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5 Steps to the Diagnosis, Management and Treatment of Prostate Cancer

REDEFINING PROSTATE CANCER TREATMENT

Suarez Prostate Cancer Institute:
“The 5 Steps to an Innovative Guide in the Diagnosis,
Management and Treatment of Prostate Cancer.”

Click each point for more information…

  • We are committed to utilizing the most sophisticated diagnostic tools for accuracy in diagnosing, mapping and staging prostate cancer as well other prostate conditions. We support the use of biopsy (extraction of tissue samples) as the ONLY way to confirm the actual level of aggression of any cancer cells. At the same time, we recognize that the way prostate biopsies have traditionally been done has flaws. It often misses cancer (up to 30% of biopsies) or it fails to capture the most aggressive cells (under staging) with the result that an inadequate treatment is chosen.Before biopsy, we want all of our patients to have a prostate MRI (Magnetic Resonance Imaging) done on the most advanced equipment, with the most advantageous methods of analyzing the images.Multiparametric MRI, the State of the Art Prostate ImagingOur patients undergo a prostate MRI done with the most powerful magnet available: a 3T MRI (meaning 3 Tesla, which is a way of measuring the strength.) The MRI takes just over a half hour, and there is no radiation involved. It is first done without a contrast agent, then the contrast agent is injected into the blood. More images are taken, because the contrast agent helps to “light up” abnormal areas. The images are then put through several different kinds of computer analysis. There are ways to tell normal from abnormal tissue: density of tissue, water content, elasticity, etc.

    If we don’t find anything on the MRI, we continue to monitor PSA blood tests. If the PSA rises, we want the patient to come back for another MRI. However, the multiparametric MRI is excellent at detecting suspicious areas that look like cancer. If this occurs, we take the next step to prepare for a targeted biopsy. The patient undergoes a special ultrasound of the prostate to give us images that we can “merge” or “fuse” with the MRI images. This is called fusion.

    During the biopsy, the MRI images are fused with ultrasound imaging. The system employs GPS-type technology to guide the biopsy needle to the lesions detected by the MRI, leading to significantly fewer needle biopsies. Compared with traditional biopsy techniques that randomly blind sample the prostate (missing cancer up to 30% of the time, and often underestimating the aggression level), our technology helps us from missing hard-to-find and often-aggressive prostate cancers. This helps provide greater certainty regarding the extent and aggressiveness of the disease. And it could enable patients to avoid multiple and unnecessary repeat prostate biopsies.

    Traditional biopsies lack precision, which can lead to either too much treatment or not enough treatment. In conjunction with tumor grade, clinical stage and genetics test, MRI/ultrasound fusion is the next generation of MRI evaluation in the fight against prostate cancer. These leading-edge imaging technologies will improve patient care by enabling us to detect and characterize abnormalities at the earliest possible stages. The platform we utilize gives correct information so we can recommend the best treatment options to the patient. In addition, the ultrasound exam, using color Doppler enhancement, helps us locate the nerve bundles necessary for erectile function. This is important, because if the patient requires treatment, we can spare the nerve bundles in order to preserve erectile function.

    Tailoring Treatment

    Advanced diagnosis paves the way for tailoring the treatment to the patient. With correct and accurate diagnosis as the result of the biopsy, many patients will qualify for focal HIFU, which allows for tissue preservation of non-cancerous tissue. In essence, the treatment of the prostate cancer now “a male lumpectomy,” similar to a breast lumpectomy that allows a breast cancer patient to preserve her femininity. A focal HIFU treatment can spare sexual potency, so a man can preserve his masculinity. Whether done as a whole gland or focal procedure, HIFU is an outpatient procedure with immediate same day recovery and less risk of potential quality of life complications such as impotence and/or erectile dysfunction.

