What is Prostiva RF Therapy?

Prostiva RF Therapy, formerly known as Transurethral Needle Ablation of the Prostate, is a minimally-invasive treatment for men with urinary symptoms for prostate enlargement. It provides better improvement for urinary symptoms than medications with much less risk than traditional prostate surgery. The American Urological Association has this to say about treatments like Prostiva RF Therapy: “…there are now many acceptable alternatives to TURP (prostate surgery) that are less costly per treatment episode, that require less time to produce positive outcomes, and that have less associated morbidity (risk).”

Prostiva RF Therapy computer and device

How does Prostiva RF Therapy work?

Prostiva RF Therapy works by heating the enlarged, inner part of the prostate to very high temperatures, which results in shrinkage of the prostate and opening of the urinary channel. The Prostiva RF Therapy device is computer-controlled and uses radiofrequency energy to heat the prostate. The energy is delivered to the prostate by two needles that are deployed from the Prostiva RF Therapy device, a telescope which is inserted through the urethra into the prostate. The lining of the urethra is protected so that men have minimal bleeding or other side effects after the procedure. Most men start to notice improvement in their symptoms within 1-2 weeks after the Prostiva RF Therapy treatment and by 6 weeks 80% of men notice substantial improvement.

Prostiva RF Therapy device heats the inner prostate

Who can benefit from Prostiva RF Therapy?

Prostiva RF Therapy was designed for men with prostate enlargement (BPH). It can help to improve the force of the urinary stream, improve bladder emptying, decrease the frequency and urgency to urinate, prevent urinary incontinence, and decrease the need to urinate at night. It is suitable for most men who have prostate enlargement, and is an alternative to using prescription medications such as Flomax or Uroxatral. Medications can give real improvement in prostate symptoms, but most men need to take the medications forever if they want long-term improvement. Some men choose Prostiva RF Therapy because they do not want to take medications or because the medications are too expensive or because the medications have undesirable side-effects. In addition, medications for erection problems such as Viagra, Levitra, or Cialis cannot be taken with some of the BPH medications. Prostiva RF Therapy is usually not suitable for men who have had previous prostate surgery, but this can be determined by the urologist. There are also some men with chronic prostate pain (chronic prostatitis) who benefit from Prostiva RF Therapy.

How is the procedure performed?

Prostiva RF Therapy is an office procedure which we perform at our Statesville office. Patients arrive early and are given oral medications for pain relief and sedation. A prostate ultrasound is performed in the office prior to the procedure to measure the exact size and shape of the prostate, and local anesthesia is injected to numb the prostate. The Prostive RF device is passed through the urethra and used to heat the inside of the prostate. The entire procedure lasts 30-60 minutes, and patients go home shortly after we are done. A catheter is left 1-4 days after the procedure. 90% of men urinate well when the catheter is removed, but some men will need to have the catheter replaced for several more days before normal voiding returns.

What are the risks of Prostiva RF Therapy?

The long-term risks of Prostiva RF Therapy are very small, which is why it has mostly replaced TURP as the initial treatment for prostate symptoms. The risk of significant bleeding, urinary incontinence, or decreased erections is less than 1%. A small number of men (<5%) will notice decreased fluid when they ejaculate compared to 90% or more with TURP. Approximately 20% of men will not get adequate improvement from the Prostiva RF Therapy procedure and may require other treatments. The short-term risks after the procedure include burning with urination, frequent urination, slower urinary stream, urinary infection, or urinary retention. If any of these occur they are easily treatable and urination returns to normal within one week.

What can I expect after Prostiva RF Therapy?

Patients will have a catheter 1-4 days after the procedure, depending on the prostate size and the severity of the urinary symptoms. For the first week after the catheter is removed patients may experience more increased urinary frequency and a slower stream than they had before the procedure. Men may also have a small amount of blood in the urine or burning with urination. After one week the urinary symptoms are back to normal and men then notice a slow, steady improvement in urinary symptoms over the next 3 months. By 6 weeks after Prostiva RF Therapy at least 80% of men notice significant improvement in their urination, and most can stop any BPH medications they were taking. All men will have blood in the semen for several weeks after Prostiva RF Therapy, but this causes no pain or other symptoms.

