POST BY DR. ANDRES BODEWIG: GREAT ARTICLE BY DR. BERT VORSTMAN

left: Andres Bodewig, M.D.
This is a great article by Dr. Bert Vorstman clearly outlining the facts about prostate cancer diagnosis and the essential need for a biopsy. Needle tracking or spread has never been documented by any urologist or pathologist in the world. There may be the rare single physician that may be an advocate if this concept. But there is no science merit to this. This concept just is not true. The reason that a biopsy is essential is that it provides hugely valuable information as to the Gleason score and the aggressiveness of the cancer. We as urologist depend on this information for planing the appropriate treatment for that individual. As well as obtaining additional information on the prognosis of the cancer. Unfortunately, there are no imaging (x-ray studies) with capabilities to determine the presence or absence of prostate cancer without a biopsy. Similar to breast cancer, no women would have their breast removed by a diagnosis based on a mammogram without having confirmation by biopsy. Like wise, no man should undergo treatment of his prostate without a biopsy.
Dr. Vorstman makes a very valid point in that the one or two urologist in America that relay on MRI, as opposed to a biopsy, are the same doctor's recommending post treatment MRI's. As well as the same physicians' that have a personal interest and ownership in the MRI equipment. As pointed out by Dr. Vorstman, there is no scientific proof or merit for a post treatment MRI. The best parameter to measure the clinical outcome of prostate cancer treatment is by periodically following the PSA.
There are three elements that are important in selecting a physician: 1) Is he board certified in his specialty?, 2) How often has he performed the recommended procedure? 3) How will the information will the test he is recommending impact on the proposed treatment? And if he is recommending a prostate MRI over a biopsy, ask for medical peer review literature to confirm that this has scientific merit,
I welcome the comments of my colleagues that treat prostate cancer on a regular basis. Can anyone them really say that they can diagnose prostate cancer with an MRI ?Can anyone of them in their professional conduct recommend an MRI over a biopsy and treat prostate cancer as such...without biopsy?

Do Prostate Needle Biopsies Spread Cancer Cells? – NO THEY DO NOT!
Posted by admin in Uncategorized on September 20, 2010 no responses
Prostate needle biopsies and needle tracking marks DO NOT spread cancer cells. Furthermore,the inflammation that brings about healing of the needle track DOES NOT cause cancer.
There are purveyors of pseudo science even in the world of urology who repeatedly offer false science that is peppered with irrelevant references and non sequitur arguments to present their case.
The sole purpose for perpetuating these untruths is to confound a vulnerable target (men who have or are at risk of having prostate cancer) and steering them towards evaluations that are self serving. Invariably,this disordered rhetoric is generated and encouraged by those physicians and organizations that have most to gain. In this regard,in-house imaging equipment such as MRI’s are well known to be potential instruments for financial abuse. Therefore, at risk patients are easily encouraged to undergo needless and expensive in-house MRI studies. This convenient arrangement and investment by owner physicians, represents a huge potential conflict of interest in managing prostate cancer patients.
There simply is NO reliable evidence to support the notion that MRI with or without spectroscopy will ever dispense with needle biopsies of the prostate.
Imaging studies are unable to definitively diagnose a prostate cancer let alone make determinations on a Gleason grade and score.
No man should ever consider treatment of his alleged prostate cancer based solely on the dubious images generated by an MRI.
Even benign lesions may mimic a prostate cancer and the only reliable method for detecting a prostate cancer is based upon a needle biopsy.
Similarly,there is no evidence that “scientific” targeted biopsies of suspicious areas provides any benefits over the standard needle biopsy without the expensive MRI. In fact,using the targeted MRI approach to the prostate may detect very early low grade,low volume cancers that are usually clinically insignificant and can be managed by active surveillance.
In addition,the questionable practice of recommending routine post HIFU MRI studies on the pretext of early recognition of incompletely treated men simply represents a further shameless and unadulterated assault on the wallets of patients and insurance companies.
Only a well designed and executed trans rectal ultrasound and needle biopsy of the prostate by an experienced urologist can answer all of the questions as to the true nature of a man’s prostate cancer.
The unabashed, pseudo intellectual and illogical recycling of these myths about prostate needle biopsies spreading cancer cells
by physicians is unfounded,unconscionable and malicious.
Certainly,those urologists that are board certified are required to practice by an ethical and scientific standard. Others,however,appear to practice the peddling of half truths and this non Hippocratic behavior taints all physicians and may be considered malpractice.

RESEARCH ON UNINSURED PROSTATE CANCER PATIENTS

Uninsured Prostate Cancer Patients Tend To Have More Severe Disease At Diagnosis.
HealthDay (9/17, Preidt) reported that, according to a paper in Cancer Epidemiology Biomarkers and Prevention, "prostate cancer patients who are uninsured or on Medicaid at the time of their diagnosis tend to have more severe disease, likely because they have less access to medical care." In fact, "compared to patients with private insurance, those who were uninsured or Medicare-insured had higher PSA levels and Gleason scores, and were more likely to be diagnosed with advanced cancer." Before reaching those conclusions, investigators "analyzed National Cancer Database records of 312,339 prostate cancer patients diagnosed between 2004 and 2006."

Emory researchers eventually discovered that "uninsured and Medicaid-insured patients had approximately 4 ng/ml higher PSA levels than their privately insured counterparts," MedWire (9/17, Guy) reported. "Furthermore, being uninsured was clearly associated with having an advanced Gleason score, with odds ratios (ORs) of 1.97 and 1.67 for uninsured and Medicaid insured men, respectively, compared with privately insured patients. Being Black, Asian, or Hispanic also increased the risk for poor Gleason score compared with being White," while "being uninsured and Medicaid-insured...increased the risk for being diagnosed with advanced-stage disease, 1.85 and 1.49 times, respectively, compared with being privately insured."

PSA SCREENING IN MEN WITH SPECIFIC GENETIC MUTATIONS

New Research Provides Support For Continued PSA Screening In Men With Specific Genetic Mutations.
BBC News (9/10) reports, "PSA screening has been contentious in the past because of concerns about over-diagnosis," and the medical community also remains at odds about "how effective it was at reducing mortality." Aiming to clarify the issue, UK scientists set about analyzing preliminary data culled from the "first large international prostate cancer screening study," which is "targeted at men with a known genetic predisposition to the disease." Investigators eventually concluded that "it appears that PSA screening is reasonably accurate at predicting potentially aggressive prostate cancer among men at higher risk of the disease due to a genetic predisposition." In other words, their work "provides support for continued screening in men with genetic mutations." Reuters (9/10, Kelland) also covers the study.


George M. Suarez, M.D.

POTENTIAL SECONDARY EFFECTS OF RADIATION THERAPY

The following is a very interesting article that appeared recently in Cancer regarding the potential secondary effects of Radiation Therapy associated with treatment for prostate cancer. Patients are often mislead into choosing radiotherapy without full informed consent of the potential side effects. As well as their fear of even greater complications associated with surgery. As HIFU continues to prove it's efficacy with decreased side effects, it is rapidly becoming the fastest growing new treatment for localized prostate cancer. For additional information on HIFU, please visit: www.hifumedicalexpaert.com.
George M. Suarez, M.D.
___________________________________________________________________________________________________
5 Common Unwanted Effects Of Radiation Therapy With Regard To Prostate Cancer
Cancer 2010-09-07
There are three techniques used in prostate cancer treatment. One of these is via radiation therapy. This kind of treatment can be delivered in two ways, outwardly and internally. Outwardly treatment methods are done in several sessions wherein the high-frequency x-ray device is used in order to destroy most cancers tissue. The internal method or medically known as brachytherapy utilizes the implantation of radioactive seed products into the prostate gland. They are efficient methods in treating cancer. Nevertheless, they can trigger some unwanted effects towards the various areas of the body.
Among the prostate cancer radiation side effects is actually tissue damage. The tissues from the body are very vulnerable to radiation. However only a small percentage of the patients undergoing this sort of treatment encounter this sort of impact. The actual tissues associated with a few organs which are near the prostate such as the skin, vesica or rectum are broken because of the contact with radioactive supplies. When this happens it can produce loss of function and may need surgery in order to cure it.
Radiation therapy with regard to cancer of the prostate may also trigger unwanted effects for example bowel problems such as diarrhea, bowel emergency as well as hemorrhoids. Since the radiation can even achieve through the bowels due to its location adjacent to the prostate, the individual undergoing the radiation can encounter this kind of problem. The radiation does not only have an effect on cancer tissue but it also kills the standard cells causing problems about the function associated with a few internal organs like that from the bowel. Drugs receive to treat these unwanted effects.
A mans individual getting radiation therapy additionally encounters urinary incontinence. This happens to about 10 percent of those who have this sort of treatment. The actual sphincter of the urinary system bladder is actually damaged that caused seapage and incontinence. Occasionally, following radiation the patient should put on a mat just to maintain him through wetting his trousers. If this situation gets worse or does not take care of, the individual will have to go through surgical treatment and make required repair about the damage of the vesica to stop this kind of healthcare issue.
Another side-effect associated with radiation therapy with regard to prostate cancer is impotence as well as inability to conceive. Because, the actual prostate gland is actually the main man reproductive system; functions associated with male sexuality are reported. There is a issue with regards to male erection and the patient will even have a issue generating sperm. Mentionened above previously, radiation therapy does not just affect most cancers cells but also those which are typical such as the semen. The patient must find out about this because it is a great issue related to his lovemaking life.
Finally, the patient will really feel weak as well as fatigue could be experienced for about a few several weeks after the process. You have to follow the related diet that will help get through with this problem. These are the common unwanted effects that a individual experiences following a radiation therapy. But the definitive goal of the remedy outweighs these minor problems. Individual education is really essential so that the individual may know what to do during the process as well as what to expect after the therapy is carried out.
Radiation therapy with regard to prostate cancer is an effective mode associated with remedy however there are certain side effects how the patient should learn and the physicians must monitor.
George M. Suarez, M.D.
Medical Director,
The Miami Urology Center of Excellence

GEORGE M. SUAREZ, M.D. IN DOCTORS HOSPITAL IN THE BAHAMAS

FROM LEFT TO RIGHT: BARRY RASSIN, PRESIDENT OF DOCTORS HOSPITAL IN THE BAHAMAS, GEORGE M. SUAREZ, M.D.,MEDICAL DIRECTOR USHIFU, BOARD CERTIFIED UROLOGIST.