  • The most dreaded time in a patient’s life is the time from biopsy to the results of the biopsy. We provide two full time pathologist specialty trained in prostate neoplasm that in most cases can provide a 24 hour interpretation of the biopsy. They are so revered that they serve as a reference pathology lab and consultants for other pathologist.This is critical, as the biopsy is the most imperative and critical factor in determining treatment options. The significant factors derived from this information are the Gleason Score, location of the cancer and number of positive biopsies and volume of cancer within each individual biopsy.This is the true and tested metrics: “the biopsy is critical in recommending a treatment, planning a treatment and predicting clinical outcome and prognosis. Particularly in men considering focal therapy or potency sparring procedures. A patient should never undergo any type of treatment without a confirmed tissue diagnosis.Additionally, there is no substitute or imaging study that can serve as alternate for the information obtained from a biopsy. In fact, imaging studies have a greater then not false-positive interpretation that in most cases are nothing more then inflammatory prostatitis conditions.

    random-biopsy

    Our program combines MRI guided images of the prostate with fusion of transrecral ultrasound images, resulting in greater accuracy and sensitivity of the biopsy. Thereby, a more accurate grading and staging of the cancer.

    There has not been the exceptional and scarce mention of needle tract cancer seeding, but this has never been scientifically proven, nor has it been accepted by any of the respected academic urology institutes on a global basis. Including the American Urologic Guidelines (AUA) in diagnosis and treatment of prostate cancer (www.aua.org). There is simply no alternative diagnostic to a tissue confirmed diagnosis for establishing the presence of prostate cancer.

  • There is that low risk disease can be safely managed by Active Surveillance or minimally invasive ablative therapy such HIFU. In addition to tumor grade and clinical stage, a genetic test (biochemical tumor markers) can assist in predicting the prognosis, clinical course of the disease and urgency of treatment. The decision to treat is often times driven by one or a combination of the following:

    • Lack of ability to determine the aggressive behavior of the cancer in the absence of genetic testing.
    • Concerns due to the tumor heterogeneity (mixed cell lines) and mutifocality (many locations in the gland).
    • Patient preference and anxiety over the predictability of the course of the disease.
    • Physician prejudice and recommendations.
    Figure 1 Electron microscopy magnification of the surface of a prostate cancer cell.

    Figure 1 Electron microscopy magnification of the surface of a prostate cancer cell.

    It is important to consider genetic testing of your individual prostate cancer, especially if you have already had another form of treatment and your cancer appears to have come back. HIFU can be used as a “salvage” treatment (second treatment if cancer recurs and is localized within the prostate) but it is best to understand how quickly the cells may mutate (change) and become more aggressive.

    Figure 2. Genomics testing is as simple as a DNA sample from a single blood drop.

    Figure 2. Genomics testing is as simple as a DNA sample from a single blood drop.

    It is not unusual that patients pursue continued research into their medical conditions well after treatment. Genomics testing of your prostate can be performed on biopsy samples or removed surgical prostate tissue that is less the 6 months old.

    Why even undergo genomics testing? What are the benefits of genomics testing?

    The platform was developed to address tumor heterogeneity and biopsy under-sampling, It is individualized based on genetics and multiple biologic pathways predictive of aggressive or indolent nature of your prostate cancer. A unique feature of genomics testing is the ability to optimize technology for very small amounts of tumor from needle biopsies and to assist in arriving at a treatment decision. Genomics testing may also be utilized in decreasing the risk of over treatment.

    Figure 3. A strand of DNA from a patient diagnosed with prostate cancer.

    Figure 3. A strand of DNA from a patient diagnosed with prostate cancer.

    In conclusion, this information will empower the patient with the knowledge to make scientifically based decisions, founded on medically statistics evidence.

    How does the BRCA gene affect men?

    Since Angelina Jolie announced she underwent preventive bilateral mastectomy due to her high risk of developing breast cancer, and the fact that she is a carrier of the BRCA gene, the world has been captivated by the news. Her picture is on the cover of Time Magazine with the heading: “The Angelina Effect.” Likewise it made the cover of People magazine, and just about the front page of every newspaper in America. She has long been a symbol of feminine beauty, and her body an expression of her fame, but now it stands to represent an even bigger dimension of her influence on the genetics testing and preventive measures of cancer. Indeed, more important then the media frenzy about one of the world’s most beautiful women undergoing what some consider radical measure of cancer prevention, is the awareness this has brought to cancer screening and genetic testing. A similar phenomenon occurred in 2000 when Katie Couric underwent a televised colonoscopy that resulted in a demand for the procedure that was promptly coined “The Couric Effect.” In which the publicity and media coverage probably saved many lives.