Understanding Prostate Cryotherapy

An exciting new treatment option for prostate cancer treatment is cryosurgery also known as cryotherapy. Because it is minimally invasive, cryotherapy as a prostate cancer treatment is gaining favor among patients and doctors. It also has fewer complications than surgery. Studies show cryotherapy can be an effective alternative to surgery and radiation for appropriate patients, particularly men who develop prostate cancer in their late 60’s or early 70’s.

Cryotherapy is actually not a new concept; this procedure has been explored in various forms over the past few decades. But new cryotherapy techniques and technology are making the procedure much more popular. In recent years, newer technology, including the use of transrectal ultrasound imaging, temperature sensors and cryoablation “needles” versus probes to freeze has made prostate cryotherapy much safer and easier.

The Procedure

Modern prostate cryotherapy is usually in a hospital with the patient under local anesthesia. Using ultrasound guidance, several ultra thin cryoablation needles are placed directly through the patient’s perineum (the place between the scrotum and anus) and into the prostate. The urologist can see each needle entering the prostate with the transrectal ultrasound, and guide the needle to its exact placement. Once the needles are in place, argon gas is released into the needles, where it circulates and plunges the temperature. As the tissue around the needles freeze, the formation and expansion of ice crystals within the cancerous cells cause the cells to rupture and die.

After approximately 10 minutes, the urologist completes the first freeze cycle and then administers another treatment to help ensure that all cancer cells are killed. To keep the urethra from freezing along with the prostate, a catheter is placed inside the urethra and filled with warming solution. Thermal sensors track temperatures in and around the prostate to avoid damaging the bladder and rectum.

The entire procedure takes one to two hours and most patients undergoing prostatic cryotherapy will have the procedure done as a single day out-patient or spend one night in the hospital. At the conclusion of the procedure, the needles are removed from the patient, no stitches are required. Most patients resume normal activity in less than one week. Some may experience temporary bruising and swelling. Usually, a urinary catheter is left in place for one to three weeks for internal healing, and then removed.

After the procedure, the urologist who performed the procedure will order tests to determine the extent of treatment success. Once known, the information is provided to the doctor, who will give the information to the patient.

There is no special preparation needed to undergo cryotherapy, although some physicians recommend ibuprofen a half-hour before the procedure to relieve minor discomfort. Antibiotics are also given beforehand as a way to guard against infection.

Advantages

Cryotherapy offers several advantages: there is no major surgery or radiation, recovery time is rapid, and most patients return to their normal lifestyle. Unlike radiation, cryotherapy is repeatable if prostate-confined cancer recurs, and it can also be used as a secondary treatment when other primary treatments fail. A recent study (October 2003) showed that 97% of patients treated with new-generation minimally invasive cryotherapy were still cancer-free after twelve months. In longer term study published in May 2002, cryotherapy outcomes using PSA measurement reported the seven year disease-free success statistics were:

• 92% success for low risk disease
• 89% success for medium risk disease
• 89% success for high risk disease

Disadvantages

With cryotherapy, controlling cancer confined to the prostate in about 90 percent of men, the results are encouraging. However, this procedure, as does all procedures, has disadvantages. In some patients, incontinence, urethral scarring, and damage to the rectum may occur. The procedure may not kill all of the cancer cells; this is rare unless the patient has been previously radiated. Other possible side effects include:

• Severe to moderate pelvic pain
• Tissue sloughing
• Impotence
• Scrotal swelling
• Blood in urine
• Mild urinary urgency

In most cases the side effects usually go away within a few weeks, and most men will regain normal bowel and bladder function.

In Brief

Choosing a treatment for prostate cancer isn’t easy. Many physicians feel that this modern technology only recently has the long-term effectiveness to recommend the procedure. Today’s traditional choices include surgery, radiation, hormone therapy and now cryotherapy. At the present time, there are hundreds of urologists and medical centers that have experience with cryotherapy for prostate cancer. With recent longer term data now available, prostate cryotherapy using modern technology may be a treatment choice for you. Ongoing clinical studies are currently being performed on selected patients, including those whose prostate cancer has grown back after failure of radiation therapy or on patients with advanced prostate cancer.