Nassau, Bahamas - Doctors Hospital has been a pioneer in minimally and non-invasive surgeries in the Bahamas with the first Laparoscopic colon surgery performed locally in 2009; today high intensity focused ultrasound (HIFU) has been added to its portfolio for treatment of prostate cancer. Doctors Hospital thus joins a select group of hospitals that is offering this innovative treatment for prostate cancer and becomes the first hospital in the Bahamas to offer this technology.
HIFU delivered with the Sonablate® 500 medical device (“Sonablate HIFU”) destroys prostatic tissue with extreme heat generated from focused ultrasound waves. Initially, the Sonablate captures real-time images of the prostate gland, allowing the physician to create a customized treatment plan for each patient. The physician then uses the Sonablate to deliver the ultrasound energy to extremely small target sites, or focal points, throughout the prostate gland. The ultrasound energy is delivered in rapid-fire succession to targeted tissue throughout the gland. The tissue at each target is destroyed while surrounding tissue remains unharmed.
HIFU treatment typically is a one-time, 2-4 hour procedure performed on an out-patient basis under spinal anesthesia. Patients generally are up and walking within hours after HIFU and can return to a normal lifestyle within a couple of days.
Considered a promising technology within the non-invasive or minimally invasive therapy segments of medical technology, HIFU uses non-ionizing, or clean, energy and may be repeated if necessary should there be a recurrence and may be used as a salvage therapy if some other treatments have failed.
Men over age 50 years are still encouraged to have an annual rectal examination and a blood test called a PSA as prostate cancer is the most common non-skin cancer in men and the third leading cause of male cancer deaths worldwide.

STUDY ON FINASTERIDE

Study Suggests Finasteride May Not Be Widely Prescribed For The Prevention Of Prostate Cancer.

Bloomberg News (8/11, Fridson) reports, "Researchers urged doctors to discuss with patients the benefits of Merck & Co.'s Proscar for preventing prostate cancer, after a study found that prescribing of the product didn't increase when a 2003 trial showed the medicine wards off tumors." The "drug, also sold generically as finasteride, was shown to reduce some men's risk of developing prostate cancer by a quarter, to 18 percent from 24 percent," according to the 2003 paper in the New England Journal of Medicine.
Thus, the "American Society of Clinical Oncology and the American Urological Association issued a joint guideline in 2009 recommending that 5-alpha reductase inhibitors be considered for prostate cancer prevention in healthy asymptomatic men with a prostate-specific antigen (PSA) level of 3.0 ng/mL or less who receive regular screening for prostate cancer," Medscape (8/10, Nelson) reported. "But, according to the new survey, 64% of urologists and 80% of primary care physicians never prescribe finasteride for prostate cancer chemoprevention." In the study published in Cancer Epidemiology, Biomarkers & Prevention, "55% of urologists expressed concern about inducing high-grade tumors, and 52% of primary care doctors were unaware that finasteride could be used as a chemopreventive agent."

DOCTORS HOSPITAL OFFERS NEW CANCER TREATMENT

PICTURED BELOW IS GEORGE M. SUAREZ, M.D., FACS, FAAP, MEDICAL DIRECTOR, USHIFU, INTERNATIONAL HIFU, BOARD CERTIFIED UROLOGIST



Doctors Hospital has been a pioneer in minimally and non-invasive surgeries in the Bahamas with the first Laparoscopic colon surgery performed locally in 2009; today high intensity focused ultrasound (HIFU) has been added to its portfolio for treatment of prostate cancer. Doctors Hospital thus joins a select group of hospitals that is offering this innovative treatment for prostate cancer and becomes the first hospital in the Bahamas to offer this technology.

HIFU delivered with the Sonablate® 500 medical device (“Sonablate HIFU”) destroys prostatic tissue with extreme heat generated from focused ultrasound waves. Initially, the Sonablate captures real-time images of the prostate gland, allowing the physician to create a customized treatment plan for each patient. The physician then uses the Sonablate to deliver the ultrasound energy to extremely small target sites, or focal points, throughout the prostate gland. The ultrasound energy is delivered in rapid-fire succession to targeted tissue throughout the gland. The tissue at each target is destroyed while surrounding tissue remains unharmed.

HIFU treatment typically is a one-time, 2-4 hour procedure performed on an out-patient basis under spinal anesthesia. Patients generally are up and walking within hours after HIFU and can return to a normal lifestyle within a couple of days.

Considered a promising technology within the non-invasive or minimally invasive therapy segments of medical technology, HIFU uses non-ionizing, or clean, energy and may be repeated if necessary should there be a recurrence and may be used as a salvage therapy if some other treatments have failed.

Men over age 50 years are still encouraged to have an annual rectal examination and a blood test called a PSA as prostate cancer is the most common non-skin cancer in men and the third leading cause of male cancer deaths worldwide.

The newest facility to become a part of the US HIFU international treatment program, Doctors Hospital joins more than one hundred (100) centers in thirty-plus countries to offer the innovative treatment. The program provides patients from the United States access to the Sonablate technology in international facilities. Just a forty-five minute flight from Florida, this high- tech procedure can now be offered close to home for some US patients and in a beautiful island setting.

According to an article published in one of the local dailies, there is a sizeable medical tourism market for the Bahamas to tap into. In 2007, some seven hundred and fifty thousand (750,000) Americans traveled abroad for overseas medical services, spending approximately $2.1 billion. The former number is predicted to swell to within six million by the end of this year.

Poised to take advantage of the door the medical tourism opens, Doctors Hospital recently accredited by Joint Commission International (JCI), Doctors Hospital joins an elite group of few hospitals worldwide, which have passed JCI’s stringent clinical quality standards. Joint Commission International (JCI) is the global arm of the US-based Joint Commission on the Accreditation of Healthcare Organizations (JCAHO); The distinction certifies that the hospital’s programs meet international standards and follow the latest US clinical guidelines establishing it as a facility with exceptionally high standards, and as part of a high-quality network offering highly-skilled doctors, state-of-the-art equipment and innovative treatment.

Source: Doctors Hospital

SOME MEN MAY EXPERIENCE URINARY PROBLEMS, TEMPORARY ED AFTER PROSTATE BIOPSY

Some Men May Experience Urinary Problems, Temporary ED After Prostate Biopsy.

Reuters (8/31, Norton) reports that some men may experience urinary problems or temporary erectile dysfunction after undergoing a prostate biopsy, according to a German study published in the Journal of Urology. After randomizing 198 men to one of three types of biopsies, investigators discovered that those who were subjected to saturation biopsies were more likely to visit the bathroom during the night or find it difficult to pass urine. As for ED, that group, as well as those who underwent standard and 10-sample biopsies, had issues.

SEXUAL DYSFUNCTION AFTER CURIETHERAPY

Sexual dysfunction after curietherapy and external radiotherapy of the prostate for localized prostate cancer]
[Article in French]
Huyghe E, Bachaud JM, Achard JL, Bossi A, Droupy S; les membres du comité d'andrologie de l'AFU.
Service d'urologie CHU de Toulouse, Hôpital de Rangueil, 1 avenue du Professeur Jean Poulhès, Toulouse cedex 9, France. huyghe.e@chu-toulouse.fr
Abstract
OBJECTIVES: Knowing the importance of sexuality items in the choice by the patient of the modality of treatment of localized prostate cancer, we aimed at reviewing and updating the effects of prostate radiotherapy and brachytherapy on sexual functions.
METHOD: A PubMed search was done using the keywords: prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, ejaculation and orgasm.
RESULTS: After both radiotherapy and brachytherapy, sexual troubles occur progressively, the onset of occurrence of erectile dysfunction being 12-18 months after both treatments. Even though the pathophysiological pathways by which radiotherapy and brachytherapy result in erectile dysfunction have not yet been fully clarified, arterial damage and exposure of neurovascular bundle to high levels of radiation seem to be two main causes of erectile dysfunction after radiotherapy and brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of erectile dysfunction. Another important factor following radiotherapy is the treatment modality. Not many data about ejaculation and orgasm after radiation treatments have been published yet. Recent data show that most of the population treated by brachytherapy conserves ejaculation and orgasm after treatment, even if a majority describe reduction of volume and deterioration of orgasm. Patients need to be correctly informed on the possible sequela of radiotherapy and brachytherapy on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for erectile dysfunction.
George M. Suarez, M.D.
Medical Director,
The Miami Urology Center of Excellence
Cell: 305-310-8238

A RUSH TO OPERATING ROOMS THAT ALTERS MEN'S LIVES

August 30, 2010, 5:00 pm A Rush to Operating Rooms That Alters Men’s Lives
By DANA JENNINGS

Jeanette Ortiz-Burnett/The New York TimesAs I scuffed through the stations of the prostate-cancer cross these past two years, I sometimes wondered whether I wasn’t a dupe caught up in a Robin Cook medical thriller.

