Patient Stories

The Prostate – Small, Yet Significant

A healthy prostate is about the size of a walnut. The small gland surrounds a portion of the urethra, the tube that carries urine from the bladder. The prostate is an integral component of the male reproductive system and helps make some of the fluid that comprises semen.

As men age, the prostate gland often grows in size. While growth can be a natural part of the aging process, it can also be a sign of something more sinister — prostate cancer.

Aside from skin cancer, prostate cancer is the most common cancer in American men. The American Cancer Society estimates that in 2021, there will be about 248,530 new cases and about 34,130 deaths from prostate cancer in the United States.

It’s important for men to be regularly screened for prostate cancer. One screening process is a blood test, which observes prostate-specific antigen (PSA) levels. PSA is a protein made by both normal and cancerous cells of the prostate gland and can help detect cancer through blood.

Randall Cody is a stickler for getting his annual physical, and when his PSA levels jumped from 3.5 to 5.7 between 2012-2015, his primary care physician referred him to a local urology group because any number above 4 is abnormal.  

“They performed a biopsy that wasn’t guided in any way; randomly removing 15-20 tissue samples that didn’t reveal any cancer,” said Randall. “I was told to come back in a year for another biopsy, and that one still didn’t detect cancer, but since my PSA was over 11, they ordered an MRI. I wondered why they didn’t do that to begin with, instead of letting me wait around while the cancer grew?”

The urologist called Randall on Christmas Eve to deliver a sobering present — his biopsy had come back positive for prostate cancer. “You kind of see your life flash in front of you and begin to wonder, ‘How much time do I have left?’” said Randall.

He was told his only options were radiation and/or complete removal of the prostate (prostatectomy). As time crept closer to his scheduled surgery, Randall began to panic. “I’ve always been an active person and didn’t want to be incontinent, having to wear a diaper for the rest of my life. I decided to do my own research.”

Randall’s research led him to treatment options outside of Greater Cincinnati — and the U.S., entirely — he had two procedures in Germany in which two cancerous spots were treated.

Prostate cancer grades have traditionally been described using the Gleason score — a grading system named for the pathologist who developed it in the 1960s. The cells are graded on a scale of 1 to 5, with Grade 1 resembling healthy cells and Grade 5 having mutated to the point of barely resembling what healthy cells look like.

While Randall had initial response, his PSA started rising again. There was a concern of residual or recurrent cancer. He was scheduled to have his prostate removed and was sent to UC Health for an MRI as part of surgery preplanning.

“After my MRI, I got a call from Dr. Verma at UC Health — she told me to cancel the prostatectomy and not to worry,” said Randall. “She’s a world-renowned radiologist and I trusted her option. She told me I had other options, and that put me at ease.”

Sadhna Verma, MD, is a professor in the Department of Radiology at the University of Cincinnati College of Medicine and a UC Health radiologist. Dr. Verma is a member of the UC Cancer Center, UC Genitourinary Cancer Center and UC Multidisciplinary Prostate Cancer Clinic.

“Dr. Verma was kind enough to take the time to talk to me for 20 minutes over the phone, explaining everything and making me feel hopeful about the options available,” said Randall. “I was ecstatic to cancel the prostatectomy.”

At the time, Randall was in Florida. While out of town, he happened to see a UC Health segment that featured a physician talking about newer prostate cancer treatment options. That doctor happened to be Abhinav Sidana, MD, assistant professor in the Department of Surgery at the UC College of Medicine and director of Urologic Oncology at UC Health. Dr. Sidana is a member of the UC Cancer Center, UC Genitourinary Cancer Center and UC Multidisciplinary Prostate Cancer Clinic.

Unbeknownst to Randall, Dr. Verma and Dr. Sidana work closely together at the UC Multidisciplinary Prostate Cancer Clinic.

“Mr. Cody had been dealing with symptoms for years before I met him in August 2018,” said Dr. Sidana. “His cancer was located in an elusive area of the prostate, but Dr. Verma, a world-renowned radiologist on our team, found an area on the MRI that hadn’t been visible to anyone else. We biopsied it and it came back as cancer.”

Innovative Localized Treatment Options for Prostate Cancer

In the past, prostate cancer patients would be treated with complete removal of the prostate, or radiology/chemotherapy, or a blend of them all.

“In most prostate cancer cases, less than 25% of the prostate is affected by cancer; yet, until recently, we had no way to treat just the cancerous area, so the entire prostate would be removed as an alternative,” said Dr. Sidana.

Now, UC Health offers treatment options for prostate cancer patients with limited involvement of prostate. Instead of having to choose between active cancer surveillance or intrusive surgery with a higher risk of side effects, some men can choose focal therapy treatment.

