer and men who developed dementia. Nead says the numbers show correlation, not causation at this point, but that there is evidence of a direct connection.

“Research shows androgens play a key role in neuron maintenance and growth, so the longer you undergo this therapy to decrease androgens, the more it may impact the brain’s normal functions,” Nead said.

The analysis was less conclusive on the question of Alzheimer’s. While there was still a connection, it was not as clearly defined as the link to dementia. Nead says evidence for a link between ADT and neurocognitive dysfunction is growing and should be part of the conversation between doctors and patients.

“There’s enough evidence of these links that patients should know about them when considering their options,” Nead said.


Story Source:

Materials provided by University of Pennsylvania School of Medicine. Note: Content may be edited for style and length.

Journal Reference:

K T Nead, S Sinha, P L Nguyen. Androgen deprivation therapy for prostate cancer and dementia risk: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, 2017; DOI: 10.1038/pcan.2017.10

Read this on Science Daily: University of Pennsylvania School of Medicine. “Link between common prostate cancer treatment, dementia detailed in new study: Analysis elaborates on correlation between dementia and testosterone-lowering therapy.” ScienceDaily, 30 March 2017. www.sciencedaily.com/releases/2017/03/170330114954.htm.


HIFU has many proven advantages over traditional treatment modalities for prostate disease. More: www.californiahifu.com #prostatecancer #HIFU #prostate #menshealth #cancerresearch

By | April 4th, 2017|News, Prostate Cancer|0 Comments

Study Reveals Quality of Life Concerns Paramount in Prostate Cancer Treatment Options

For many men newly diagnosed with early-stage prostate cancer, concerns about potential quality-of-life issues often guide treatment decisions. A new study led by UNC Lineberger Comprehensive Cancer Center researchers identifies distinct patterns of side effects that patients could use to guide their choices.

In the Journal of the American Medical Association, the study examines quality-of-life outcomes for the treatment choices most patients will face. Those choices include active surveillance, radical prostatectomy, external beam radiation treatment, and brachytherapy, a treatment that involves inserting radioactive seeds into the prostate. “Patients diagnosed with early-stage prostate cancer — and that’s the vast majority of patients with this disease — face many treatment options that are thought to be similarly efficacious,” said Ronald C. Chen, MD, MPH, UNC Lineberger member and associate professor in the UNC School of Medicine Department of Radiation Oncology. “Therefore, the quality-of-life differences among these options become an important consideration when patients are trying to make their decisions.”

The study is needed as prostate cancer treatment technologies have advanced, and as active surveillance has emerged as an important strategy for sparing low-risk prostate cancer patients unnecessary side effects. Active surveillance involves regular testing to check for cancer growth rather than immediate treatment, and many patients with low-risk prostate cancer on active surveillance may be able to avoid treatment for several years or altogether. The American Society of Clinical Oncology has endorsed active surveillance for most men with low-risk prostate cancer.

“There has not been a large-scale comparison of the quality-of-life impact for these modern options, until now,” Chen said. “Existing quality of life studies have studied older types of surgery and radiation that are no longer used, and patients need updated information regarding the impact of modern treatment options so they can make informed decisions about the choices they face today.”

For the study, UNC Lineberger researchers surveyed 1,141 men who were diagnosed with early-stage prostate cancer between January 2011 and June 2013. They compared patients’ self-reported quality of life related to bowel, urination, and sexual function across four strategies: active surveillance; prostatectomy; external beam radiotherapy; and brachytherapy. Almost all prostatectomy patients received robotic surgery, and almost all external beam radiotherapy patients received intensity-modulated radiation, reflecting modern treatment technologies.

Prostatectomy was linked to higher sexual dysfunction and urinary leakage than the other options. At two years after treatment, more than 57 percent of men who had normal sexual function prior to treatment reported poor sexual function after surgery, compared with 27 percent who reported poor sexual function after external beam radiation, 34 percent after brachytherapy, and 25 percent after active surveillance. “With modern robotic surgery, sexual dysfunction and urinary incontinence continue to be some of the side effects that surgery can cause,” Chen said. “While we do see improvement over time, even at the two-year point, surgery still causes more of these issues than other treatments.”

Meanwhile, other treatment choices were linked to worse scores for other side effects. External beam radiotherapy and brachytherapy caused more short-term urinary tract obstruction and irritation, while external beam radiotherapy was linked to more short-term bowel symptoms.

For the group of men who chose active surveillance, urinary issues and sexual function worsened over time. This is likely partly due to aging, and partly due to some men who experienced cancer progression that necessitated treatments that caused these side effects.

