HIFU Physician Spotlight: Dr. Stanley Myers

Dr. Stanley A. Myers was born in Portland, Oregon. He graduated Magna Cum Laude with a B.S. in Biochemistry from the University of Oregon in 1986. After completing both his medical degree and surgical internship at Oregon Health Sciences University (OHSU) in Portland, Dr. Myers completed residency training in general surgery at Kaiser-Permanente Sunset Medical Center in Los Angeles and in urology at OHSU.

Dr. Myers is a Board Certified Diplomate of the American Board of Urology and a member of the American Urological Association, the Northwest Urological Society, and the Society of Laparoendoscopic Surgeons. His special interests include prostate HIFU (high-intensity focused ultrasound), cryosurgery, laparoscopy, endourology, percutaneous renal stone surgery, erectile dysfunction, and Peyronie’s Disease.

Learn more about Dr. Myers and specifically his experience with HIFU for prostate cancer by reading the interview below.

What was your main motivation in becoming a doctor? When did you decide on this path?

In high school, I dated a girl whose father was a general practice doctor in the Vancouver area. I had a lot of admiration and respect for him. He was a wonderful mentor and he had a huge influence on my decision to go into medicine.

How did you decide on your particular specialty? Why urology?

I was attracted to urology by the fact that it is a subspecialty of surgery. I’ve always enjoyed problem solving and working with my hands to fix things. These skills are particularly applicable in urology. Urologists gets to use advanced technologies in laparoscopic and endoscopic procedures, as well as a fair amount of traditional open surgery. Most other physicians only have a very basic knowledge of urology, which puts us in a unique and valuable position in the field of medicine. I like being an expert in what I do.

What is your favorite part about being a physician?

My absolute favorite part about being a physician is my doctor-patient relationships. I have been practicing urology for over 20 years. Over my career, I’ve had the privilege of getting to know some of my patients very well and enjoy helping them improve their health and quality of live. I consider many of them friends.

When did you first learn about HIFU as a treatment for prostate cancer?

I started reading about this technology called HIFU in the early 2000s. At the time, it seemed quite experimental. But then in 2008, a patient came to me asking me to be his urologist. He had prostate cancer and was going to Germany to have HIFU. He was having trouble finding a urologist who was willing to follow him after this “experimental” treatment. Like them, I tried to convince him to have traditional prostate cancer treatment like radical prostatectomy or radiation therapy. But he had done his research, and he was set on having HIFU. When he came back from Germany after his treatment, I took care of him. I was amazed that his PSA was undetectable, he had excellent urinary control and had no issues with erections. He was an easy patient because he had no complications to manage after his treatment. This is when I decided I need to do more research on HIFU. This led me to attending observation and training sessions offered by International HIFU in Mexico in 2010. After doing this, I became a believer and started bringing my own patients down to their Puerto Vallarta treatment location.

When did you become involved in treating patients using HIFU technology?

I started training in 2010. I treated my first patient at International HIFU’s Puerto Vallarta site in 2011.

What do you typically tell a patient when they are first diagnosed with prostate cancer?

It really depends on many factors like the patient’s age, how much cancer they have, how aggressive the cancer appears, whether it’s still contained within the prostate or spread outside the prostate. The first thing I do is explain to patients that prostate cancer is often very slow growing and that there are many men who will develop prostate cancer but never die from it and may never even know about it. On the other hand, some patients develop very aggressive, fast-moving prostate cancer that is life-threatening. We have some tests that help us decide whether their cancer is more likely to be life-threatening. However, these tools are not perfect. Some patients have cancer that looks slow-growing but is in fact aggressive. In others, it may look aggressive but because of health reasons, it may not grow fast enough to cause them problems. Deciding whether to treat prostate cancer and which treatment is the best is anything but simple. I never tell a patient that he must do this or that treatment. I try to educate them as best as possible and help them make their own decision.

What different types of treatments do you offer men with localized prostate cancer?

