Prostate Cancer Procedure Preserves Quality of Life
Steve Kane of Rochester, New York was finally at the threshold of retirement, working less and transitioning into his second act that was supposed to give him the time and freedom to travel, dabble in music, sing in community choirs and basically enjoy life with John, his husband and partner of 27 years.
Steve was about to put his career as a psychiatric social worker on the back burner and return to his love of music – for which he earned his first degree from Eastman School of Music, where he dreamed of conducting his own choir.
However, at age 66, Steve learned he had prostate cancer. Now he would be conducting a search for the right prostate cancer treatment.
Steve had a routine PSA test in 2017 at Rochester General Hospital. His urologist, John Valvo, M.D., was concerned about his test results. Doctors consider PSA levels of 3.9 or lower to be normal. Steve’s PSA score was 5. Dr. Valvo scheduled him for a biopsy and confirmed the prostate cancer diagnosis.
Like many people, Steve had been touched by cancer that came with a huge loss. His mother learned she had pancreatic cancer and died six months later. It left a deep impression and prompted him to be very diligent about getting his annual physicals – and PSA tests. Prostate cancer in most men is slow growing, and if detected early can be treated and beaten. In fact, most men Steve’s age and older will have prostate cancer at some point as they age.
Since Steve’s cancer was detected early, he wasn’t terrified. He was able to take pause and investigate his options. At first Dr. Valvo explained the typical ways to manage prostate cancer. Steve could choose to have Dr. Valvo keep an eye on the cancer — watchful waiting or active surveillance. But even though prostate cancer is slow growing he wasn’t comfortable living with a diagnosis of cancer. He preferred treatment.
Typically, prostate cancer is treated with surgery and/or radiation, but both of these standard options more typically result in serious side effects of urinary incontinence, erectile dysfunction and even penile shrinkage.
On the other end of spectrum was radical surgery, which involved removing the entire prostate, or radiation. Steve had met with a radiation oncologist for a treatment called brachytherapy. The doctor told him his enlarged prostate would have to be treated with hormones to shrink it before being seeded with high doses of radiation beamed into his body. This option did not appeal to Steve.
Dr. Valvo mentioned another, newer treatment called high intensity focused ultrasound (HIFU), which was going to be offered at Rochester General Hospital in the fall of 2019, and Steve was a good candidate.
Steve had faith in doctors, having switched careers to the healthcare field in 1989. He valued their expertise and had gotten good advice over the years. So when Dr. Valvo explained HIFU as an option, he took heed. And he could wait the two years because his cancer was slow growing and he didn’t want the negative side effects of the standard treatments. HIFU offers a better quality of life post-procedure with fewer incidence of impotence, incontinence and penile shrinkage because it spares the healthy portion of the patient’s prostate and the nerve endings attached to it.
HIFU uses high-frequency sound waves directed at the cancerous tissue through an ultrasound probe inserted into the rectum. No incisions are made. No radiation is emitted. The high intensity sound waves heat up and destroy the cancerous tissue. Dr Valvo told Steve to think of holding a magnifying glass above a leaf on a sunny day. The sun’s rays shine through the lens and cause the leaf to burn. The concept of how HIFU works is similar.
HIFU fuses magnetic resonance images with biopsy data and real-time ultrasound imaging, and the doctor views it in 3D on a large screen. From that view the doctor can draw a precise contour around the diseased tissue and destroy only that portion of the prostate. Dr. Valvo said HIFU was very accurate and would come with fewer side effects than brachytherapy.
Steve had the HIFU procedure in October of 2019. He had no discomfort with the procedure. He wore a catheter for four days, post procedure, and there was some normal, expected bleeding for a few weeks when urinating. Steve has had no other side effects.
“At my follow-up appointment, Dr. Valvo explained that he targeted the more dangerous cells and he will continue to monitor my prostate,” Steve said. “I’m scheduled for a biopsy in three months and I can always repeat the HIFU procedure if the more dangerous cancer cells return, unlike radiation and surgery, which offer no other options once the patient has had either procedure.
“I would recommend HIFU to any man over standard treatments. My quality of life is as good as I’d hoped it would be as I move into the next chapter of my life.”
