Vahan Kassabian, MD, a physician at Advanced Urology, is the most experienced HIFU doctor in the state of Georgia and one of the most experienced HIFU physicians in the country. He has been the only doctor using HIFU to treat localized prostate cancer in Georgia in the last four years. Prior to offering HIFU in the U.S., Dr. Kassabian treated men with HIFU in Canada where he is also licensed to practice medicine. He is a nationally recognized surgeon in urology and a pioneer in HIFU.
Read more about him in the interview below. Learn how he got involved with HIFU and what led him to become a urologist.
Interview with Dr. Kassabian
What was your main motivation in becoming a doctor? When did you decide on this path?
I decided as a teenager that I wanted to be a physician. At that time, an M.D. was the highest level of academia that I could attain while at the same time, serve the better good.
How did you decide on your particular specialty? Why urology?
During medical school, I realized I wanted to be a surgeon, but I didn’t know what kind. Later, while I was in an urology rotation, I fell in love with the different types of urologic surgeries including outpatient endoscopies, or big open technically challenging cases. I was also drawn to the types of people in urology. The physicians were happy, content, and well-rounded. The patients were also very happy with the results of their surgery. There was immediate gratification and that provided a very gratifying experience.
What is your favorite part about being a physician?
When did you first learn about HIFU as a treatment for prostate cancer?
Back in the 90s and early 2000s, I was very experienced in open radical prostatectomies for prostate cancer. I was fellowship trained, an assistant professor at Emory and in private practice. I was well versed in prostate cancer treatment for localized disease but I also thought we could do better. I was helping a lot of people, obviously, but there are potential side effects with surgery and I also knew that I was over-treating some patients. I was the first in Georgia to attempt a Robotic Radical Prostatectomy, but I did not see better outcomes than what I was obtaining with open radical prostatectomy. I learned about HIFU and liked that it was an outpatient ablative therapy without radiation and could tailor the treatment to the individual patient.
When did you become involved in treating patients using HIFU technology?
I traveled out of the country in 2006 to train to use the Sonablate HIFU device and started treating patients almost immediately in countries where it was authorized and approved for use. I performed most of the HIFU procedures in Montreal, where I was also licensed to practice medicine. I also had a limited license to provide HIFU in Bermuda and Nassau, Bahamas, where I treated patients prior to US FDA approval in 2015.
What do you typically tell a patient when they are first diagnosed with prostate cancer?
My job as a physician is to find out what stage and grade of disease a patient has in order to treat their prostate cancer. Fortunately, we have all the tools at our disposal and it is my job to determine the best treatment option for each individual patient and present those options to him.
What different types of treatments do you offer men with localized prostate cancer?
I can offer all the available treatment options to men with localized prostate cancer, including surgery, radiation, cryotherapy, and HIFU. I even offer active surveillance for appropriate patients who are comfortable watching their disease. Our team at AU also offers research trials and we just closed an active surveillance trial.
In your professional opinion, what are the benefits of HIFU as a treatment for prostate cancer?
HIFU is truly a minimally invasive, outpatient, procedure with combined efficacy and a low side effect profile. The most appealing thing for me is to be able to tailor the treatment to the individual as well as to preserve all aspects of the patient’s quality of life.
How do you decide if HIFU is right for a patient?
Stage of cancer, aggressiveness of disease, PSA, and prostate size help me to determine if HIFU is right for a patient. I balance all that with the patient’s desire to preserve their quality of life.
In general, how quickly do your patients recover after HIFU? What do you tell men to expect?
Overall, patients recover quickly and feel great. Even as early as the night of the procedure, the patients are walking, eating, and feeling good. I tell patients that the worst part of the procedure is the nuisance of the catheter.
There are obviously a lot of different treatments for prostate cancer; where do you think HIFU best fits in the prostate cancer landscape?
I think HIFU fits best for patients with low to intermediate disease and who want to preserve as much of their quality of life as possible.
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 think that the whole PSA controversy of the U.S. Preventative Task Force has done a great disservice to our patients. There is no question that PSA is a valuable tool. In the 90s, we didn’t have the diagnostic tools to determine who was an appropriate patient to treat; now we do. We can even offer active surveillance to some patients now. Unfortunately, however, we have seen a significant increase in the number of men diagnosed with Stage 4 prostate cancer because of the U.S. Preventative Task Force recommendations.
When you aren’t practicing medicine what do you like to do?
I enjoy lecturing to my peers and spending time with my family. I also enjoy exercising, riding my bike, and playing golf.