For localized prostate cancer, I educate them on radical prostatectomy, radiation therapy, cryotherapy, brachytherapy, and HIFU ablation of the prostate. Personally, I offer HIFU and cryotherapy as treatment options. If a patient wants a radical/robotic prostatectomy, I send them to one of my partners that has done hundreds of them. If they want brachytherapy or radiation therapy, I send them to one of our radiation oncologist colleagues.

In your professional opinion, what are the benefits of HIFU as a treatment for prostate cancer?

HIFU has been shown to be an effective treatment option in patients with localized prostate cancer. It is non-invasive and it has a fairly low risk of erectile dysfunction and a very low risk of causing permanent incontinence. Also, it does not limit any other treatment options should there be a recurrence of cancer. If cancer returns after HIFU, you can repeat the HIFU, or move forward with a radical prostatectomy, have cryotherapy, or even have radiation therapy.

How do you decide if HIFU is right for a patient?

When we are considering treatment for prostate cancer, or any cancer for that matter, we want to consider the risks versus benefits. There are several scenarios that I use when discussing prostate cancer treatment.

In some patients, there may be a low risk that the patient will die from prostate cancer if left untreated. But we don’t know that for certain. In this patient, the risks of complications from radical prostatectomy, radiation therapy, brachytherapy, and cryotherapy may not be worth it. The potential complications from these treatments tips the scale of risk versus benefit toward not treating. However, HIFU has a fairly low risk of significant complications and is very effective at destroying prostate cancer. This tips of scales in favor of going ahead with HIFU as a treatment option.

The other scenario is a patient who is at high risk for prostate cancer already being outside of the prostate and therefore potentially not curable with local treatment (the cancer will eventually come back in this situation, no matter which local treatment was used). Unfortunately, there are no tests that can tell us with absolute certainty that there is no cancer outside of the prostate. Some cancers silently spread and only show up years later. Going ahead with a radical prostatectomy, or radiation therapy, etc., puts the patient at risk for having to live with complications such as incontinence or erectile dysfunction, yet they still may not be cured after treatment. In this situation, we have harmed the patient more than helped them. In the high-risk prostate cancer patients, HIFU offers a potential cure with a lower risk of having to live with incontinence or erectile dysfunction or other issues the rest of his life in the event that the cancer was not curable after all.

In general, how quickly do your patients recover after HIFU? What do you tell men to expect?

The vast majority of men recover very rapidly. After HIFU, most patients have little or no pain. They go home the same day after surgery. Most men will have a sensation of pressure or urge to urinate for several days. Most men get back to normal activity within a week or two after HIFU.

There are obviously a lot of different treatments for prostate cancer; where do you think HIFU best fits in the prostate cancer landscape?

Because it is effective and has low risk of complications and does not preclude any other treatment options if HIFU fails, it is my opinion that, with few exceptions, HIFU should be first line therapy for most patients with localized prostate cancer.

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?

I tell my patients that unfortunately the US preventive Services Task Force got it wrong. The task force had no urologist nor any oncologists on their panel. They reviewed data that was contaminated by patients that were getting screened even though they were in the control group for not being screened. Not surprisingly, when they compared to the two groups, the difference in the survival outcomes were not that good. However, as the data has matured, there appears to be more and more of an advantage to screening for prostate cancer. Which five years later prompted the task force to revise their recommendation and give it a grade C instead of D. I predict that in the future it will get even a higher grade as the data shows more and more of an improvement in survival in men getting screened as the data continues to mature. Also, the task force recommendation against prostate cancer screening was never intended to apply to patients with a family history of prostate cancer or African-American men. More and more evidence is coming out that screening does make a difference. If you don’t know, you can’t make an informed decision about whether to get treated or not.

When you aren’t practicing medicine, what do you like to do?

I am a private pilot and enjoy flying. I also enjoy hiking and a backpacking, snowboarding, stand-up paddle boarding, and mountain biking.

Feel free to learn more about Dr. Myers, schedule a consultation, or ask us any questions you may have about HIFU treatments by reaching out to us.

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