Robert G. Pugach

Robert G. Pugach

Pacific Coast Urology Medical Center, led by Dr. Robert Pugach, is one of the leading medical practices in the US specializing in the minimally invasive treatment of urological conditions, including procedures to improve and correct bladder control. 

Connect with Dr. Pugach by calling (888) 735-4336 or visit www.pacificcoasturology.com

I have just been treated for prostate cancer.  This is my personal story.  My prostate cancer was diagnosed last year.

My internist, as part of my annual check-up, ordered a PSA blood test and I requested that a “free” PSA be added to the total PSA level that is typically done. The next step was to undergo a biopsy, where a colleague of mine, got the honor/task of doing my biopsy. My biopsy showed a miniscule focus of cancer.

So, what to do about a tiny, moderately aggressive prostate cancer? Well, some would do nothing. I am a candidate for “active surveillance” or “watchful waiting.” There are many patients whose cancers will never progress to the point where they pose a danger.

My concern about that approach is that no one really knows what we are waiting for. There is no level of PSA and there is no imaging study that says when we must treat prostate cancer. Add to that the fact that 37% of men have more aggressive or more extensive prostate cancer than what is found on biopsy.

I am not a gambler, especially when it comes to my health. I desire and plan to live a long, healthy life. So, I’ve decided to have my prostate cancer treated with High Intensity Focused Ultrasound (HIFU).

In the weeks leading up to my treatment, I was surprisingly calm. I can honestly say that I never had a moment of fear, anger, panic or any of the other emotions that many of my patients have shared with me in over 30 years of treating this potentially lethal, terrible disease.

The reason for my attitude was that my cancer was diagnosed at the earliest possible stage. The odds are overwhelmingly likely that it will never return. That meant that I was in charge of my cancer instead of it being in charge of me. I was spared the fear that patients experience when they are diagnosed with advanced prostate cancer that can be extensive or aggressive and, potentially, not curable.

I was also calm because I had the utmost confidence in my doctor. Like me, he had been traveling to other countries for the past 10 years treating patients with HIFU. On the morning of my procedure I awoke at 4:30 AM for my final HIFU preparations and went to the surgery center.

I woke up in the recovery room four hours later and saw my wife’s smiling face. I was a bit groggy, but pain free and comfortable. My doctor confirmed that my procedure went perfectly! Within an hour or so after waking up I was discharged.

There was no pain. The catheter was a bit uncomfortable. I had no ill effects and enjoyed a meal of clam chowder and pizza. I arrived in San Francisco with prostate cancer and would leave the following day cancer free. I had a HIFU procedure that has a 3% chance of bladder control problems and a 5-10% chance of erectile dysfunction. Contrast that with surgery where incontinence rates are typically 35% or higher and erectile dysfunction is common. I was able to return to normal activities 3 days later!

The key to successful treatment of prostate cancer is to have it diagnosed at its earliest stage so HIFU is a treatment option. I can tell you now, from my personal experience, that it’s the key to getting on with your life while leaving you whole.

I’ve been a practicing urologist for just over 30 years. I have always stressed the importance of annual prostate screening because early diagnosis saves lives.  While some feel that delaying the diagnosis or treatment of prostate cancer is justified, rising death rates from prostate cancer show that this approach is ill advised.

Prostate cancer is detected with a 15 second prostate examination and a blood test.  If either of those are abnormal, a prostate biopsy is the next step.  It’s virtually painless.  I can vouch for that because I just had one done! 

Traditional biopsies are done with ultrasound guidance in the office.  Now, there is a dramatic improvement in biopsy procedures.  For the first time, urologists have the remarkable imaging advances that most other areas of medicine use in biopsies of other areas of our bodies, including breasts, kidneys, bones, abdominal masses, etc.  Until now, doing a prostate biopsy did not benefit from the precision of real time imaging to direct a biopsy needle into an abnormal area. 

At Western States HIFU/Pacific Coast Urology Medical Center, we are proud to be the FIRST private practice west of the Mississippi to offer UroNav – an advanced technology for patients who may have prostate cancer!  This is truly a potential game changer in both diagnosis and treatment of prostate cancer.  

UroNav is a software program that fuses MRI images of the prostate with instant ultrasound images from our state-of-the-art GE Medical Systems Ultrasound system. Our new, GE Logic 8 is one of the most sophisticated ultrasound units in the world, allowing us to merge MRI data with ultrasound images, so our patients get the most precise biopsies possible. This can result in little or no damage to surrounding prostate tissue!  UroNav has the potential to diagnose and treat prostate cancer with more precision than ever before!

