A new radiation-free therapy has recently been approved by the Food and Drug Administration for prostate tissue ablation, which also means that it can be used to treat prostate cancer.
Eugene Rajaratnam, MD, explains HiFU as a treatment for Prostate Cancer and who might be a candidate for this new procedure.
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Exciting New Treatment: HiFU for Prostate Cancer
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Learn more about Eugene Rajaratnam, MD
Eugene Rajaratnam, MD
Eugene Rajaratnam, MD graduated 1976 from Stanley Medical College, Chennai India. Moved to New York and completed a surgical and urological residency in 1982. Received my Board Certification in 1985. Worked as an attending Urologist in Brooklyn, NY at Coney Island Hospital until 1988, then moved to California. I have been in Private Practice in Lancaster since 1988. Founded The Antelope Valley Impotence and Incontinence Center. We treat all Urological conditions with special focus on Erectile Dysfunction and Urinary Incontinence.Learn more about Eugene Rajaratnam, MD
Transcription:
Exciting New Treatment: HiFU for Prostate Cancer
Melanie Cole: A new radiation-free therapy has recently been approved by the Food and Drug Administration for prostate tissue ablation, which also means that it can be used to treat prostate cancer. My guest today is Dr. Eugene Rajaratnam. He's a board-certified neurologist and board certified in anti-aging regenerative medicine and he's a member of the medical staff at Palm Regional Medical Center. Welcome to the show. Let's just start with some of the mainstays of therapy for prostate cancer and what's been the main therapy that you do.
Gene Rajaratnam, MD: Prostate cancer has many different treatment options. The one that we do in the US most commonly is robotic surgery where we remove the whole prostate using a robot assistant and that’s caught the fancy of all of the urologists in America. It’s also been done in other countries, but if you go to Europe, the mainstream treatment is not surgical. They do nonsurgical therapy, just ablating the cancer or doing something without having to cut into people. I trained in Germany and Dominican Republic training on two different machines that do tissue ablation using high-intensity focus ultrasound. It's soundwaves that are focused and you get heat at the focal point and directed to the tissue that you want ablated, this situation with the prostate gland. The other options would be radiation. People do that a lot, but I see a lot of patients with complications from radiation and if you have a highly invasive cancer, I don’t think radiation works very well. It may work for lower grade cancers, but for a lower grade cancer, why give radiation when there are other less invasive and less complicated therapies. The other option is cryoablation where we put needles in the prostate under anesthesia and ablate the cancer by freezing it -50 Celsius. Those are the common ways we treat cancer. Of course, there's hormone therapy, which I usually start when I diagnose the patient at least to stop the cancer from growing until we decide what options are the best for the patient. I explain all the options and I generally like to do less invasive procedures. If they work, why not?
Melanie: I certainly agree with you and you can try all of these different therapies and speak to your physician about them, but people have heard about focal therapy, about something that’s very direct. Tell us about this new hi-fu, or high intensity focused ultrasound.
Dr. Rajaratnam: High intensity focused ultrasound has been in development and has been in treatment for probably over 20 years. Like I said earlier, I've trained on this machine in Germany where that’s the first treatment and that’s the only treatment that they use for many patients. That was over 10 years ago, 2007 at that point. Professor Turoff in Munich had already done over 10,000 patients with very good results. Initially, they were doing therapy without doing anything else to the prostate like resecting part of it and do the treatment, so they noticed during the latter part of the study that if you resect a tumor a little bit or make a channel in the prostate so patients could urinate better and remove some of the tissue and leave behind the periphery of the prostate gland and treat that, you get a better result than trying to treat the whole large prostate. There are some restrictions to how much you can treat. Preferably it should be within 30 grams or about an ounce. I think that’s the best size for the prostate, so obviously it’s not a very good treatment if your prostate is very large, in which case you have to shrink it first. You can either give a shot of Lupron, which is an antihormone treatment, it not only stops the cancer from growing, it also shrinks the cancer, so the patients feel better, the cancer is controlled for the time being as long as they're on the hormone therapy and they're in preparation for a more definitive treatment, either cryoablation or hi-fu.
Melanie: Tell us about some of the advantages and disadvantages for the patient to use hi-fu and who might be a candidate? You said if they had a very large prostate, then probably not, or if there are multiple tumors. Tell us a little bit about patient selection criteria.
Dr. Rajaratnam: I think the most attractive reason why people would want hi-fu is because we can control the tumor ablation to just the prostate without doing any harm to the blood vessels and the nerves that are adjacent to the prostate around the 3 o'clock and 9oclock position. We can actually see those blood vessels pulsating and you know there's a nerve right next to it and you can control the treatment in such a perfect way that it does not go outside the prostate capsule. That’s the number one reason why people choose that, a younger patient or somebody who does not want to have the erectile function destroyed from treatment, which happens quite often with radiation surgery.