Sure, the biopsy (so I was told) showed that my prostate was cancerous. And after it was removed, the pathology report revealed that the cancer was unexpectedly aggressive, thrusting me from the relative comforts of Stage 1 to the deep woods of Stage 3.

But at least on the surface, the cancer itself never did any damage. It was the treatments that razed me — the surgery, radiation and hormones producing a catalog of miseries that included impotence, incontinence and hot flashes. And a small voice kept whispering: What if this is all a lie? A dark conspiracy of the global medical-industrial complex?

And now comes “Invasion of the Prostate Snatchers,” by Ralph H. Blum and Dr. Mark Scholz, effectively confirming my whimsical paranoia.

Mr. Blum, a cultural anthropologist and writer, has lived with prostate cancer for 20 years without radical treatment, and Dr. Scholz is an oncologist who has treated the disease exclusively since 1995.

Their book, written tag-team style, is a provocative and frank look at the bewildering world of prostate cancer, from the current state of the multibillion-dollar industry to the range of available treatments.

About 200,000 cases of prostate cancer are diagnosed each year in the United States, and the authors say nearly all of them are overtreated. Most men, they persuasively argue, would be better served having their cancer managed as a chronic condition.

Why? Because most prostate cancers are lackadaisical — the fourth-class mail of their kind. The authors say “active surveillance” is an effective initial treatment for most men.

They add that only about 1 in 7 men with newly diagnosed prostate cancer are at risk for a serious form of the disease. “Out of 50,000 radical prostatectomies performed every year in the United States alone,” Dr. Scholz writes, “more than 40,000 are unnecessary. In other words, the vast majority of men with prostate cancer would have lived just as long without any operation at all. Most did not need to have their sexuality cut out.”

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.Yet radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that it extended the lives of just 1 patient in 48.

And surgery, of course, is most often recommended by surgeons and urologists — who are also surgeons. Mr. Blum writes: “As one seasoned observer of the prostate cancer industry told me, ‘Your prostate is worth what Ted Turner would call serious cash money.’ ” As for patients, their rational thinking has been short-circuited by the word “cancer.” Scared, frantic and vulnerable — relying on a doctor’s insight — they are ripe to being sold on surgery as their best option. Just get it out.

Every urologist I met with after my diagnosis recommended surgery, even though it was believed then that I had a low-risk Stage 1 cancer. The best advice came from my personal urologist, who declined to do my operation because it was beyond him: “Avoid the community hospital guys who do a volume business in prostates.”

I did, but I’m still maimed. In my experience, doctors play down punishing side effects like incontinence, impotence and shrinking of the penis. Those are just words when you hear them, but beyond language when you go through them.

Despite the impression the authors give, though, judging the velocity or voraciousness of a prostate cancer can still be imprecise. I know this firsthand.

After my biopsy, it appeared that I had a Stage 1 cancer, a doddering old nag that the authors would have designated for active surveillance. As it turned out, I had an especially pure Stage 3 cancer, a real top-fuel eliminator in terms of velocity (and hunger).

I’m a wild card, the 1 man in 48 saved by surgery. Without it, my doctors wouldn’t have learned the cancer was so advanced, and wouldn’t have given me the hormones and radiation that helped keep me alive.

So yes, prostate cancer is a dark and mysterious country, and Mr. Blum and Dr. Scholz are good, levelheaded guides through these thickets. And in telling men to slow up and take a deep breath after they learn they have prostate cancer, they provide an invaluable service. I wish I had had this book back in 2008.

But all of this raises one last stark question: Was my life worth the 47 other prostatectomies that probably didn’t have to be performed?

I don’t know. I’m a man, not a statistic.

THE FOLLOWING ARE DR. SUAREZ' COMMENTS ON THE ABOVE ARTICLE

There are so many valid points in this article and in this book. However, there is no mention of the alternative to surgical removal of the prostate. I am specifically referring to a technology known as High Intensity Focused Ultrasound (HIFU). The manufacturer of the technology is USHIFU, it is called the Sonoblate-500 and is based in Charlotte, N. C. This is a non invasive treatment for prostate cancer that has been approved in Europe and throughout the world since 1998. It is in final phase of investigation clinical trials by the FDA, and should be approved in the U.S. in the next 18-24 months. It provides an efficacy and cure rate similar to surgery and/or radiation, but it has less risks of complications such as referred in the article: impotence and urinary incontinence. It utilizes ultrasound energy that has no toxicity, and provides a precise treatment without scatter or displacement of the treatment to surrounding tissue. Therefore, less risk of collateral damage.
The U.S. is typically the last country to adopt new technology and new medical treatments. Mostly due to the rigors of FDA clinical evaluation, and this is a good thing. No one wants to be rendered a treatment that has not undergone proper evaluation for patient safety, efficacy and clinical outcomes. Once HIFU is approved, it will be the only prostate cancer therapy that would have undergone FDA approval. As all other therapies have had "grand fathered approval" by virtue that they were procedures performed prior to revision of FDA guidelines in 1976.
HIFU is an excellent alternative that merits consideration by men diagnosed with localized prostate cancer. It is available, and being performed by hundreds of American board certified urologist in countries where it is approved. In certain cases it is covered by insurance. The technology is based on similar delivery of energy used to break up kidney stones. It is called piezoelectric energy in the form of extracorporeal shock wave lithotripsy (ESWL). Before ESWL, patients underwent major surgery to remove kidney stones. With ESWL, they are now treated in an out patient setting with non invasive technology.
The advances in computer technology and imaging capabilities continue to transform the practice of medicine at fast and rapid speed. Some of these technologies may be considered disruptive by older , and less adopting physicians. But this the natural and normal course of evolution of medical care. I am convinced that HIFU will be the state of the art treatment of choice in the future.

For additional information, please visit website: www.hifumedicalexpert.com or www.ushifu.com.
George M. Suarez, M.D.
Medical Director,
The Miami Urology Center of Excellence
9195 Sunset Drive
Miami, Florida, 33173
Tel:305-595-0199. 1-877-949-5325
www.hifumedical.expert.com

PROSTATE CANCER SCREENING FOR OBESE MEN

Prostate Cancer Screening Should Be Adjusted For Overweight, Obese Men. Fact: Overweight and obese men may have diminished prostate cancer detection.
September is prostate cancer awareness month. The following was provided by the American Urologic Association, and is placed here for educational purposes.

MedWire (8/27, Guy) reported, "Overweight and obese men may have diminished prostate cancer detection owing to low prostate-specific antigen (PSA) levels," University of Texas researchers found after evaluating data on 3,697 individuals. More specifically, "potential explanations for the association between overweight/obesity and PSA is a possible hemodilution effect caused by greater blood volume, or the suppression of PSA production caused by lower testosterone levels and higher estrogen levels," according to the paper in Urology. Thus, the study authors "recommend adjusting prostate cancer screening to allow for the impact of body mass index (BMI)."

HIFU SHOWS PROMISE AS A PROSTATE CANCER THERAPY

AMSTERDAM—High-intensity focused ultrasound (HIFU) shows promise as a treatment for early-stage prostate cancer, according to interim study results presented here at the 7th Meeting of the European Association of Urology's Section of Oncological Urology.
The study included 20 men with stage T1c-T2b, N0, and M0 unilateral prostate cancer. All subjects had a PSA of 15 ng/mL or lower, a Gleason score of 7 or less, and a prostate size of 40 cc or less. Six months after treatment with HIFU, 95% of men were able to achieve erections and had pad-free urinary continence. Also six months post-procedure, 55% of men had wet ejaculations and no patient had rectal toxicity. One man refused a biopsy at six months. Of the 19 men who underwent biopsy, two (10.5%) had cancer recurrence. One patient was switched to active surveillance and the other underwent another HIFU treatment. Six months later, magnetic resonance imaging and biopsy revealed no evidence of disease.
“By treating the disease using focal therapy we avoid the morbidity associated with radical therapy, while restoring men to a position in which they can have access to active surveillance,” said lead investigator Mark Emberton, MD, Consultant Urologist at University College London Hospital in London. “It's controversial, but it's definitely exciting—focal therapy is currently the only strategy on the table that might lead to significant and important reductions in treatment-related harms.”
From the June 2010 Issue of Renal And Urology News

HEALTHDAY NEWS

MONDAY, Aug. 23 (HealthDay News) -- The initial treatment given to prostate cancer patients has a major impact on short- and long-term costs of care, a new study has found.
For example, while some may opt for an initial treatment that is less expensive in the short-term, the long-term costs of that treatment may actually be higher, the study authors explained.