Carolina HIFU – High Intensity Focused Ultrasound

NOW APPROVED FOR TREATMENT IN THE US

High intensity focused ultrasound treatment of prostate cancer is the newest and least invasive treatment for localized prostate cancer and is now approved for treatment in the United States. HIFU offers treatment success rates similar to more invasive treatments such as radiation and surgery with less pain, and one of the lowest risks of erectile dysfunction (less than 20%) and incontinence (<1%)

Dr. Michael Schlesinger of Piedmont HealthCare Urology in Statesville North Carolina has been successfully treating prostate cancer with HIFU since 2008. He is pleased to announce his affiliation with HIFU Prostate Services with a treatment facility located in Huntersville, NC.

Please call our office today for a consultation regarding minimally invasive options for the treatment of prostate cancer at (704)873-1777.

For more information about prostate cancer and treatment options read on.

Prostate Cancer

Do you or your loved one have prostate cancer? What do you do now?

The first thing to realize is that you are not alone. The American Cancer Society has estimated that there will be more than 239,000 new cases of prostate cancer diagnosed this year. This makes prostate cancer the most common cancer other than skin cancer diagnosed in American Men. Prostate cancer is the second leading cause of cancer deaths in American men after lung cancer. Almost 34,000 men will die from this disease this year.

Despite recent media publicity, people do die from prostate cancer. When caught early however, this is a highly treatable disease. In its advanced stages, prostate cancer has no real cures.

For early stage prostate cancer there are many different treatment options. These include:

• Radical Prostatectomy either open or robot assisted
• External beam radiation therapy
• Prostate brachytherapy (radioactive seed implant)
• Proton beam therapy
• Cyberknife
• Cryosurgical ablation
• High Intensity focused ultrasound (HIFU)

Choose the best treatment for prostate cancer – for you

Treatment choice can be difficult, and you must take into account many variables. Ultimately you must make a decision that is best for you.

Because of the relatively slow grow of the tumor and early detection, you do have time to make an educated decision

When I talk with patients about treatment options, I refer to the three goals in prostate cancer treatment:

1. Treat the cancer. This is most important!
2. Maintain urinary function.
3. Maintain erectile function.

The good news is that each of these treatments carries about a 90% chance of a cure for patients with a PSA of less than 10 and a Gleason score of 6 or less.

Urinary function is a very important issue that affects you on a day to day basis. Incontinence or the inability to control your urine can be devastating. Many of the treatments can affect this since the prostate sits right between the bladder and urethra. Radical prostatectomy in particular has the highest rate of incontinence with as much as 40% of patients experiencing mild leakage when they cough or sneeze to 2% risk of complete loss of control. Many of the radiation options can cause another type of incontinence called urge incontinence which involves a sudden urge to urinate that you cannot control.

With all prostate cancer treatments, if you have problems with your erections prior to your diagnosis, none of the treatments will make it better. That being said, each treatment carries of risk of erectile dysfunction. Cryosurgery has the highest risk of essentially 100%. HIFU carries the lowest risk at about 10-20%.

There are many other factors to consider as well. These include:

• Pain
• Blood loss/transfusions
• Hospitalization
• Time away from work
• Radiation exposure and secondary malignancies

All these factors must go into your decision for the type of treatment that is best for you. If you are the kind of person that is very anxious about your cancer and cannot live with anything but cutting it out despite the risks of prostate surgery, then a radical prostatectomy is for you.

I suspect however that since you found my website, that you value a safe and effective treatment that has a very low risk of incontinence or erectile dysfunction. This would be high intensity focused ultrasound of the prostate or HIFU.

HIFU

High Intensity Focused Ultrasound (HIFU) uses similar sound waves to the ultrasound that your doctor used to look at your prostate. These sound waves are more powerful than those used in diagnostic ultrasound and are then focused much the same way you can focus the sun with a magnifying glass. This results in a small precise area about ½ inch long by 1/8 inch wide of powerful heating of the prostate tissue. This small area of prostate reaches near boiling in a matter of seconds leaving the surrounding tissue unharmed. The treated prostate tissue is later reabsorbed by body and disposed of. The precision of the device allows the nerves and urinary sphincter to remain intact preserving erectile and urinary function.

Amazing as it sounds; this technology was first discovered in the 1950’s and was originally being used to treat brain lesions. These first machines were crude and did not have the technology of a modern day HIFU generator. By the 1990’s HIFU was first used on prostate. In 2004 the Sonoblate 500 was introduced. This machine combined the HIFU technology with the accuracy of a 3D sonogram machine, and impressive computer controls. The most recent advance allows for MRI fusion that allows for pin-point treatment of cancerous lesions.