Melanie: That’s a very common side effect.
Dr. Rajaratnam: That’s one of the major side effects of prostate cancer surgery or even radiation. Patients end up being impotent or incontinent or both. There's a way less change that you're going to have those problems when you do hi-fu because it’s so precise and robotically done so you don’t even have to mess with it too much, but you have to watch the treatment live so you can control where to focus that treatment. Also, it can be done focally, meaning let's say the cancer is only in the right side of the prostate on the top part and not on the rest of the gland on that side and the other side, you can direct the treatment straight to that area, just ablate that and maybe a small area around it. Also, we do MRI studies before the prostate cancer is treated and you can actually identify a good MRI the region where the prostate cancer is located and you can take that image and use it into the ultrasound image on the prostate cancer treatment machine, which is a hi-fu machine and actually destroy the cancer and then do an MRI later and don’t see the cancer anymore.
Melanie: What are you seeing for outcomes? That’s amazing.
Dr. Rajaratnam: The outcomes, in a sense, it’s only been used in America for a short period. It was only FDA approved the latter part of the last year, but there are studies that have been done for the last couple of years, and the treatment results are just as good as any other treatment.
Melanie: That’s really fascinating, so give us your bottom line on this treatment and what you would like listeners to ask their urologist if a spouse is in with her husband or trying to figure out what kinds of treatments to look at, what do you want them to ask you about this type of hi-fu treatment for prostate cancer?
Dr. Rajaratnam: Like I said, the most important reason why they would do that is to conserve their sexual function, so if you want to kill the cancer but maintain your lifestyle, I would say hi-fu is probably is the number one option. Any other option is risky for erectile dysfunction as well as incontinence. The other option that can be done, the reason why you want it is just because it can be done outpatient, so there are no cuts involved, there are no incisions, it's all done transrectally, so you can walk out of the procedure and go have dinner at night with your family. It's very noninvasive, you don't need a hospital stay, there are no incisions, hardly any pain, the only thing you need is probably a catheter for a few days so the initial swelling from the treatment will be overcome by having a catheter and then you take it out. The tissue, of course, sloughs off and then it takes a little while for that slough tissue to fall off the prostatic fossa or the region right around the mouth of the bladder. Some patients have a little trouble passing that so they may require a treatment with a catheter for a longer time. It’s low risk, outpatient, no incisions, you go home and do whatever you do, and you maintain the lifestyle.
Melanie: Absolutely fascinating information. Thank you so much for joining us today and sharing your expertise on this new and unique treatment for prostate cancer. So many people will be interested to hear this. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit palmdaleregional.com. Physicians are independent practitioners who are not employees or agents or Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Exciting New Treatment: HiFU for Prostate Cancer
Melanie Cole: A new radiation-free therapy has recently been approved by the Food and Drug Administration for prostate tissue ablation, which also means that it can be used to treat prostate cancer. My guest today is Dr. Eugene Rajaratnam. He's a board-certified neurologist and board certified in anti-aging regenerative medicine and he's a member of the medical staff at Palm Regional Medical Center. Welcome to the show. Let's just start with some of the mainstays of therapy for prostate cancer and what's been the main therapy that you do.
Gene Rajaratnam, MD: Prostate cancer has many different treatment options. The one that we do in the US most commonly is robotic surgery where we remove the whole prostate using a robot assistant and that’s caught the fancy of all of the urologists in America. It’s also been done in other countries, but if you go to Europe, the mainstream treatment is not surgical. They do nonsurgical therapy, just ablating the cancer or doing something without having to cut into people. I trained in Germany and Dominican Republic training on two different machines that do tissue ablation using high-intensity focus ultrasound. It's soundwaves that are focused and you get heat at the focal point and directed to the tissue that you want ablated, this situation with the prostate gland. The other options would be radiation. People do that a lot, but I see a lot of patients with complications from radiation and if you have a highly invasive cancer, I don’t think radiation works very well. It may work for lower grade cancers, but for a lower grade cancer, why give radiation when there are other less invasive and less complicated therapies. The other option is cryoablation where we put needles in the prostate under anesthesia and ablate the cancer by freezing it -50 Celsius. Those are the common ways we treat cancer. Of course, there's hormone therapy, which I usually start when I diagnose the patient at least to stop the cancer from growing until we decide what options are the best for the patient. I explain all the options and I generally like to do less invasive procedures. If they work, why not?