Treatments options for early-stage prostate cancer include surgery, radiation therapy, hormonal treatment, watchful waiting, or combinations of those methods. Decisions about which treatment to use are based on a variety of factors, including cost, according to background information in the study, published online Aug. 23 in the journal Cancer.
In the study, U.S. researchers analyzed data from 13,769 prostate cancer patients, aged 66 and older, who were diagnosed in 2000 and followed-up for a period of five years. The data came from the Surveillance, Epidemiology and End Results (SEER)-Medicare database.
The men were divided into groups based on the treatment they received during the first nine months after being diagnosed with prostate cancer: watchful waiting, radiation, hormonal therapy, hormonal therapy plus radiation, and surgery. The men in the surgery group may also have received hormones and/or radiation therapy.
For most of these cases, treatment costs were highest in the first year and then declined sharply and remained steady over the next several years. According to the report, watchful waiting had the lowest initial ($4,270) and five-year total costs ($9,130), and hormonal therapy had the second lowest initial cost but the highest five-year total cost ($26,896).
The highest initial treatment costs were observed among those receiving hormonal therapy plus radiation ($17,474), and those undergoing surgery ($15,197), the investigators noted.
Over five years, total costs for hormonal therapy plus radiation were $25,097, and $19,214 for surgery.
When the researchers took into account that costs of treatment in the last 12 months of life are different than other treatment years and excluded the costs for that year, they found that total costs were highest for hormonal therapy plus radiation ($23,488) and hormonal therapy only ($23,199).
"This demonstrates that treatments that may be less expensive in the short term may have higher long-term costs," study leader Claire Snyder, of the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore, said in a journal news release.
More information
The U.S. National Cancer Institute has more about prostate cancer.

CONSIDERING RADIATION THERAPY FOR PROSTATE CANCER...GET THE FACTS

If you are considering radiation therapy for prostate cancer, including the highly marketed concept of radioactive seeds. Get the facts before making a decision.The fact is that radioactive seeds are nothing more than another form of radiation. It is not much different than External Beam Radiotherapy, Image guided Modulated Radiotherapy (IMRT) or Proton radiotherapy. With all forms of radiation comes the toxic side effects of radiation. Anyone considering radiation should look into High Intensity Focused Ultrasound (HIFU) . There no radiation and no surgery. HIFU is truly totally non- invasive outpatient procedure. For further information, visit: www.hifumedicalexpert.com. If you want to get the facts on the secondary effects from radiation exposure in the treatment of prostate cancer, click on the link below and read the comments that follow.

Please see the recent article in Urology Times in the link below commenting on clinical outcomes of radiation therapy being similar to HIFU in treating prostate cancer.

http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008/index.php?startid=24


"Although this is another important article in the fast gaining popularity of HIFU as a treatment option for localized prostate cancer, and the efficacy in clinical outcomes. The fact is that as a slow growing cancer, it seems to respond to almost any type of treatment when it is diagnosed early and has favorable PSA and Gleason score. However, Radiation has additional toxic side effects that are not often discussed with the patients. Yet, it remains the most common form of treatment for prostate cancer. Mostly because of men's fear of undergoing surgery and the collateral damage associated with it. Even with radiation there is still high degree of side effects. These include erectile dysfunction and urinary incontinence and high degree of irritable or "bother symptoms" (bladder and bowel). What is seldom mentioned is the increased risk of developing a secondary malignancy. Particularly bladder and rectal cancer, reported as high as 70 % greater than men treated with alternatives other than radiation. (1) Furthermore, a recent study from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database has revealed that PSA recurrence after radiotherapy occurred in 63 % of men with 93 % being treated with Androgen deprivation therapy for salvage of PSA failure. (2) The alternative to Androgen deprivation is to treat radiation failures with Salvage HIFU and saving patients from being placed on hormone therapy. That in the end Androgen deprivation is only palliative and never curative."


References:

(1) Baxter NN, Tepper JE, Durham SB. et al, Increased risk of rectal cancer after radiation: a population-based study. Gastroenterology, 2005;128:819-824.

(2) Agarwal PK, Sadestsky N, Konety BR et al: and the CaPSURE group. Treatment failure after primary and salvage therapy for prostate cancer: Likelihood, patterns of care, and outcomes. Cancer 2008;112:307-14.




Acute Toxicity Predicts Late Injury After Prostate Radiotherapy -

MORE COMMENTS ON THIS ARTICLE

http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008/index.php?startid=24

"Although this is another important article in the fast gaining popularity of HIFU as a treatment option for localized prostate cancer, and the efficacy in clinical outcomes. The fact is that as a slow growing cancer, it seems to respond to almost any type of treatment when it is diagnosed early and has favorable PSA and Gleason score. However, Radiation has additional toxic side effects that are not often discussed with the patients. Yet, it remains the most common form of treatment for prostate cancer. Mostly because of men's fear of undergoing surgery and the collateral damage associated with it. Even with radiation there is still high degree of side effects. These include erectile dysfunction and urinary incontinence and high degree of irritable or "bother symptoms" (bladder and bowel). What is seldom mentioned is the increased risk of developing a secondary malignancy. Particularly bladder and rectal cancer, reported as high as 70 % greater than men treated with alternatives other than radiation. (1) Furthermore, a recent study from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database has revealed that PSA recurrence after radiotherapy occurred in 63 % of men with 93 % being treated with Androgen deprivation therapy for salvage of PSA failure. (2) The alternative to Androgen deprivation is to treat radiation failures with Salvage HIFU and saving patients from being placed on hormone therapy. That in the end is palliative and never curative."
George M. Suarez, M.D.
Co- Founder,
Medical Director Emeritus, USHIFU

PLEASE GO TO PAGE 24 25 UROLOGY TIMES

http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008/index.php?starid=24

DR. SUAREZ COMMENTS ON THE ABOVE ARTICLE FROM UROLOGY TODAY

This is another important article in the fast gaining popularity of HIFU as a treatment option for localized prostate cancer. The fact is that as a slow growing cancer, it seems to respond to almost any type of treatment when it is diagnosed early and has favorable PSA and Gleason score. However, Radiation has additional toxic side effects that are not often discussed with the patients. Yet, it remains the most common form of treatment for prostate cancer. These include erectile dysfunction and urinary incontinence and high degree of irritable or "bother symptoms. (bladder and bowel)" What is seldom mentioned is the increased risk of developing a secondary malignancy. Particularly bladder and rectal cancer, reported as high as 70 % greater than men treated with alternatives other than radiation. (1) Furthermore, a recent study from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database has revealed that PSA recurrence after radiotherapy occurred in 63 % of men with 93 % being treated with Androgen deprivation therapy for salvage of PSA failure. (2) These outcomes also add to the ability to treat radiation failures with Salvage HIFU and saving patients from being placed on hormone therapy.


References:

(1) Baxter NN, Tepper JE, Durham SB. et al, Increased risk of rectal cancer after radiation: a population-based study. Gastroenterology, 2005;128:819-824.

(2) Agarwal PK, Sadestsky N, Konety BR et al: and the CaPSURE group. Treatment failure after primary and salvage therapy for prostate cancer: Likelihood, patterns of care, and outcomes. Cancer 2008;112:307-14.

http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008/index.php?starid=24

http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008/index.php?starid=24

http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008/index.php?starid=24

COMMENTS ON THIS ARTICLE BY GEORGE M. SUAREZ, M.D.

This is another important article in the fast gaining popularity of HIFU as a treatment option for localized prostate cancer. The fact is that as a slow growing cancer, it seems to respond to almost any type of treatment when it is diagnosed early and has favorable PSA and Gleason score. However, Radiation has additional toxic side effects that are not often discussed with the patients. Yet, it remains the most common form of treatment for prostate cancer. These include erectile dysfunction and urinary incontinence and high degree of irritable or "bother symptoms. (bladder and bowel)" What is seldom mentioned is the increased risk of developing a secondary malignancy. Particularly bladder and rectal cancer, reported as high as 70 % greater than men treated with alternatives other than radiation. (1) Furthermore, a recent study from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database has revealed that PSA recurrence after radiotherapy occurred in 63 % of men with 93 % being treated with Androgen deprivation therapy for salvage of PSA failure. (2) These outcomes also add to the ability to treat radiation failures with Salvage HIFU and saving patients from being placed on hormone therapy.


References:

(1) Baxter NN, Tepper JE, Durham SB. et al, Increased risk of rectal cancer after radiation: a population-based study. Gastroenterology, 2005;128:819-824.