“With focal therapy, which is similar to a lumpectomy for a breast cancer patient, we’re able to target the cancerous area only, treat it more effectively, and save healthy prostate tissue to limit side effects. We’ve been using the MRI-guided technique to biopsy prostate cancer for a long time, but we’re now using the technique to destroy the cancer,” said Dr. Sidana. “UC Health is the only place in Greater Cincinnati in which such a strategy is employed in taking care of patients with prostate cancer.”

Randall underwent focal cryotherapy with MRI guidance by Dr. Sidana in January 2019.

MRI-Guided Focal Cryotherapy

Focal therapy involves the use of magnetic resonance imaging (MRI) as a guidance tool to find the cancer, and specialized equipment to freeze (cryotherapy) or burn (high intensity focused ultrasound therapy) the cancer, effectively killing the harmful cells.

In the past, Randall’s scans hadn’t revealed one particular cancerous area of his prostate. He lived with the stress of his cancer diagnosis and various treatment options for about five years before finding Dr. Sidana.

Randall’s past biopsies had been done without the aid of an MRI, and his cancer was located in a portion of the prostate where biopsy without MRI wouldn’t be able to spot it.

“Imagine the prostate as a spherical ball. Normally, a biopsy without an MRI only biopsies the sides of that ball, but this patient’s cancer was located at the top of the ball,” said Dr. Sidana. “We only ever biopsy that area if we see a known reason, which we were able to see from our MRI-guided scans.”

On Jan. 29, 2019, Dr. Sidana removed Randall’s cancer via MRI-guided focal laser cryotherapy.

Randall’s recovery was quick. So quick, in fact, that he and his wife, Karen, were able to vacation in Hawaii just six days after the procedure. It was a trip they’d planned for a long time and were thrilled to not have to reschedule.  

“I felt like I was finally back to normal, I was up and functioning the day after my procedure,” said Randall. “In Hawaii, we went hiking, climbing mountains, surfing — having fun. It’s amazing the amount of prostate that can be ablated and how resilient the body is.”

A large part of that resilience is credited to Randall’s persistence to do everything in his own power to live healthy and set his immune system up for the best fighting chance. “I took an active role in supporting myself through this process. I’d been researching for years about prostate cancer before I met Dr. Sidana. He treated my cancer AND I also know I’ve given my body the best possible care,” said Randall.

Prior to the procedure at UC Health, Randall would get exhausted easily. He recalls after mowing his lawn he would need to go inside and sleep because he was so drained. Now he not only mows the grass; he removes weeds, prunes trees and completes all the maintenance of his one-and-a-half acres of yard — with energy to spare.

At age 62, Randall is thrilled to continue his active life. “Dr. Sidana moved quickly — he got me in for my MRI and told me that based on my cancer location and past health history, focal cryotherapy was the best option — that made the procedure a no-brainer decision for me,” said Randall. “What I like about Dr. Sidana is that he sees his patients as people first, not as their disease. He’s very professional, yet at the same time warm and personable.”

In 2018, Randall’s PSA number was 18; now it falls between 4-5, which is a healthy score for a naturally enlarged prostate.

“Mr. Cody was one of my first patients to have this procedure, and I’m grateful he had enough faith in someone like myself, telling him about a new treatment which I had just started offering, but I was confident it would help — and he believed in me,” said Dr. Sidana.

HIFU – High-Intensity Focused Ultrasound for Prostate Cancer

Duke Ganote began experiencing uncomfortable symptoms when he was around 58 years old. These symptoms — difficulty urinating, a weak urine stream, not feeling like the bladder is empty — are caused by an enlarged prostate and can be a noncancerous condition called benign prostatic hyperplasia (BPH). BPH is common and cannot be prevented — age and family history of BPH may increase the chances of diagnosis.

“When I was almost 60 years old, I went to my primary care physician for a physical exam to discuss my symptoms,” said Duke. “My PSA test score was 4.8, and my doctor said anything over 4 was cause for additional testing, so I was sent to Dr. Sidana.”

The biopsy came back positive for prostate cancer. “I didn’t go into panic mode, but I was pretty close, starting to wonder if I’d actually live to see 70,” said Duke. “I assumed I’d need my prostate completely removed, because of friends and family members who’ve had prostate cancer and that’s the way it was treated.”

Dr. Sidana explained all the various treatment options available for Duke’s cancer and highlighted that he would be a good candidate for focal therapy. Thankfully, Duke’s cancer was found early, and the general prognosis for early treatment of prostate cancer is promising.