• Is your family just the right size?
• Do you want to enjoy sex without worrying about pregnancy?
• Does your partner has health problems that make pregnancy difficult?
• Do you want to avoid the risk passing on a hereditary disease or disability?
• Are you tired of using condoms or other less reliable means of contraception?
• Do you want to save your partner the more extensive surgery involved in tubal ligation, as well as the extra expense?

Then a no-scalpel vasectomy may be right for you.

Find out about this safe, simple in-office procedure that is covered by most insurance plans. Dr. Schlesinger has successfully performed hundreds of no-scalpel vasectomies in the comfort of his office avoiding expensive hospital and anesthesia charges. For more information call for an appointment to find out if no-scalpel vasectomy is right for you.

Vasectomy is a simple surgical procedure for permanent male fertility control, in which the tube leading from each testicle is cut and sealed in order to stop sperm from reaching the prostate, where it mixes with the semen. This tube is called the vas deferens, hence “vasectomy.” Without sperm in the semen, a man cannot make his partner pregnant.

A vasectomy leaves the patient unchanged except for the fact that the sperm cord (vas) is blocked. The testes still produce sperm, but they die and are absorbed by the body. The level of male hormone remains the same and all sexual characteristics remain the same. Ability to have an erection is also entirely unchanged.

Over 500,000 vasectomy procedures are performed each year in the United States. The procedure is usually done in an office setting with the use of a local anesthetic such as Xylocaine and takes approximately 20 minutes, depending on the surgeon, his technique, and the patient’s specific anatomy. A vasectomy is far safer and far less expensive than female tubal ligation. Furthermore, the effectiveness of a vasectomy can be verified after the surgery with a semen analysis; the only way a woman could know her tubal ligation was ineffective would be if she became pregnant or had expensive X-ray tests.

As with any surgical procedure, the primary risks are infection and bleeding. These risks are generally low for vasectomy. While vasectomy can be reversed surgically at times, its successful reversal cannot be guaranteed, and vasectomy is done with the intent of being permanent. Conversely, the vas deferens can rarely grow back together on its own and cause a pregnancy. This is called recanalization and occurs substantially less than one percent of the time.

Over the years, many questions have been raised regarding possible long-term effects of vasectomy. Issues as to whether vasectomy causes arthritis or atherosclerosis or heart disease have long been put to rest. Most recently, some studies have suggested that vasectomy may cause a slight increase in the risk of getting prostate cancer. By and large, these studies have also been refuted by other urologic data. Studies including tens of thousands of vasectomy patients have showen no clear trends regarding an association between vasectomy and heart disease, arthritis, atherosclerosis, or cancer.

Dr. Schlesinger uses the “No-Scalpel” vasectomy technique. In a conventional vasectomy, the physician may make one or two small incisions with a scalpel, and then use sutures or stitches to close them at the end of the procedure. In the “No-Scalpel” method, rather than making an incision, Dr. Schles9inger makes only one tiny puncture into the skin with a special instrument. This instrument is used to gently stretch the skin opening so that the tubes can be reached easily.

The tubes are then cut and sealed using the same method as a conventional vasectomy, but because no incision was made, there is very little bleeding and no stitches are needed to close the tiny opening. The opening will heal quickly with little or no scarring.

The technique of the No-Scalpel vasectomy was developed in 1974 by a Chinese physician, Dr. Li Shunqiang, and has been performed on over 8 million men in China. No-Scalpel vasectomy was introduced to the United States in 1988 and is now used by many doctors in the U.S. and elsewhere.

Compared to the traditional incisional technique, the “No-Scalpel” vasectomy usually takes less time, causes less discomfort, and may have lower rates of bleeding and infection. Recovery following the “No-Scalpel” procedure is usually complete in three to five days.

The vasectomy only divides the vas and has no effect on sperm that are already beyond that point. It is important not to have unprotected intercourse until the absence of sperm from the ejaculate has been confirmed.

Overall, vasectomy is a simple and safe form of birth control which is often preferable to birth control pills, a tubal ligation, diaphragms, or spermicides. Some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex is more relaxed and enjoyable than before.

A vasectomy may not be right for you if:

• You are very young.
• You are having a vasectomy just to please your partner and you do not really want it.
• You are under a lot of stress.
• You are counting on being able to reverse the procedure in the future.