(2) Agarwal PK, Sadestsky N, Konety BR et al: and the CaPSURE group. Treatment failure after primary and salvage therapy for prostate cancer: Likelihood, patterns of care, and outcomes. Cancer 2008;112:307-14.

NEW IN INDIA

India HIFU adopts revenue sharing model with healthcare providers to penetrate in South Asian market

Monday, August 16, 2010 08:00 IST
Nandita Vijay, Bangalore

India HIFU, the Indian arm of US-HIFU specializing in treatment of prostrate cancer with its ultrasound technology 'Sonablate', is aggressively targeting the South Asian market. The company has adopted a unique financing concept which ensures that hospitals need not make upfront investment in the technology installation but partner India HIFU on a revenue sharing model.

According to Mukesh Rana, country manager, India HIFU, the company foresees huge potential in the Indian healthcare market going by the rising incidence of prostrate cancer which is an age-related and genetic condition aggravated by fatty diets and poor exhibition of the disease symptoms but are detected only with a blood test for prostrate specific antigen (PSA) levels.

Also the financing model envisaged by India HIFU would be a win-win situation for both the technology and the healthcare provider. Further the concept would ease the burden of equipment maintenance for hospitals and in the process help them to concentrate on treatment modalities, he said.

In the last 18 months, the company has set up five installations across India, which includes two hospitals in New Delhi: Rajiv Gandhi Cancer Centre and Primus; one each in Mumbai at Jaslok and Hyderabad Parimala Hospital. Currently, India HIFU charges Rs 3.25 lakh for the procedure to patients, he added.

'Sonablate' is a high intensity focused ultrasound equipment that targets the cancer cells. The robotic ablation technology according to the company is an alternative modality to combat prostate cancer with significant lower side effects as compared to other traditional treatment protocols like prostatectomy and radiotherapy.

In India so far, around 100 patients have undergone treatment with Sonablate and there has been a positive response, he said.

The product was developed by Prof Naren Sanghvi president of the Focus Surgery, Indianapolis. Sonablate studies on patients globally has proved it as a solution for organ confined prostrate cancer therapy. In fact, in Japan alone the company has a 10-year follow-up study with Sonablate therapy.

The treatment offers high economies-of scale and its success rate is reported to be around 93 percent. The big advantage of the technology is the minimally invasive feature which is viewed as far safer and as effective compared to prostatectomy or radiotherapy. The only challenge is to ensure that early stage detection is made, explained Rana.

The company is looking at the Indian sub-continent going by its 18,000 prostrate cancer patient population and a similar number in other south Asian countries. The challenge before India HIFU now is to look for right partners across the region to augment its installation base.

India HIFU is the exclusive distributor of the Sonablate system in the country. The company is in-charge of marketing and setting up Sonablate HIFU Centers too in the run.

On the alternate treatment options with HUFU, Rana stated that advanced research on use of Sonablate for kidney and pancreatic cancers were on. It will take a while to introduce the therapy to patients.

Globally the only other company which offers a similar technology is the France-based Edap. But, for US HIFU its longer presence in the market has allowed it to garner a higher installation base, said Rana.

Dr. George M. Suarez is the co-founder and Medical Director, Emeritus of USHIFU and International HIFU. Dr. Suarez has served on the Board of Directors of Focus Surgery, the manufacturer of the Sonoblate 500. As well as currently serves on the Board of Directors of USHIFU. He has performed more HIFU procedures than any single urologist in North America, and has trained the vast majority of urologists performing HIFU. He has been involved with teaching, training and educational materials of HIFU dating back for almost 10 years.

For additional information on HIFU and on Dr. George M. Suarez, please visit www.hifumedicalexpert.com

HIFU IN BANGALORE INDIA

Innovative Prostate Cancer Treatment Introduced In Bangalore, India
High intensity focused ultrasound technology with the Sonablate® 500 medical device now available for patients through HealthCare Global Enterprises Ltd. (HCG)

CHARLOTTE, N.C., August 11, 2010—USHIFU, LLC (“US HIFU”), a worldwide leader in the development, distribution and use of minimally invasive high intensity focused ultrasound (“HIFU”) technologies, and its affiliate India High Intensity Focused Ultrasound Devices Private Limited (“India HIFU”), announce the introduction of Sonablate® HIFU technology for prostate cancer in Bangalore, India at several HealthCare Global Enterprises Ltd. (“HCG”) centers.
Dr. Raghunath S.K., the first urologist in Bangalore to treat prostate cancer using HIFU, treated the city’s first patient today at Bangalore Institute of Oncology, one of the HCG centers to offer Sonablate HIFU.
Sonablate HIFU is a minimally invasive, targeted approach to treating prostate disease with precision-focused ultrasound energy that, when delivered, raises the temperature of the tissue in a matter of seconds. The extreme, rapid-firing heat destroys the tissue at a specific target, known as a lesion, which measures 12x3x3 mm, approximately the size of a grain of rice. Lesions are created throughout the prostate that result in its destruction.

“We are thrilled with this new association with HCG and what it means for prostate cancer patients in India,” said Alex Gonzalez, US HIFU’s vice president of international operations. “Since HCG has 18 cancer care centers across Southeast Asia and India, more men facing prostate cancer will learn about and gain access to the technology through their network.”

Bangalore Institute is the fifth facility in India to offer Sonablate HIFU for men with localized prostate cancer. The first Sonablate HIFU services were introduced in December 2008 in Hyderabad; other cities to subsequently offer the treatment include New Delhi and Mumbai. More than 50 prostate cancer patients have been treated with Sonablate HIFU since its introduction.

“It has been our goal to partner with the finest hospitals in India in order for exponentially more men to gain easier access to the treatment.” said Mukesh Rana, country manager, India HIFU. “We knew there was a need for HIFU in this area because a few Bangalore residents recently traveled more than 2,000 kilometers to New Delhi for treatment.”
# # #


About USHIFU, LLC
USHIFU, LLC (US HIFU), a privately held healthcare company, is a world leader in minimally invasive high intensity focused ultrasound (HIFU) technologies. US HIFU manufactures the Sonablate® 500 medical device and is focused currently on treating primary and recurrent prostate cancer using Sonablate® HIFU. The company is engaged in ongoing research for technological advancements for the Sonablate® system or other ultrasound applications. US HIFU was founded in 2004 and is headquartered in Charlotte, N.C. Additional information can be found at www.ushifu.com.

About India HIFU
India High Intensity Focused Ultrasound Devices Private Limited (India HIFU) is an affiliate of US HIFU. India HIFU sells, markets and services Sonablate® HIFU devices for HIFU treatment of prostate cancer as well as develops new Sonablate® HIFU centers throughout India. Additional information can be found at www.india-hifu.com.

About the Sonablate® 500
The Sonablate® 500 is a minimally invasive medical device that utilizes ultrasound energy to destroy tissue within the body. It was developed by Focus Surgery, Inc. Takai Hospital Supply Ltd. distributes the Sonablate® 500 in Southeast Asia. The Sonablate® 500 is not approved for use in the U.S. The Sonablate® 500 remains investigational in the U.S. and is being studied for the treatment of prostate cancer in clinical trials in the U.S. FDA has made no decision as to the safety or efficacy of the Sonablate® 500 for the treatment of prostate cancer.

US HIFU BREAKING BARRIERS IN ULTRASOUND TECHNOLOGY

US HIFU - Breaking Barriers in Ultrasound Technology
US HIFU, LLC is a privately held health care company focused on treating primary and recurrent prostate cancer using HIFU, a minimally invasive outpatient procedure which potentially improves patients’ quality of life. US HIFU was founded in 2004 and is headquartered in Charlotte, N.C.


HIFU Around the World
The company is focused on becoming a global market leader utilizing HIFU to revolutionize the delivery of minimally invasive patient care. US HIFU has established partnerships and relationships throughout the world, creating an extensive international presence by making HIFU technology available outside the U.S. in Central America, South America, Canada, India and the Caribbean.

HIFU in the United States
US HIFU is also managing the process of conducting FDA U.S. clinical trials of the Sonablate® 500, including a trial for primary prostate cancer patients and a trial for patients who have experienced radiation failure.

Clinical Trials in US
For more information about clinical trials that are enrolling patients for treating localized prostate cancer with high intensity focused ultrasound, click here.

A MESSAGE FROM BRUCE

Bruce,

Thank you for this information. I will pass it on to our blog and website. I am so happy all is well. BTW, your brother is also doing great and in addition to being cured with a non detectable PSA after HIFU, he too has had no side effects or complications. Places like John Hopkins are academic centers that typically lag behind the day to day"pulse" of new and disruptive treatments. On the other hand, Dr Mark Schoenberg, chief of urologic oncology at John Hopkins is the Chief Medical Officer for USHIFU. Therefore, there is an obvious connection and a believe in our technology (HIFU) by the John Hopkins department of urology.

Tried and time,,, I am sure HIFU will prevail as the optimal treatment for localized prostate cancer
Regards,

George


George M. Suarez, M.D.