Melanie: I certainly agree with you and you can try all of these different therapies and speak to your physician about them, but people have heard about focal therapy, about something that’s very direct. Tell us about this new hi-fu, or high intensity focused ultrasound.
Dr. Rajaratnam: High intensity focused ultrasound has been in development and has been in treatment for probably over 20 years. Like I said earlier, I've trained on this machine in Germany where that’s the first treatment and that’s the only treatment that they use for many patients. That was over 10 years ago, 2007 at that point. Professor Turoff in Munich had already done over 10,000 patients with very good results. Initially, they were doing therapy without doing anything else to the prostate like resecting part of it and do the treatment, so they noticed during the latter part of the study that if you resect a tumor a little bit or make a channel in the prostate so patients could urinate better and remove some of the tissue and leave behind the periphery of the prostate gland and treat that, you get a better result than trying to treat the whole large prostate. There are some restrictions to how much you can treat. Preferably it should be within 30 grams or about an ounce. I think that’s the best size for the prostate, so obviously it’s not a very good treatment if your prostate is very large, in which case you have to shrink it first. You can either give a shot of Lupron, which is an antihormone treatment, it not only stops the cancer from growing, it also shrinks the cancer, so the patients feel better, the cancer is controlled for the time being as long as they're on the hormone therapy and they're in preparation for a more definitive treatment, either cryoablation or hi-fu.
Melanie: Tell us about some of the advantages and disadvantages for the patient to use hi-fu and who might be a candidate? You said if they had a very large prostate, then probably not, or if there are multiple tumors. Tell us a little bit about patient selection criteria.
Dr. Rajaratnam: I think the most attractive reason why people would want hi-fu is because we can control the tumor ablation to just the prostate without doing any harm to the blood vessels and the nerves that are adjacent to the prostate around the 3 o'clock and 9oclock position. We can actually see those blood vessels pulsating and you know there's a nerve right next to it and you can control the treatment in such a perfect way that it does not go outside the prostate capsule. That’s the number one reason why people choose that, a younger patient or somebody who does not want to have the erectile function destroyed from treatment, which happens quite often with radiation surgery.
Melanie: That’s a very common side effect.
Dr. Rajaratnam: That’s one of the major side effects of prostate cancer surgery or even radiation. Patients end up being impotent or incontinent or both. There's a way less change that you're going to have those problems when you do hi-fu because it’s so precise and robotically done so you don’t even have to mess with it too much, but you have to watch the treatment live so you can control where to focus that treatment. Also, it can be done focally, meaning let's say the cancer is only in the right side of the prostate on the top part and not on the rest of the gland on that side and the other side, you can direct the treatment straight to that area, just ablate that and maybe a small area around it. Also, we do MRI studies before the prostate cancer is treated and you can actually identify a good MRI the region where the prostate cancer is located and you can take that image and use it into the ultrasound image on the prostate cancer treatment machine, which is a hi-fu machine and actually destroy the cancer and then do an MRI later and don’t see the cancer anymore.
Melanie: What are you seeing for outcomes? That’s amazing.
Dr. Rajaratnam: The outcomes, in a sense, it’s only been used in America for a short period. It was only FDA approved the latter part of the last year, but there are studies that have been done for the last couple of years, and the treatment results are just as good as any other treatment.
Melanie: That’s really fascinating, so give us your bottom line on this treatment and what you would like listeners to ask their urologist if a spouse is in with her husband or trying to figure out what kinds of treatments to look at, what do you want them to ask you about this type of hi-fu treatment for prostate cancer?
Dr. Rajaratnam: Like I said, the most important reason why they would do that is to conserve their sexual function, so if you want to kill the cancer but maintain your lifestyle, I would say hi-fu is probably is the number one option. Any other option is risky for erectile dysfunction as well as incontinence. The other option that can be done, the reason why you want it is just because it can be done outpatient, so there are no cuts involved, there are no incisions, it's all done transrectally, so you can walk out of the procedure and go have dinner at night with your family. It's very noninvasive, you don't need a hospital stay, there are no incisions, hardly any pain, the only thing you need is probably a catheter for a few days so the initial swelling from the treatment will be overcome by having a catheter and then you take it out. The tissue, of course, sloughs off and then it takes a little while for that slough tissue to fall off the prostatic fossa or the region right around the mouth of the bladder. Some patients have a little trouble passing that so they may require a treatment with a catheter for a longer time. It’s low risk, outpatient, no incisions, you go home and do whatever you do, and you maintain the lifestyle.
Melanie: Absolutely fascinating information. Thank you so much for joining us today and sharing your expertise on this new and unique treatment for prostate cancer. So many people will be interested to hear this. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit palmdaleregional.com. Physicians are independent practitioners who are not employees or agents or Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.