Dr. Anshu Guleria has been pioneer in minimally invasive prostate cancer treatments since the mid-1990s.
In 2010, expecting FDA approval, he began treating patients with HIFU in the Bahamas. As medical director of NOVA HIFU, he will assure that patients have a rigorous pre-treatment evaluation in order to achieve the best post-treatment outcome.
1. What was your main motivation in becoming a doctor? When did you decide on this path? My father is a doctor and many of his friends were also doctors. I am the oldest sibling, so it was kind of expected of me to follow in his footsteps. I always loved biology and nature so I decided when I was about 15, that I would pursue a medical career. I was accepted into a 6 year college-medical school pathway and started that just after I turned 17.
2. How did you decide on your particular specialty? Why urology? When I was doing my required surgical rotations as a student, I saw a man who was in agony after hernia surgery because he could not urinate. The urology resident placed a catheter and I saw instant relief in the patients face. I also liked the access to high tech gadgets in urology like scopes, lasers, lithotripsy, and more recently robotics and HIFU.
3. What is your favorite part about being a physician? I really enjoy helping someone feel better both physically and emotionally.
4. When did you first learn about HIFU as a treatment for prostate cancer? Probably about 2008 there were some publications from early European trials. As I learned more, I really liked the results and wanted to see what was available to my patients.
5. When did you become involved in treating patients using HIFU technology? In 2010, a patient about my age (mid-40s) asked what prostate cancer treatment I would get if I were him. He became my first HIFU patient once I was signed up to train and do cases in the Bahamas.
6. Why did you initially become interested in HIFU as a treatment for prostate cancer? Over the past 25 years, I have seen so many patients having severe complications after radical prostatectomy or radiation therapy for localized and not very life-threatening cancer. When the reports for HIFU coming from Europe showed such low side effects, while still treating the cancer, I naturally wanted to learn about it.
7. What do you typically tell a patient when they are first diagnosed with prostate cancer? Survival rates are almost 100% at 5 years, even for men with advanced cancer. The cancer is almost always asymptomatic and the treatment should match the disease. Each individual patient and cancer are unique and we must look at the big picture before starting any treatment.
8. What different types of treatments do you offer men with localized prostate cancer? I was among the first in Washington DC to do radiation brachytherapy in the mid-1990’s. I was an early adopter of prostate cryoablation in 2002. I trained on HIFU therapy in 2010 and continued offshore treatments until FDA approval in 2015. I trained in the era of open radical prostatectomy then learned robotic prostatectomy in 2013.
9. In your professional opinion, what are the benefits of HIFU as a treatment for prostate cancer? It is a virtually painless recovery with only a bladder catheter for 5-7 days after. The ability to treat only the areas where there is cancer allows for sparing injury to the surrounding nerves, blood vessels, and the urethra. Impotence rates are universally less than 10% while other therapies are at best 50%.
10. How do you decide if HIFU is right for a patient? There are several factors: 1. Prostate size should be less than 40cc in volume or at least the cancer containing part has to be within the treatment zone of the HIFU device. 2. The cancer should be thought to be contained within the margin of the prostate, not extending outside it. 3. The patient has to understand that part of the prostate will remain alive and may have a risk of undetected cancer in these areas. 4. The patient has to be in generally good health with greater than 10 year life expectancy. 5. There are some other decisions based on prostate anatomy, patients other health conditions, etc. that may limit HIFU’s effectiveness.
11. In general, how quickly do your patients recover after HIFU? What do you tell men to expect? As soon as the catheter is removed, 5-7 days after the procedure, the patient should feel nearly 100%. There may be some minor blood or discharge in the urine for a few weeks. Probably the only restriction up to 6 weeks after HIFU would be biking, horseback riding, or other activities that directly press on the prostate.
12. There are obviously a lot of different treatments for prostate cancer; where do you think HIFU best fits in the prostate cancer landscape? Patients who have a significant cancer but would otherwise choose observation due to concerns about complications from surgery or radiation. HIFU is particularly good for men who want to maximize their chances to maintain normal erectile function.
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? Prostate cancer remains the second leading cause of cancer related death for men in the United States, so we should not ignore its impact on men’s lives. PSA is not a bad test, only its interpretation and then, the over treatment of cancer, led to recommendations against prostate cancer screening. Over the 30 years since PSA has been in use, the urology community has made numerous changes to better assess and treat for prostate cancer.