-----Original Message-----
From: Bruce Howard
To: gmsuarezmd@aol.com
Sent: Wed, Aug 4, 2010 1:00 pm
Subject: Fw: Fwd: Enlarged Prostate: Acupuncture for Chronic Prostatitis


My Acupuncturist asked me to send this to you, I'm sure in the hopes that you will recommend him to some of your client's with Prostatitis. He has helped me numerous times over the years with assorted ills. I don't know if you have any faith in Eastern medicine, but I thought I would forward it to you as a favor to him. When I read the suggested treatments for prostate cancer it blows my mind that an institute like Johns Hopkins, so highly regarded, does not even list HIFU as a suggested treatment. Maybe the article was too old. I appreciate what you must go through trying to get your miraculous treatment through the "old school" people in the Medical profession.

I got my psa score back and it was 0.07......thanks again. Continue to have patients contemplating the treatment call me and I will preach the gospel according to George.

Hope all is good with you.


Bruce Howard
Principal

BRUCE HOWARD & ASSOCIATES
Landscape Architects, Site Planners, & Golf Course Designers
4872 S.W. 72nd Avenue
Miami, Florida 33155
(305) 668-3196 Phone
(305) 668-2871 Fax
e-mail: bruce@brucehoward.net
----- Original Message -----
From: Santiago Sifre
To: Bruce Howard
Sent: Wednesday, August 04, 2010 10:26 AM
Subject: Fw: Fwd: Enlarged Prostate: Acupuncture for Chronic Prostatitis


Bruce, maybe you cn send this to your prostate guy and let him know on my behalve that it came from me. I would appreaciate it.



----- Forwarded Message ----
From: Dan Radcliffe
To: Santiago Sifre
Sent: Wed, November 18, 2009 11:44:56 AM
Subject: Fwd: Enlarged Prostate: Acupuncture for Chronic Prostatitis





Begin forwarded message:


From: Johns Hopkins Health Alerts

Date: November 17, 2009 10:02:02 AM EST

To: danradcliffe@mac.com

Subject: Enlarged Prostate: Alternative Treatment for Chronic Prostatitis

Reply-To: editor@johnshopkinshealthalerts.com


Johns Hopkins Health Alerts:
Enlarged Prostate and Prostatitis
Alternative Treatment for Chronic Prostatitis May Help
Should you try acupuncture to relieve the pain of chronic prostatitis? Results from a recent study provide the answer. Read on ...

(800) 829-0422www.johnshopkinshealthalerts.com | Johns Hopkins Health Bookstore | Email this to a friend
Alternative Treatment for Chronic Prostatitis May Help





Should you try acupuncture to relieve the pain of chronic prostatitis? Results from a recent study provide the answer.
Like other forms of chronic pain, chronic prostatitis is a complex condition with no simple solutions. Successful management depends on treating the original source of the pain as well as the neurological and psychosocial problems that often accompany it.
As a result, your doctor may prescribe several different types of medication. Some men also benefit from cognitive behavioral therapy, which can help improve coping strategies and psychological well-being.
But what if you've tried medications and they haven't helped? Should you give acupuncture a try?
Results from a small study in The American Journal of Medicine suggest that acupuncture may provide relief to men with chronic prostatitis. The study compared the potential benefits of acupuncture versus sham (inactive) treatments in 89 men who had symptoms of chronic prostatitis for three or more of the past six months and who had a score of 15 or higher on the National Institutes of Health Chronic Prostatitis Symptom Index.
The men were randomly assigned to receive two acupuncture treatments or two sham treatments a week for 10 weeks. The sham treatments were nearly identical to genuine acupuncture needle insertions except for the location and depth of placement.
True acupuncture was nearly twice as effective as the sham procedure in relieving chronic prostatitis symptoms. Moreover, patients treated with acupuncture were more than twice as likely as the men given the inactive treatment to experience long-term prostatitis relief. Few of the men experienced complete resolution of their symptoms.
This study supports findings from other trials showing a benefit from acupuncture for chronic prostatitis. More study is needed before the treatment can definitively be recommended, but if nothing else has worked for you, a trial of acupuncture might be worth considering.



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Restoring Sexual Intimacy After Prostate Cancer Treatment
Written by Drs. Jacek Mostwin and H. Ballentine Carter from Hopkins' James Buchanan Brady Urological Institute, Restoring Sexual Intimacy After Prostate Cancer Treatmentpresents the latest thinking on erection rehabilitation after radical prostatectomy. It explore the full range of your erectile dysfunction treatment options -- effective oral medications, injection therapy, penile implants, and more. The report includes answers to dozens of real questions from patients on sexuality and prostate cancer.


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Bojangles on Cancer Compass

people treated with Hifu
by bojangles on Sat Jul 31, 2010 10:09 PM

Quote | Reply Looking for anyone in the late 50's who have had HIFI treatments. Would love to talk to them and see how they're doing. How's your sex life.
Look me up on Cancer Compass

MR. BOJANGLES ON HIFU AND ED

Whatever your sex life is prior to hifu it will most likely be the same after it, as least that's what I keep reading and that's what happened to me.

I'll try to bring up old threads where people discussed it...

The published rate is 19% have ED.

The most important thing is - if you have trouble with erections after hifu then take Cialis, 5mg daily, it keeps the blood flowing so the vessels stay open and heal open. HIFU shrinks the gland and the vessels are attached so they could get crimped. Cialis works....good luck!
Quote | Reply
Share
ohnoo

EDITORIAL by GEORGE M. SUAREZ, M.D.

Bill McCollum has a plan. Rick Scott has a motto: "let's get to work???" What are we getting to work on?" Rick, do you have a plan, proposal, anything??? Maybe we will go with your skills and talent in the adventures of health care fraud...oh, not again. Yep, Rick says: "let's get to work." God knows you don't have any on the job work experience other than insurance fraud. I understand, I am a doctor. But I don't expect you to understand any of that. You are good at what you do and did...cheat , lie and self- benefit monetarily.
Hey, do you have problems sleeping at night??? Hum? I sleep well knowing that in over 30 years I have cared for patients without cheat, lie or self benefit . I have no issues. I love what I do.Do you love what you do/did? I was never employed by HCA to have done what you did---paid 1.7 billion in insurance fraud. You walked away with 300 million in bonus, and now you want to be elected governor of Florida??? Please, someone tell me this a joke... Please help us understand??? Vote for Rick Scott on a promise of "let's get started?" What are we getting started on??? Don't think so...........................
George M. Suarez, M.D.

IN CASE YOU MISSED IT

FOR IMMEDIATE RELEASE
JULY 15, 2010

CONTACT: Kristy Campbell
850-241-1885
kristy@billmccollum.com

IN CASE YOU MISSED IT: ST. PETERSBURG TIMES: Rick Scott’s Medicare fraud explanations are unsatisfactory

“Private wealth and public accountability”
St. Petersburg Times
Editorial
July 15, 2010
“Republican candidate for governor Rick Scott has shown in the past week he's not above exploiting his role as a hospital executive in a family's private medical issue to get votes — yet he still refuses to candidly answer questions about how his company ultimately paid a $1.7 billion fine for Medicare fraud. Democratic U.S. Senate candidate Jeff Greene likes to tout his experience as a ‘proven job creator’ as he accumulated a onetime $1.3 billion business empire — yet he still hasn't disclosed information on his finances that would give voters more time to independently evaluate his record. Private business executives have to recognize that running for public office requires more transparency, particularly when their opponents have long public records.
“Scott and Greene have earned vast sums of money in the private sector, but they are unknown and untested politically. They have become competitive in their respective races largely because they have spent millions of their own money on television ads and face weak candidates in primary elections. At least the public records are clear for Attorney General Bill McCollum, who faces Scott in the Republican primary for governor, and U.S. Rep. Kendrick Meek of Miami, who faces Greene in the Democratic Senate primary. Scott and Greene are far less transparent and unwilling to go beyond sound bites in describing their track records.
“Scott's posturing is particularly galling as he's been exploiting a family's medical crisis on the campaign trail to prove he is a ‘prolife leader.’ As CEO of Columbia/HCA he continued to fight a lawsuit filed by a Texas couple whose wishes for the treatment of their premature infant daughter were ignored. And his campaign and a third-party committee have spent at least $20 million on television ads, including one that references the fine his hospital company paid after a federal investigation for Medicare fraud. The ad includes Scott saying he is going to give the ‘unvarnished truth’ and that he ‘learned’ from the experience. He notes he was never interviewed by investigators or charged in the case.
“But unvarnished truth apparently has its limits. After the Miami Herald found at least one of Columbia/HCA's illegal practices — giving kickbacks to doctors who referred patients to the company's hospitals — traced back to the original Texas hospitals Scott ran, his campaign declined interview requests. It ultimately issued another oblique and wholly unsatisfactory statement. What lessons did Scott learn? What did he know? Scott won't elaborate. As governor would he insist on giving written statements rather than candid responses to the public?
“Then there is billionaire Greene, who sought a one-month delay June 18 in filing financial disclosure papers required under state election law. Greene claimed his attorney ‘hasn't been able to get it in yet.’ That Greene — who has the cash to hire a posse of professionals — didn't think it was a priority is disconcerting at best. Now it appears he's intent on making voters wait as long as possible by running out the clock.
“With less than six weeks before the Aug. 24 primary, and many ballots already in the mail, time is running short for Scott and Greene to open up to voters about their track records in private business. But they are going to have to offer more than slick television commercials or campaign stump speeches. If they are not comfortable with public disclosure of their private business dealings, they should not be running for public office.”
To view this piece, please visit the St. Petersburg Times online at http://www.tampabay.com/opinion/editorials/article1108979.ece. For more information, campaign news, and updates, visit www.BillMcCollum.com.