“I went home and spent two to three weeks deeply researching and studying all the treatments,” said Duke. “I’m an engineer by trade, so it’s in my nature to dig into as much research as possible. I read medical journals, studying various procedures and one of those options was high intensity focused ultrasound.”   

UC Health had recently acquired HIFU — a very new and exciting treatment technology, which allows a completely non-invasive way to manage prostate cancer.

“HIFU seemed more focused and precise than other treatment and since we caught my cancer early, I was willing to try it,” said Duke. “I knew there were other fallback treatment options if this one didn’t work.”

High-intensity focused ultrasound (HIFU) is a safe, minimally invasive and radiation-free treatment. Patients go home the same day. Similar to how light through a magnifying glass can burn a hole through paper, HIFU uses ultrasound energy, or sound waves, to heat and destroy the targeted cancerous tissue in the prostate gland. During HIFU, sound waves pass through healthy tissue without causing any damage. When the focal point is targeted, tissue temperature rises rapidly, burning and destroying the focused area(s) of cancer.  

“HIFU is leading-edge clinical care that is covered by insurance,” said Dr. Sidana. “It’s not yet considered a standard of care in the U.S. for prostate patients who have recently been diagnosed, but it’s been a standard of care in many other countries for some time.”

Among 100 patients with prostate cancer who received HIFU, 91% were able to avoid radical treatment for at least two years, according to a retrospective analysis, which was published in the Journal of Urology. Also, nearly three-fourths (73%) of patients did not experience treatment failure, and there was a 100% continence preservation rate.

Dr. Sidana performed focal HIFU to destroy Duke’s prostate cancer, and then it was time for the recovery process — which wasn’t exactly a walk in the park. “It makes sense if you think about it — your body is essentially reacting to an attack, so it takes time to recalibrate and heal. Even though the prostate is small in size, it affects so many functions of the body.”

Duke says after a few days of recovery, he knew he made the right choice. He notes that patients should be invested enough to do their own thorough research in order to be able to fully trust a new standard of care for prostate cancer.

“One of the reasons why I wanted to try HIFU is because if everybody stuck with the old treatment options, then how would the field of prostate cancer ever progress? Trying newer treatments could open the door for future patients to have a better quality of life,” said Duke. “The HIFU seems to have reset the clock on my prostate by at least 10 years. It’s not like when I was 20 years old, but it’s like when I was 40 and that’s good enough for me.”

Duke graduated from UC as an engineer, and now writes software and is a computer engineer consultant. He enjoys spending time with his wife, Lora, and their two daughters, Lena and Lily.

Prostate Cancer Follow-Up Care

Patients are seen by Dr. Sidana about six months after their procedure to receive MRI scans and another biopsy to ensure no signs of cancer. “I always biopsy a second time after the procedure because it’s a new treatment and since it doesn’t treat the entire prostate, we want to make sure no cancer was overlooked,” said Dr. Sidana.

Patients will come back every year or two for either an MRI scan or a biopsy. Both Randall and Duke have maintained low PSA scores as well as clear MRI scans and biopsies.

UC Cancer Center’s Multidisciplinary Prostate Cancer Clinic

The first of its kind in the region, our clinic educates prostate cancer patients about treatment options so you can determine what is best for you.

“Typically, a significant portion of patients see a variety of physicians for treatment of their prostate cancer: a urologist, a radiation oncologist, a medical oncologist,” said Dr. Sidana. “In our multidisciplinary clinic, we’ve adopted a model where multiple specialists work together in one location and on the same day, patients can see all their doctors at the same time.”

UC Health has the most experience in the region using MRI/ultrasound fusion technology, which helps diagnose and treat prostate cancer patients more effectively.

“I talked to Dr. (William) Barrett, and we came up with this multidisciplinary prostate cancer clinic where we can all offer our specialties to treat the patient in the best way,” said Dr. Sidana. “This atmosphere was very instrumental in giving me the confidence to offer focal treatments for patients with prostate cancer.” 

The information from the MRI becomes a 3D model of the patient’s prostate, and that model is used as a guide during surgery. For example, cancerous areas are shown using a red color on the 3D model, so Dr. Sidana knows exactly where to target. An ultrasound probe is also used to scan the patient’s prostate through the rectum, creating a second 3D model. “That’s why we refer to these as fusion treatments,” said Dr. Sidana. “The two 3D models are superimposed — making the fusion of both MRI and ultrasound guidance.” 

Dr. Sidana notes that it also requires patients who are open-minded and motivated to be on board for newer treatments.

“Variations of these procedures have been done over the last 10-15 years, but using MRI guidance and special ultrasound technology is what’s unique — allowing us to be very accurate,” said Dr. Sidana.

For more information about UC Health’s Genitourinary Cancer Center, call 513-475-8000.