An avid runner, bicyclist and skier, Ron was worried that surgery or radiation to treat his prostate cancer would put his active lifestyle in jeopardy. But not treating his cancer could potentially shorten his life by decades.
Standard treatment, which includes surgery or radiation, can cause erectile dysfunction and incontinence, side effects that can last a lifetime. Prostate cancer is typically discovered later in life, when many men are less physically and sexually active, and the benefits of treatment can outweigh the risks of side effects. But for men as young as Ron, side effects can factor heavily into the treatment decision.
“We didn’t make a decision very quickly,” said Yolanda, his wife of 34 years. Instead, they researched treatment options and doctors. A friend recommended Stanford, and suggested they see Geoffrey Sonn, MD, an assistant professor of urology.
“Dr. Sonn indicated that Stanford was looking into a new kind of focal therapy, where they treat just part of the prostate gland, instead of removing the entire gland, with better outcomes in terms of fewer negative side effects,” said Ron. “So that was appealing to me, obviously.”
Stanford has been offering MRI-guided high-intensity focused ultrasound (HIFU) for the treatment of prostate cancer as part of a clinical trial for the past three years. The treatment is already approved and available to patients in Europe andAsia, but is undergoing FDA approval in the U.S.
With HIFU, ultrasound energy is aimed from outside of the body, and concentrated within a target deep inside the body. “The technology is something akin to taking a magnifying lens and focusing sunlight onto a leaf—you can basically destroy the tissue that’s at that target and the surrounding structures are left intact,”said Pejman Ghanouni, MD, PhD, assistant professor of radiology. HIFU is possible at Stanford because of the merger of two technologies—MRI andfocused ultrasound. “We can see thetarget on the MR scanner, and then use those real-time images with the patient on the table to plan the treatment and see where we want to aim the energy,” he said.
HIFU for prostate cancer is only offered at a handful of centers in the United States, and it is not recommended for every patient. There are some men with small, non-aggressive cancers who benefit from no immediate treatment, just observation, said Sonn. Conversely, men with larger, particularly aggressive cancers may have better long-term outcomes from a robotic radical prostatectomy or internal or external radiation.
As Sonn explained, “HIFU gives us an intermediate step between no treatment and really aggressive treatment that can have lifelong side effects.” It is ideally suited for a man with an intermediate grade prostate cancer that warrants treatment, but perhaps for whom removing the entire prostate is too aggressive, he said.
“What we have found with HIFU is lower rates of erectile dysfunction, lower rates of urinary incontinence, quicker recovery and minimal pain,” said Sonn. “To be able to offer this treatment to a man in his 50s or 60s is very gratifying.”
For Ron, traveling a few hours to Stanford meant receiving the most advanced standard of care available. “Quality of life was the most important thing,” he said. “I’m lucky to have benefited from this cutting-edge technology.”
On the day of the procedure, Ron recalls waking up as if nothing happened. “Yolanda and I went out to dinner that night,” he said. Having a catheter in place for seven days after the procedure was the most discomfort he experienced. “The day the catheter came out, I started running again,” said Ron. “It was that easy. If it weren’t for Stanford, I don’t think I’d have the quality of life I’ve had over the past year. I’m good as new, if not better than new.”
Like many people who face a cancer diagnosis, Ron has a newfound appreciation for the simple things in life—the runs with his dogs, savoring good food. “Next year, I turn 60,” he said. “People tell me I look better than before. You start to take a little better care of yourself, appreciate what you have and what you may have lost.”