    There are two BRCA genes, known as BRCA1 and BRCA2. The gene produces a protein that helps stabilize DNA. However, when it can’t do its job it allows for the proliferation of some of the most destructive cells in the form of cancer cells. It is well known that in women BRCA confer a greater risk of breast and ovarian cancer. More recent research has looked at the effects of these genes on men. What emerged from the most recent studies is that BRCA2 particularly seems to be associated with a much higher chance of developing aggressive prostate cancer. To date there is no conclusive studies as to just how much greater a man’s risk to cancer with BRCA is, but the Institute of Cancer Research has published data showing a definite link. What we do know is that both forms of BRCA gene belong to a group known as tumor-suppressor genes, and carriers have an increase risk of other cancers beyond ovarian and breast, but also pancreas, testicular and prostate, as well as a rare form of male breast cancer.

    Could preventative prostate surgery become a reasonable option for men?

    Prostate cancer is typically thought of as a slow growing cancer that often times does not even require treatment other than observation: particularly in men over the age of 70. However, BRCA genes have been linked with a more aggressive form of prostate cancer that affects younger men and carries the ability to spread much faster. The critical question is preventive prostate surgery a reasonable option for men that carry the BRCA gene? There are numerous ongoing studies to determine the implications of the BRCA gene in men with prostate cancer. However, at this stage there is no conclusive evidence that such extreme prostate surgery is indicated.

    The British media recently reported on a man with BRCA gene that underwent preventive prostate cancer surgery as the first of its kind. However, it is important to highlight it was not strictly preventative: he already had the very earliest of signs of prostate cancer, and was part of a research trial and was known to be BRCA2-positive. The gene alone would not have been reason enough to remove his prostate, but in this case the medical team involved agreed to such radical surgery because the patient had both the BRCA gene and the early signs of prostate cancer. In fact, a biopsy revealed subtle changes of prostate cells associated with the earliest stages of cancer, and doctors and patient agreed to operate. Earlier tests – an MRI, magnetic resonance imaging, scan and a prostate-specific antigen test – had been clear of the same.

    The urologist performing the surgery was quoted: “The relatively low level of cancerous cells we found in this man’s prostate before the operation would these days not normally prompt immediate surgery to remove the gland”, Professor Kirby told The Sunday Times, “but given what we now know about the nature of BRCA2, it was definitely the right thing to do for this patient.”

    One can argue that prophylactic mastectomy with immediate reconstruction may be considered a reasonable cancer preventive measure with typically good functional and cosmetic outcomes. However, the concept of radical prostate surgery is a more complex issue, in that there are potentially major downsides and collateral damage as to quality of life matters. Such as impotence, ejaculatory dysfunction and urinary incontinence.

    There has recently been a great deal of controversy about prostate cancer screening and the usefulness of PSA testing. The BRCA gene adds another dimension to this controversy. However the controversy spins out, most doctors are not against prostate cancer screening, instead they are more concerned about the potential complications associated with standard treatment for it: particularly in the compromise of quality of life issues such as impotence and urinary incontinence. However, the fast growing global acceptance of High Intensity Focused Ultrasound (HIFU) makes this for a very exciting treatment option in such high-risk patients, and offers less risk of complications or collateral damage commonly seen with other treatment options.

    Dr. George M. Suarez is a board certified urologist with special interest in prostate cancer. He is based in Miami, Florida and is considered the leading expert in the application of HIFU for the treatment of prostate cancer, as well as other minimally invasive treatment options. He is the founder and medical director emeritus of SonaCare Medical (formerly USHIFU). He is regarded as the most experience HIFU urologist in the world.

  • As the pioneering founder of the first HIFU center in the Americas, and the most experienced HIFU physician. Additionally, for first 2 years after establishing the center, he was only urologist in North America performing HIFU before others adopted the technology. Since then he has trained over 400 physicians and has been instrumental in developing many of the current hardware, software applications and training materials.

    He served as the company’s first medical director, and was an integral part of designing the guidelines for FDA clinical trials. He has developed numerous unique applications to the technology that have proven to be the best clinical patient outcomes. He remains a member of the company’s board of directors and maintains an active urology practice in Miami, Florida.

