When the doctor becomes the HIFU patient – Dr. Robert Pugach’s Story

Dr. Robert Pugach opens up about his ownprostate cancer journey

Author: Robert Pugach, M.D.

Most of the people reading this post do not know that I have prostate cancer. Some of you do. To prevent rumors, crazy stories and wild scenarios about my upcoming demise (not!) I’ve decided to blog about my disease.

Please understand that there is a wide range of people reading this – most are not in the medical field. While many are, including physicians, please understand the verbiage that follows so we can all understand what I’m saying.

My prostate cancer was diagnosed late last year. My internist, as part of my annual check-up, ordered what all good primary care physicians should order – a PSA blood test. I requested that a “free” PSA be added to the total PSA level that is typically done.

My total PSA was completely normal with a value of 1.5. But, my free PSA was less than the 25% figure good urologists want. It was 18%.

So, I traveled north to Santa Rosa for a biopsy. A colleague of mine, Michael Lazar, got the honor/task of doing my biopsy. I’ve known Michael for almost 10 years as we treated prostate cancer patients with HIFU out of the country.

My biopsy showed a minuscule focus of cancer. It is a Gleason 3+3, involving 4% of a single area.

I’ve had 3 MRI scans. None have shown the cancer. One was a bit scary as it suggested possible cancer outside of the prostate. Thanks to the good work of radiologists at Los Alamitos Medical Center they determined that some enlarged lymph nodes had been present for some time so I have no cause for concern.

Dr. Robert Pugach
HIFU physician, Robert Pugach, MD was diagnosed with prostate cancer and will have HIFU treatment.

So, what to do about a tiny, moderately aggressive prostate cancer? Well, some would do nothing. I am a candidate for “active surveillance” or “watchful waiting.” There are many patients whose cancers will never progress to the point where they pose a danger.

My concern about that approach is that no one really knows what we are waiting for. There is no level of PSA and there is no imaging study that says when we must treat prostate cancer.

Add to that the fact that 37% of men have more aggressive or more extensive prostate cancer than what is found on biopsy.

I am not a gambler, especially when it comes to my health. I desire and plan to live a long, healthy life.

So, I’ve decided to have my prostate cancer treated. I don’t want to have radical surgery due to the potential of permanent urinary incontinence and erectile dysfunction. I don’t want radiation due to the likelihood of a recurrence in the future.

I am going to have a urethral sparing HIFU procedure by Dr. Lazar on May 9. I look forward to having the same result as most of my HIFU patients have. I look forward to the same cancer free, normal, uninterrupted quality of life that my brother experienced when he had a HIFU procedure almost 10 years ago.

The difference is that I can have my HIFU procedure in the U.S. Until last year, that wasn’t possible. Now that our FDA has approved HIFU, patients are now treated locally. In Los Alamitos, our HIFU center is the most experienced west of the Mississippi.

If there’s a message here it’s this: EVERY man is at risk for prostate cancer and every man should be screened EVERY year with a free/total PSA and a digital prostate examination.

If you are a primary care physician, be sure you include the PSA in your annual screening for patients and be sure you order a FREE PSA. If the results are not completely normal, refer them to a urologist.

If you are a patient, be sure you ask your doctor to order BOTH a free and a total PSA as part of your annual check-up.

I am going to write more with an update after my procedure. I want to record my thoughts before, immediately after and months later after my HIFU procedure for my prostate cancer. It will help me and, hopefully, many of you reading this.

Click here to read part II of Dr. Pugach’s story.

About the Author
Dr. Robert Pugach is the fourth most experienced HIFU practitioner in the U.S. and one of only a few certified HIFU teachers and proctors. He first trained with Sonablate HIFU in 2006 and since then has treated or been involved with approximately 400 HIFU cases.

Pugach is the medical director of Pacific Coast Urology Medical Center, the first urology practice centered on minimally invasive treatments of urological conditions. It continues to be at the forefront of new, innovative technologies like High Intensity Focused Ultrasound (HIFU). Read More.

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