POSTED BY MATT WILLIAMS

Dear George,
The stakes in August’s Republican primary could not be higher. Florida faces a multitude of challenges, including a major jobs shortage, a budget crisis, and a need for a strong conservative leader in the Governor’s Mansion.
On one hand, Florida Republicans can elect Bill McCollum – leading our nation’s legal efforts to repeal President Obama’s health care laws, fighting for meaningful litigation reform to ease Florida’s doctor shortage and lower healthcare costs and working to implement an economic plan that will create 500,000 new jobs over six years.
As a Congressman and Attorney General, Florida’s healthcare community has had no better friend than Bill McCollum. His record on cutting government red tape and ending frivolous lawsuits prompted one of Florida’s most prominent trial lawyers to call Bill “the trial lawyers’ worst nightmare.”
On the other hand, Florida Republicans can put their hopes for our future in disgraced former Columbia CEO Rick Scott, who ran the company as it systematically defrauded the government in the largest Medicare fraud scheme in American history. Using the millions he made from defrauding taxpayers, Rick Scott has taken to the airwaves to mislead Floridians about his record.
As the campaign continues, we learn more about Rick Scott’s questionable background as a healthcare CEO. Here are the facts about Rick Scott’s tenure as Columbia CEO:
· While Rick Scott was CEO of Columbia the company would purchase inferior equipment to cut cost that could hinder doctors abilities to perform their duties:
o “Surgical gloves were thinner and more likely to break, alcohol sponges were smaller, and the valve on new chest drainage tubes substituted by Columbia did not indicate whether the device was turned on or off” (allnurses.com)

o “’Gloves rip easily,’ complained hospital workers in Florida. In California, some nurses protested “filthy conditions” and being “stretched to the limit as the hospital slashed the ratio of nurses to patients” “I sometimes had to watch 72 patients heart monitors at a time,” one nurse reported. “I was told, either do it, or there’s the door.” In Indianapolis nurses complained to state authorities that babies in the neonatal unit were left unattended for as long as three hours.” (healthbeatblog.com: Who is Richard Scott and why is he saying these things about healthcare reform?)


· Richard Scott and Columbia attempted to bribe doctors:
o In 1997, in El Paso, Texas, a Federal jury found that Columbia, “personally” authorized by Rick Scott, had secretly paid doctor Ambrose Aboud $152,000 for "outstanding expenses" that he had not incurred as part of an unlawful conspiracy to defraud the business partner. (Kurt Eichenwald, New York Times: A Health Care Giant's Secret Payments Taint a Texas Deal, March 29, 1997)

o Agents with the Federal Bureau of Investigation wrote in a memorandum that executives from hospitals that Columbia was attempting to buy reported that Columbia offered them “perquisites and promises of jobs” and other inducements as bribes to affect their decisions on whether to sell to Columbia. This includes John Geanes, a former administrator of South Miami Hospital who stated before a grand jury that he was approached by several Columbia officials including Rick Scott.( NEW YORK TIMES: HEALTH CARE'S GIANT: Powerhouse Under Scrutiny -- A special report.; Biggest Hospital Operator Attracts Federal Inquiries, March 28, 1997, by Martin Gottlieb, Kurt Eichenwald and Josh Barbanel)

· Rick Scott and Columbia cut doctors that were not bringing in maximum profit, at the expense of patient care
o “The profit pressure that left Lawrence County, which is 71 miles southwest of Nashville, without an obstetrician also helped make Columbia the target of federal investigators. And it began affecting patient care immediately after Columbia's 1994 takeover of Hospital Corp. of America, current and former hospital employees say.”

o “Critics point to one incident in 1994, when Columbia cut back on services at a money-losing hospital in Destin, Fla. A man injured in a boating accident was left pleading from his stretcher for emergency room staff to treat him, as yellow tape blocked entry to the ER door.” (John Hendren, Hospital chain's profits took toll on patient care, employees say” John Hendren, AP, Hospital chain's profits took toll on patient care, employees say, 9/7/1997)

With the Florida Medical Association’s recent announcement to unanimously endorse Attorney General Bill McCollum for Governor, we feel the momentum heading into August is on our side. But to ensure it remains that way and to keep Rick Scott and his fraudulent business tactics out of the Governor’s Office, we need your support. Your maximum donation of $500 per person of $1,000 per household will ensure Florida’s medical community will have a strong advocate in the Governor’s Mansion and help us educate Florida Republicans about Rick Scott’s real record as CEO of Columbia. To keep up with Rick Scott’s massive spending, we need your support.

Matt Williams
Campaign Manager
McCollum for Governor

P.S. Support our campaign by clicking here.

NEW POST BY DR. GEORGE SUAREZ

Just when you thought we heard it all on Rick Scott's mafia approach to business and politics, here is more. He simply wants to buy his way into the Governor's mansion, into Floridian and will stop at nothing. He even regressed on his own promise to obey the state campaign finance law – the same law Rick Scott agreed to follow when he filed to run for Governor of the State of Florida. But with the change of events that have revealed who the true Rick Scott is, he now tried desperately to break away from campaign finance laws, spend more money and try to buy his way to becomes Florida's Governor. That is the truth on Rick Scott.

Yep, a zebra does not change it's stripes, nor a leopard his spots. We got Rick Scott's stripes and spots. They are called untruthful, dishonest, liar and cheat. Plus a lack of moral accountability. This guy really thinks he can be governor of Florida by buying his way? The same way he bought himself out of insurance fraud charges with 1.7 billion dollar fine?

George M. Suarez, M.D.

LATEST NEWS

RICK SCOTT SUES THE STATE DESPITE EARLIER PLEDGE TO ABIDE BY CAMPAIGN SPENDING CAPS

Tallahassee, FL – Today, McCollum for Governor Campaign Matt Williams issued the following statement regarding Bill McCollum’s motion to intervene in the case of Rick Scott v. the Florida Department of State:

“On the day Rick Scott filed to run for Governor, he pledged to abide by campaign spending caps currently in state law. Now that he is failing to win over voters, despite the millions he is personally hemorrhaging into his campaign to pay for false and negative attacks against Bill McCollum, he wants to change the rules of the game. There Rick Scott goes again, saying one thing and doing another.

“On June 17, Rick Scott promised to stay under the $24.9 million limit on spending and less than a month later he now says he plans to exceed that. Now he’s using money he ripped off from taxpayers to sue the state of Florida, in a greedy and dishonest attempt to avoid the repercussions of his decision.

“Today, Bill McCollum filed a motion seeking to join the case in support of upholding state law. Given that Rick Scott’s lawsuit mentions him directly, it is only appropriate for Attorney General McCollum to join this case to ensure his position is adequately represented.”

“Thankfully, Florida voters are becoming increasingly disgusted with a greedy and dishonest insider who will say and spend anything to avoid his record – from profiting off illegal immigrants to making millions off President Obama’s $780 billion stimulus boondoggle.”

To view video of Rick Scott pledging to abide by campaign spending caps, visit: http://www.youtube.com/watch?v=VGXFdP6oOFU.

To access the motion, please click here: http://billmccollum.com/press-release/2010/07/12/rick-scott-sueing-the-state-despite-earlier-pledge-to-abide-by-campaign-spending-caps/.

For more information, campaign news, and updates, visit www.BillMcCollum.com.

# # #





Political advertisement paid for and approved by Bill McCollum, Republican, for Governor.
The purchase of a ticket for, or a contribution to, the campaign fundraiser is a contribution
to the campaign of Bill McCollum. Contributions are not deductible for federal income tax purposes.
PO Box 10829, Tallahassee, FL 32302-2829 | P: 850-241-1885

