Dr. Michael Schlesinger is a urologist who loves working with patients and using advanced technologies to treat his patients. Learn more about him in the following Physician Spotlight and find out when and why he started using HIFU for his patients with localized prostate cancer.
When did you decide that you wanted to become a doctor?
I recently found a piece that I wrote in third grade that said I wanted to be a fireman and race car driver. I did get to slide down a fire pole and even drive a fire truck as a city councilman, but never did work as one of these dedicated professionals. I tried being a race car driver for a short period of time and quickly realized that I was better at being a physician. It seems that for as long as I can remember though, I have always wanted to be a doctor.
How did you decide on your particular specialty? Why urology?
I remember a lecture we had back in medical school by the Director of Urology. He said, “if you want to make a friend, help a man that can’t urinate.” This has held true. Urology combines both medical and surgical treatments and has some of the best technologies in medicine, like HIFU.
What is your favorite part about being a physician?
I love to be able to use my knowledge and skills to improve other people’s lives. I enjoy the relationships that I have built with my patients.
When did you first learn about HIFU as a treatment for prostate cancer?
I first learned about HIFU in 2008 while attending a conference on focal therapy for prostate cancer.
Why did you initially become interested in HIFU as a treatment for prostate cancer?
I had already been skilled at other minimally invasive treatments for prostate cancer such as brachytherapy (radioactive seeds) and cryoablation (freezing). HIFU fit in nicely with these treatments but had even less side effects.
What do you typically tell a patient when they are first diagnosed with prostate cancer?
Even after 25 years, it is not easy to share a new cancer diagnosis with my patients. Thanks to yearly screening we typically find prostate cancer very early. I explain to them that in most cases, cure rates are excellent and unlike many other cancers, there are choices for treatment. I try to reassure them that we have time to make a good decision regarding which treatment is right for them
What different types of treatments do you offer men with localized prostate cancer?
I am part of multi-specialty group with three urologists. My expertise is in minimally invasive treatment options for prostate cancer including brachytherapy, cryoablation and HIFU. One of my partners performs robotic surgery. Our hospital has a state-of-the-art radiation therapy department.
In your professional opinion, what are the benefits of HIFU as a treatment for prostate cancer?
For low to intermediate risk cancer, I have come to believe that HIFU therapy is equal to other treatments including radical surgery in terms of cancer control. Its real benefit is its favorable side effect profile with very low incontinence and erectile dysfunction rates. Recovery times are also very quick.
How do you decide if HIFU is right for a patient?
After reviewing the Gleason score, percent of tumor involvement and size of the prostate, I will present the patient with the treatments that will best cure their cancer. We will then discuss the side effects and the impact that they could have on their lives. Every person is different, and no one treatment is right for everybody when we have such good options.
In general, how quickly do your patients recover after HIFU? What do you tell men to expect?
Very few patients have much pain or disability after HIFU. I am often reminded of a patient that I treated many years ago in Nassau before it was approved in the US. On the evening of the day of his procedure, I saw him sitting at the edge of the pool with his legs dangling in the water sipping on a drink. I asked him how he was doing, and he said, “isn’t it obvious.” This has been very typical in my experience. Most men can go back to normal activity very quickly. Sometimes less than a week.There are obviously a lot of different treatments for prostate cancer; where do you think HIFU best fits in the prostate cancer landscape?
It is an ideal treatment for the man that has a relatively small prostate with well to moderately differentiated cancer that sexual function and urinary control is very important. With focal therapy (treating only the cancer and preserving the rest of the prostate) becoming a reality due to improved diagnostic testing, HIFU presents itself as the ideal treatment.
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 believe strongly in screening. At its early stages, prostate cancer is a very curable disease. In its late stages, it may not be. PSA is a valuable tool when used correctly. Early and regular screening saves lives. We now know that not all prostate cancer is deadly. For the right patient, active surveillance or focal treatment will preserve quality of life without jeopardizing quantity of life.
When you aren’t practicing medicine, what do you like to do?
I like to spend time with my family and watch my kids play sports. I like to travel, cook, shoot and collect guns, take photographs and tinker in my shop. I gave up racing cars when I found out it wasn’t good for my health.
Click here to read more about Dr. Schlesinger and where he offers HIFU for localized prostate cancer.