“At the two-year time point, patients who chose radiotherapy or brachytherapy actually had quality-of-life results similar to patient who chose active surveillance, and that may be surprising to some patients,” Chen said. “With advances in treatment technologies for both surgery and radiation, patients and physicians today must base their decisions on the quality-of-life results of modern treatments, not on results for outdated treatment modalities that caused much more side effects historically.” Overall, Chen said the data can help patients weigh their treatment options based on their own baseline health and on their priorities.

“With all of the modern treatment options, patients should have accurate and realistic expectations about the frequency of side effects from treatment,” Chen said. “We found that the different treatment options have trade-offs in side effects. Each patient can look at these data to see what they care about most.”


Story Source:

Materials provided by University of North Carolina Health Care System. Note: Content may be edited for style and length.


Journal Reference:

  1. Ronald C. Chen et al. Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer. JAMA, March 2017 DOI: 10.1001/jama.2017.1652

See this article on ScienceDaily: 21 March 2017. www.sciencedaily.com/releases/2017/03/170321124231.htm.
By | March 27th, 2017|Dr. Michael Lazar, News|0 Comments

Study reveals genetic connection to aggressive prostate cancer

An international study published in the Journal of the National Cancer Institute has identified a genetic connection to the aggressive form of prostate cancer. The study showed a threefold increase in the risk of aggressive prostate cancer for men with the genetic mutation. The frequency of the gene variants varied from 6 to 14% of the population of men with prostate cancer.

Much like the association between BRCA gene mutation and the risk for breast cancer in women changed the approach to treatment/ prevention, the identification of the Kallikrein 6 gene region may change the course of prostate cancer care through a blood test developed by the Lunenfeld-Tanenbaum Research Institute.

The study was led by Dr. Alexandre Zlotta, Director of Uro-Oncology at Mount Sinai Hospital, and researcher with the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health System in Toronto, Canada, and Dr. Paul Boutros, Principal Investigator, Informatics and Bio-computing, Ontario Institute for Cancer Research (OICR). The first author of the paper was Dr. Laurent Briollais, Senior Investigator, Lunenfeld-Tanenbaum Research Institute.

These findings are important because it is well established that most men will die with prostate cancer, and not from the disease. Dr. Zlotta was the lead author of a study in 2013 which revealed the unexpected high prevalence of indolent prostate cancer in men. Diagnosing the aggressive form of the disease is an important unmet need.

“As an oncologist I know firsthand how valuable it would be to have a genetic tool that could help choose the best course of action with my patients,” explains Zlotta. “It would help spare patients with indolent disease from unnecessary treatments and their side effects and aid in the diagnosis and directing patients with aggressive disease to the appropriate treatment.” Up until now, no single test could predict the severity of the cancer type- the current PSA test (Kallikrein 3), which is located near Kallikrein 6, only identifies the risk of prostate cancer, not the severity.

To identify the relevant mutations the scientists analyzed the blood samples of 1,858 men from three independent cohorts in Europe and North America: the Swiss arm of the European Randomized Study for Prostate Cancer Screening, the large American Screening trial, Prostate, Lung, Colorectal, and Ovarian (PLCO), Princess Margaret Cancer Centre (University Health Network) and Mount Sinai Hospital (Sinai Health System) in Toronto. The KLK6 variants also independently predicted treatment failure after surgery or radiation for prostate cancer in an independent cohort of 130 men from the International Cancer Genome Consortium (ICGC).


Story Source:

Materials provided by Lunenfeld-Tanenbaum Research Institute. Note: Content may be edited for style and length.


Journal Reference:

  1. Laurent Briollais, Hilmi Ozcelik, Jingxiong Xu, Maciej Kwiatkowski, Emilie Lalonde, Dorota H. Sendorek, Neil E. Fleshner, Franz Recker, Cynthia Kuk, Ekaterina Olkhov-Mitsel, Tristan Juvet, Ioannis Prassas, John Trachtenberg, Ants Toi, Michael Fraser, Theodorus van der Kwast, Robert G. Bristow, Bharati Bapat, Eleftherios P. Diamandis, Paul C. Boutros, Alexandre R. Zlotta. Germline Mutations in the Kallikrein 6 Region and Predisposition for Aggressive Prostate Cancer. JNCI: Journal of the National Cancer Institute, 2017; 109 (4) DOI: 10.1093/jnci/djw258

Read this article on ScienceDaily:

“Genetic association with aggressive prostate cancer discovered: Study showed a threefold increase in the risk of aggressive prostate cancer for men with the genetic mutation..” 16 March 2017. www.sciencedaily.com/releases/2017/03/170316141120.htm.

