HIFU Physician Spotlight: Steven Gange, MD

Steven Gange, MD
Steven Gange, MD

Steven Gange, MD, a urologist in Salt Lake City, Utah, loves being able to genuinely interact with his patients and takes his speciality very seriously. Learn more about him and his experience with HIFU in the interview below!

Read a full bio of Dr. Gange here.

  1. What was your main motivation in becoming a doctor? When did you decide on this path? I’ve always looked at medicine as a bit of a “calling”—there has to be more to it than having a lucrative career, because frankly it’s a long hard road. Mid way through high school I took some aptitude tests; while it seemed I had what it takes to become a doctor what convinced me to pursue a career in medicine was the prospect of really helping others. This focus sustained me through the rigors of my subsequent 12 years of education and training, and it is now what gets me out of the bed in the morning (and on occasion in the middle of the night!). Every single day I am convinced I chose the right path for me.
  2. How did you decide on your particular specialty? Why urology?In my third year of med school as I was exposed to various specialties I seemed to fit best into urology. We take care of men and women of all ages, utilize the latest technologies to do so, and almost everyone gets better from our interventions. I enjoy the blend of cognitive and procedural efforts in my specialty. And we are often the confidants of the most sensitive aspects of being human; I take that seriously.
  3. What is your favorite part about being a physician?The genuine smiles, handshakes, and occasional hugs that come from satisfied patients is addictively gratifying. I have also found a niche in providing education to patients and their families, students, and my peers.
  4. When did you first learn about HIFU as a treatment for prostate cancer?Mid-2000s
  5. When did you become involved in treating patients using HIFU technology?I began treating men with prostate cancer in about 2007; since it was not available in the US yet I began doing HIFU on my patients by traveling to treatment centers in Mexico, and later in the Cayman Islands
  6. Why did you initially become interested in HIFU as a treatment for prostate cancer?I immediately appreciated the remarkable science of HIFU, and its minimally invasive nature fit into my existing general approach to urological care. When I began seeing the cancer outcomes and lack of significant side effects I was sold!
  7. What do you typically tell a patient when they are first diagnosed with prostate cancer?I want my patient to be well educated and gain a sense of control in what can be a scary situation. There are always options, and I find that by listening to my patient I can help him find a care pathway that he can feel good about. Significant other input and support is invaluable and I involve them early and whenever possible along the way.The first thing we need to determine is whether his cancer even needs to be treated (nearly half of the prostate cancers I diagnose are low grade and low volume—these can often be simply monitored with Active Surveillance: while some will progress over time, some will be indolent and never threaten a patient’s health or longevity). In the others we next exclude any evidence of spread beyond the prostate—those that have spread to lymph nodes or bone cannot be cured, but can certainly be managed and slowed down, preserving as long as possible a man’s quality of life. Finally those that can potentially be cured can be approached with several treatment strategies, including HIFU. I talk to my patient about risk/benefit of the treatment options, and share my level of expertise in each. I always encourage second opinions. When a decision has been made I strive to provide clear communication throughout the process, and for the years of care that follow.
  8. What different types of treatments do you offer men with localized prostate cancer?I did radical prostatectomy through a perineal approach for nearly 20 years. As HIFU emerged I looked critically back at my experience: I determined that while many cancers were stopped in their tracks, many urinary and sexual side effects followed; over the next several years as I adopted HIFU into my practice I appreciated that there were other less invasive but still very effective ways to address this disease. I dabbled with cryotherapy but found it to be imprecise and very toxic from a sexual standpoint. I also began doing more HDR brachytherapy and appreciated its overall patient experience. I now no longer perform radical prostatectomy. I elected not to learn the robotic approach; from my ongoing observations I’m not convinced that it has reduced the morbidity of my perineal approach. I simply cannot recommend any approach to radical prostatectomy to my patients; there are kinder and gentler ways to effectively deal with localized prostate cancer
  9. In your professional opinion, what are the benefits of HIFU as a treatment for prostate cancer?HIFU offers effective cancer control with minimal sexual and urinary risk. It is truly precise delivery of cancer cell ablative energy
  10. How do you decide if HIFU is right for a patient?This decision hinges on the nature of the cancer, the anatomy of that prostate, and the balance of a patients view of risk and benefit.
  11. In general, how quickly do your patients recover after HIFU? What do you tell men to expect?There is typically no pain after HIFU. Recovery is affected by the presence of a suprapubic tube or urethral catheter. It is hard to be too active when those are present, though within a few weeks almost all patients are tube-free and activity restrictions are lifted; urination typically returns to normal at this time. Sexual recovery may take a few months.
  12. There are obviously a lot of different treatments for prostate cancer; where do you think HIFU best fits in the prostate cancer landscape?HIFU is best reserved for men with localized cancer in a relatively  small gland, and in someone who wishes to have the best hope for sexual preservation. Insurance coverage is still an issue so HIFU does require some degree of financial outlay
  13. In recent years there has been some discussion about over treating prostate cancer and even changing guidelines on when men should start getting regular screening for prostate cancer. What do you tell men?PSA testing has been recently bashed, mostly by those who do not care for men with prostate cancer. As urologists we see the ongoing value of PSA (which remains one of the very best cancer detection blood tests in mankind), although in 2018 it is but one tool in the diagnostic pathway (eg, digital rectal exam, free psa, psa-density, psa-velocity, pre-biopsy genomic testing, multiparametric MRI with PI-RADS scoring, etc). I am dismayed when I read articles in the lay press that imply that every man with an abnormal psa gets an invasive and risky prostate biopsy and that urologists aggressively surgically remove all cancerous prostates with no regard for the harm of these endeavors. I’ve never met such a narrow-minded and uneducated colleague, and I strive to be far more discriminatory in my decision making, and transparently share my thought processes with my patient.



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