THE LANCET - ONCOLOGY

The Lancet Oncology, Early Online Publication, 1 July 2010doi:10.1016/S1470-2045(10)70146-7Cite or Link Using DOIMortality results from the Göteborg randomised population-based prostate-cancer screening trial
Original Text
Prof Jonas Hugosson MD a , Sigrid Carlsson MD a, Gunnar Aus MD a, Svante Bergdahl MD a, Ali Khatami MD a, Pär Lodding MD a, Carl-Gustaf Pihl MD c, Johan Stranne MD a, Erik Holmberg PhD b, Hans Lilja MD d e
Summary
Background
Prostate cancer is one of the leading causes of death from malignant disease among men in the developed world. One strategy to decrease the risk of death from this disease is screening with prostate-specific antigen (PSA); however, the extent of benefit and harm with such screening is under continuous debate.
Methods
In December, 1994, 20 000 men born between 1930 and 1944, randomly sampled from the population register, were randomised by computer in a 1:1 ratio to either a screening group invited for PSA testing every 2 years (n=10 000) or to a control group not invited (n=10 000). Men in the screening group were invited up to the upper age limit (median 69, range 67—71 years) and only men with raised PSA concentrations were offered additional tests such as digital rectal examination and prostate biopsies. The primary endpoint was prostate-cancer specific mortality, analysed according to the intention-to-screen principle. The study is ongoing, with men who have not reached the upper age limit invited for PSA testing. This is the first planned report on cumulative prostate-cancer incidence and mortality calculated up to Dec 31, 2008. This study is registered as an International Standard Randomised Controlled TrialISRCTN54449243.
Findings
In each group, 48 men were excluded from the analysis because of death or emigration before the randomisation date, or prevalent prostate cancer. In men randomised to screening, 7578 (76%) of 9952 attended at least once. During a median follow-up of 14 years, 1138 men in the screening group and 718 in the control group were diagnosed with prostate cancer, resulting in a cumulative prostate-cancer incidence of 12·7% in the screening group and 8·2% in the control group (hazard ratio 1·64; 95% CI 1·50—1·80; p<0·0001). The absolute cumulative risk reduction of death from prostate cancer at 14 years was 0·40% (95% CI 0·17—0·64), from 0·90% in the control group to 0·50% in the screening group. The rate ratio for death from prostate cancer was 0·56 (95% CI 0·39—0·82; p=0·002) in the screening compared with the control group. The rate ratio of death from prostate cancer for attendees compared with the control group was 0·44 (95% CI 0·28—0·68; p=0·0002). Overall, 293 (95% CI 177—799) men needed to be invited for screening and 12 to be diagnosed to prevent one prostate cancer death.
Interpretation
This study shows that prostate cancer mortality was reduced almost by half over 14 years. However, the risk of over-diagnosis is substantial and the number needed to treat is at least as high as in breast-cancer screening programmes. The benefit of prostate-cancer screening compares favourably to other cancer screening programs.
Funding
The Swedish Cancer Society, the Swedish Research Council, and the National Cancer Institute

THE ADVANTAGES OF HIFU

Great article in the WSJ on the University of Gothenburg's findings on the value of PSA to be more sensitive that in screening for other types of common cancers, such as breast and colon cancer. The facts are: 1) PSA is the most precise and sensitive of all tumor markers. 2) Prostate cancer is the most common cancer in men. 3) Prostate cancer is the second most common cancer in men. 4) If detected early, it's curable. The conclusion of the Gothenburg research: PSA screening and treatment can reduce the risk of death from prostate cancer by as much as 50%.
The real challenge for men is when it comes to choosing a treatment. There lies the real issue, in that among physician worldwide, there is no general consensus as to the optimal treatment. Instead, treatment recommendations are a bias of the specialty and the training of the treating physician: surgeons will recommend surgery, and radiation oncologist radiation. As the saying goes: "to hammer everything looks like a nail." Likewise, is the bias when it comes to treating prostate cancer. The latest craze is the Robotic prostatectomy! However, most recent evidence shows that Robotic prostatectomy has a higher risk of recurrence and no better clinical outcomes in the incidence of impotence and urinary incontinence. After all, it's still the same human hands directing the Robotic instruments.
Other unique characteristic about prostate cancer is that the standard treatments available come with a high risks of complications. Particularly in quality of life matters such as greater than 50% incidence of impotence and 10-20 % risk of urinary incontinence associated with surgical removal of the prostate. There are similar risks with radiation. Plus a high risk of developing a secondary cancer from the exposure to the radiation. These issues are so concerning to men, that they often elect on "watchful waiting" or "active surveillance" at the risk of progression of cancer and metastasis... another unique characteristic of prostate cancer. I certainly know of no malignancy where a patient would consider opting for no treatment at the risk of death.
For the past 7 years I have offered High Intensity Focused Ultrasound or HIFU to patients with localized prostate cancer. The technology has been approved in Europe and other countries since 1998, and currently is approved worldwide, except in the U.S. However, American urologist have embraced the procedure and travel with their patients to treat them in countries where it is approved. Another unique characteristic of prostate cancer: American urologist and their patients are willing to travel outside the U.S. in order to perform and receive this very advanced futuristic treatment. But this is not really unique, as Americans are familiar with seeking health care outside the U.S. while procedures and medications are pending FDA approval.
The principle advantage to HIFU is that there are less risk of impotence and incontinence: the two most dreaded potential complication feared by men. Clinical efficacy of HIFU in recent years has proven post treatment PSA (PSA Nadir) of the same range as surgical removal or radiation therapy. To the skeptics, the initial impression is that the whole thing is too good to be true. But it is that good, in efficacy of treatment, and less risk of complications. Otherwise, the FDA would not have allowed the clinical trials to progress from Phase I and II, to current phase III. Another interesting bit of information: None of the "standard" treatments available for treating prostate cancer was ever FDA approved, nor did any of them undergo any type of clinical trial. Instead they were "grand- fathered" as treatments that were used prior to more rigorous FDA regulation came into place.
The Gothenburg study will undoubtedly influence the application of PSA screening by both physician's use and patient's request. Unfortunate, this will lead to the potential risk of overtreatment and increase number of patients at risk of compromised quality of life. The American Cancer Society reports approximately 250,000 new cases of prostate cancer per year. Increase screening, as well longer living population, will lead to more patients diagnosed with prostate cancer. Potentially doubling the number of newly diagnosed patients per year. As well as creating a huge economic burden, if not a crisis in the cost of healthcare. The cost of treatments does vary, with radiation being the most costly. The cost of a HIFU treatment is significantly less than all standard treatments. In Addition, as an outpatient procedure, it allows the patient to return to work and other routine activities the day after treatment is a plus for patient convenience as well as lost of revenue and productivity.
The advantages of HIFU have been recognized by many health insurance companies in the U.S., to the point that many of them are pre-approving payment or reimbursing patient afterwards. Interestingly, Tricare for Life, the healthcare carrier for retired and active federal government employees has pre- approved payment for HIFU with the Sonoblade-500 device. Another challenging question: it is approved by the healthcare provider to federal government employees, but not FDA approved? Yet, I am confident that it will soon be available to Americans. But in the mean time, they can travel to almost anywhere in the world for HIFU treatments. HIFU Clinical trials are being performed in some of the most prestige's medical centers in the country. Including The Walter Reed hospital, where American soldiers and veterans receive unequaled best medical care.
How likely is HIFU to get FDA approval? Having personally performed over 2,000 cases, and trained hundreds of urologist from around the world, I am confident that HIFU will be approved. It just a matter of the time it takes to complete the trials. What impact will HIFU have as a treatment option for prostate cancer? Several Biomedical Wall Street analysts and industry newsletters predict a 91% compounded yearly growth over the next five years, with HIFU becoming the most common treatment for prostate cancer by 2015. I never imagined a four letter word would impact healthcare so positively and so powerfully. But it has happened before. I remember the huge incisions we made to remove tiny kidney stone, the ensuing pain and days of recovery. Sometimes resecting ribs and injuring adjacent tissue and whole organs. Then there came another four letter word: ESWL, (extracorporael shock wave lithotripsy) and no more opened surgery for kidney stones. ESWL was approved by the FDA in 1884. Interestingly, the science and technology of ESWL is the same as for HIFU. It's called piezoelectric energy. How big is HIFU as an available treatment for the most common cancer in men, and the second most common cause of death related to cancer versus the impact of ESWL? Kidney stone affects a small number of Americans, and patients typically don't die from kidney stones.
George M. Suarez, M.D. F.A.C.S.
Board Certified Urologist
305-595-0199
9195 Sunset Dr. Suite 110
Miami, Florida


www.hifumedicalexpert.com

DRAMATIC HOPE AND CHANGE IN NOVEMBER

Governors of 35 states have already filed suit against the Federal
Government for imposing unlawful burdens upon them. It only takes 38 (of
the 50) States to convene a Constitutional Convention.

This will take less than thirty seconds to read. Please pass it on.

For too long we have been too complacent about the workings of Congress.
Many citizens had no idea that members of Congress could retire with the
same pay after only one term, that they didn't pay into Social Security,
that they specifically exempted themselves from many of the laws they have
passed (such as being exempt from any fear of prosecution for sexual
harassment) while ordinary citizens must live under those laws. The latest
is to exempt themselves from the Healthcare Reform that is being
considered...in all of its forms. Somehow, that doesn't seem logical. We
do not have an elite that is above the law. I truly don't care if they are
Democrat, Republican, Independent or whatever. The self-serving must stop.
This is a good way to do that. It is an idea whose time has come.

Have each person contact a minimum of twenty people on their Address list;
in turn ask each of those to do likewise.

In three days, most people in The United States of America will have the
message. This is one proposal that really should be passed around.

Proposed 28th Amendment to the United States Constitution:
"Congress shall make no law that applies to the citizens of the United
States that does not apply equally to the Senators and/or Representatives;
and, Congress shall make no law that applies to the Senators and/or
Representatives that does not apply equally to the citizens of the United
States ."

You are one of my 20.
Don't forget to "Take out the trash this November

Google News Alert for: prostate cancerMonitoring Can Be the Right
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