By | March 21st, 2017|Dr. Michael Lazar, HIFU, News, Prostate Cancer|0 Comments

Dr. Michael Lazar Offers Free HIFU Presentation Online

Dr. Michael Lazar of California HIFU recently gave a presentation in Santa Rosa discussing the benefits of high-intensity focused ultrasound for prostate cancer and now offers the presentation online.

A public presentation recently held in Santa Rosa for a group gathered to learn more about high-intensity focused ultrasound (HIFU) provided an overview of how this exciting new prostate cancer treatment works, and included comparisons to other treatment options, as well as HIFU patient outcomes. The event also offered people a chance to meet Dr. Lazar who is a four-time board certified urologist and prostate cancer specialist providing HIFU to patients in California. It also gave attendees a chance to learn more prostate cancer and to ask important questions.

During the presentation, Dr. Lazar discussed how HIFU offers hope for prostate cancer patients by targeting cancer cells through a focused precision technology with minimal to no side effects. The procedure is accomplished in a one to four-hour session and patients return to their normal routines fairly quickly. “Our recent presentation was so well received, we wanted to be able to offer it to a wider audience,” explained Dr. Lazar. “By providing this information to patients online we hope to be able to educate men who currently have prostate cancer about HIFU as a treatment option, and to perhaps provide some important answers to unasked questions.”

About HIFU

Although relatively new to the U.S. Sonablate® technology has been used around the world on more than 15,000 patients in over 30 countries for more than 15 years. Approximately 4,000 U.S. men have received HIFU treatment outside the U.S. prior to FDA approval.

“I started treating with HIFU in 2007 and since receiving FDA approval in 2015 began offering the treatment in San Francisco,” Dr. Lazar said.  Prior to FDA approval Dr. Lazar explained that he performed outpatient procedures at a U.S. Joint Commission approved bilingual hospital in Mexico – helping to bring this innovative prostate cancer treatment to hundreds of men diagnosed with the disease. During that time, Dr. Lazar also served as a HIFU instructor for other physicians and is now actively training doctors in HIFU for prostate cancer in San Francisco.

Serving as Medical Director for HIFU Prostate Services (HPS) Dr. Lazar founded California HIFU to provide HIFU services in the San Francisco area, the first such facility on the west coast. Since that time HIFU using Sonablate® technology has become available in more than 40 locations across the nation.

For patients with prostate cancer, HIFU treatment is most effective in the early stages, where it is localized to the prostate. Performed on an out-patient basis, the procedure is able to preserve healthy tissue and nerves, so urine flow and erectile function is maintained in a high percent of cases. “This is an extremely well tolerated procedure,” said Dr. Lazar. “Patients return to normal activity very quickly. There is no blood loss and very little pain when compared to other treatments for prostate cancer.”

Dr. Lazar explains how all prostate cancer treatments can have side effects. But with HIFU the side effects are lower than with any of the other treatments for prostate cancer. “Unique to HIFU, if you have an HIFU treatment and still require additional treatment, patients can opt to have a second HIFU treatment, or any other treatment they decide to pursue,” he says.

The presentation is free and available online on the California HIFU YouTube Channel accessible by following this link: HIFU YouTube Channel.

About Dr. Lazar

Dr. Lazar is part of Northern California Medical Associates and operates California HIFU in Santa Rosa. He is the medical director of HIFU Prostate Services, LLC, a leading provider of minimally-invasive prostate cancer treatments using High Intensity Focused Ultrasound (HIFU). Dr. Lazar is also a clinical partner with HPS with the HIFU San Francisco Surgery Center of Excellence, a state-of-the-art facility that is convenient to hotels and the airport.  For more information about Dr. Lazar, HIFU treatment for prostate cancer visit the HIFU website or to make an appointment call: (707) 546-5553.

 

 

By | March 6th, 2017|HIFU, News|0 Comments

Patient Testimonial: “I cannot be more appreciative of his comprehensive approach to treating patients ….” – Charles Lawrence

Click to View PDFAs a retired malpractice insurance professional, Charles Lawrence is very familiar with the many complex problems in today’s healthcare industry. He knows what to look for in a good doctor, and he deeply appreciates quality healthcare services. When Charles thought he was having urinary problems, he came to see Dr. Michael J. Lazar in Santa Rosa for an examination. Dr. Lazar didn’t find any problems with Charles’ urinary system, and Charles’ symptoms went away on their own shortly thereafter. However, Dr. Lazar discovered a lump on his thyroid that other physicians had failed to find previously …

Lazar testimonial 8.18 lower half

 

By | August 18th, 2015|Dr. Michael Lazar, Testimonials|0 Comments