    1. Professional physician’s fee will be waived in the event of a re-treatment is required within 5 years of the original therapy in cases of whole-gland ablation that meet appropriate criteria.
    2. Samples Pre-HIFU medications will be provided at no cost to the patient.
    3. With your samples of medication, you will also receive a coupon to order a specially designed device to be used after your HIFU treatment as part of our tried and proven “Return to Potency Program.” This will also include medical samples such as Viagra, Cialis, or Levitra, at no cost.
    4. You will receive a “medic Alert” card with pertinent information regarding your treatment and access numbers to our medical team.
    5. A detailed report of your procedure will be provided to you so that you may keep for your records and for your other doctors.
    6. My staff and I will provide with the necessary documents and assist you in receiving reimbursement of your HIFU treatment through our in-house company: Global Insurance Recovery company.
    7. If you need to visit our Miami practice, my staff will arrange complimentary pick-up and transportation from airport to our office or your hotel. We will also be happy to arrange travel and hotel reservation.
    8. The patient and their family will have access to the doctor and his entire medical team 24 hours/7 days a week.
    9. We may be reached via our office, including 1-800 toll free number, email or Dr. Suarez’s personal cell number.
    10. If you wish, we will include you in our monthly email newsletter in order to keep you informed of the latest developments in prostate cancer, ranging from new treatment, prevention, dietary and supplement concerns and other health related issues.
    11. We will send you periodic remainders alerting you that you are due for your routine follow up PSA.
    12. You will receive scientific articles that are published on the efficacy of HIFU so that you are kept abreast of the development of this exciting technology.
    13. Your referring and primary doctors will also receive published papers on HIFU and its application for prostate cancer and other conditions. such as kidney, liver, bladder, uterus, Parkinson’s Disease, and heart etc. As HIFU technology continues to expand into other applications.
    14. We will be happy to send educational material to your friends, family or colleagues on our experience with HIFU.
    15. We want to hear about your experience with your treatment and will ask you to complete a survey of your experience and let us know how we can serve you and future patients better.

    We want to make every effort to have a doctor-patient relationship that continues long after you leave our facility and the energy from the HIFU machine has been turned off.

The past decade of breakthroughs in clinical research and unprecedented technical advancements has affected few medical conditions more than in prostate cancer. Even the most up-to-date advice can vary significantly from one doctor to the next.

This is particularly influenced by the doctor’s specialty, expertise, if not just simple prejudice; surgeons will recommend surgery, radiation and medical oncologist will favor radiation and cryosurgeons will advocate freezing it.

Above all, we recognize that just as every prostate cancer is different in every man who is diagnosed, likewise, each man has very different concerns, needs and expectations.

The goal of treatment recommendations is a cure based on the clinical and pathologic stage of the cancer. However, treatment recommendations should be individualized and incorporate such factors as the patient’s age, personal and family situation, occupation, emotional needs with emphasis on preservation of quality of life issues.

What is good for one man may be completely wrong for another, even if they have similar type and grade of prostate cancer. It is as simple as: “one size does not fit all” when it comes to past, present or future treatment of prostate cancer care. The goals of our comprehensive program help men and their and families learn about prostate cancer from diagnosis through treatment options and beyond. We have developed the most comprehensive program for:

  • Diagnosis,
  • Staging,
  • Genetic Markers for Risk Stratification and
  • Treatment Options.

For those interested in HIFU, we urge to communicate with previously HIFU treated patients from our “patient testimonial” section on our website. You will learn how all men from all walks of life have found health and improved quality of life in the course of their prostate cancer journey by using our innovative and unique “5 Step Program and Personalized-Concierge Services.”

On the forefront of innovative platforms of approaching
diagnosis, management treatment options is the
Suarez Prostate Cancer Institute 5 Step Approach:

Why Choose Hifu Prostate Cancer Institute Miami?

PERSONALIZED CONCIERGE Medical Care, 24 Hours / 7 Days Per Week:

Most medical treatments, including HIFU, are performed in brief time frame. In fact, diagnosis, arriving at a treatment decision and post-treatment care consumes the majority of patient-doctor time and care. By offering PERSONALIZED- CONCIERGE medical care, our patients have 24/7 access to Dr. Suarez.

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