What does that mean for you?  I can give you proper information and counseling about your prostate cancer so you can choose among many treatment options that include surveillance (watchful waiting), radical robotic surgery, radiation (from proton beams to cyberknifes), cryoablation and the latest FDA-approved High Intensity Focused Ultrasound (HIFU).  We are the most experienced HIFU practice in the western United States to help you navigate all of your treatment options and choose what is best for your cancer.  Learn more about these treatment options at www.WesternStatesHifu.com

UroNav in detail:

We begin with a state-of-the-art multiparametric MRI.  Once MRI images are acquired, they are transmitted to our offices and uploaded into the UroNav software platform.  UroNav then “fuses” the MRI images into our GE ultrasound system so I can aim exactly where abnormal areas are located.

There is an even more amazing concept to fusion targeted biopsies with UroNav. We can fuse the biopsy images with the Sonablate HIFU treatment system so I can target specific areas of cancer in the prostate while sparing healthy tissue. The result is shorter treatment times, faster recovery periods and better cancer treatment outcomes.

Men are travelling to our offices from all over the country because of our experience and excellent outcomes.  With the addition of UroNav, I’m proud to remain at the forefront of the latest in targeted biopsies and focal HIFU treatment.

It seems as if not a month goes by where we read headlines proclaiming new medical breakthroughs. A recent headline and article in the AARP Bulletin caught my attention. In the article, Brave New Worlds in Diagnosing Diseases, several new promising diagnostic tests, including one about a new prostate cancer assay, were outlined.

The test they discussed was captioned as a “less-guess” prostate test, the Oncotype Dx Prostate Cancer Assay test. While the AARP article implied that this was a brand new test, we’ve actually been using it at Pacific Coast Urology Medical Center for the past 6 months. We’ve been evaluating and using tests like this for the past several years. We made the switch to the Oncotype Dx test because it seems to provide better information than tests promoted by other companies.

The Oncotype Dx test looks at cancer from a molecular level. This new medical field is called genomics. By analyzing DNA sequences in prostate cancer specimens, it has the potential to give us far more precise information about an individual patient’s cancer than a traditional pathologist can do using slides and a microscope. It may become extremely valuable in helping to determine which prostate cancers need treatment and what type of treatment should be provided.

Do tests like Oncotype Dx replace standard prostate cancer screening measures like an annual digital rectal exam (DRE) and PSA blood test? Can it replace prostate biopsies? The answer to both questions is “definitely not.” Screening for prostate cancer remains the only way to determine if a patient may have it. Unfortunately, the death toll from prostate cancer is on the rise. Since the ill-advised recommendations of the U.S. Preventive Services Task Force three years ago, that advised against routine screening for all men, the number of cases of advanced, incurable prostate cancer has risen significantly. Equally worrisome is the fact that it has been responsible for more prostate cancer deaths. In 2011, 29,000 men died of prostate cancer; this year that number will be 30,400.

So, while all men should be screened for prostate cancer, the good news is that new tests like Oncotype Dx may help to target treatments only for those men with more aggressive genetic tumor markers. It may also allow us to develop therapies that target the genetic basis of cancer so that more minimally invasive therapies can be developed.

At Pacific Coast Urology Medical Center, we’re proud of the international reputation we have earned in the field of diagnosis and treatment of prostate cancer. If you haven’t been screened for prostate cancer in the past 12 months call us to schedule this potentially life-saving test.

Bladder control problems affect 50 million Americans and it is one of the most common health problems that women face. While many think that the condition only affects older women, the truth is that women of all ages may have urine leakage (incontinence) or other bladder control issues.

There are four main categories of bladder control problems:

Stress incontinence - leaking urine when you cough, sneeze, laugh or exercise. This occurs when the pelvic and sphincter muscles become weak or the urethra loses its support and moves too much.

Urge incontinence - leaking urine after a sudden and strong urge to urinate. This problem may be caused by nerve damage from diabetes, infection, a stroke, back problems, hormone imbalance or other medical conditions.

Overactive bladder - the need to urinate frequently during the day and/or getting up to urinate during the night. With this condition you may also have urge incontinence.

Mixed incontinence - a combination of stress and urge incontinence.

Some of these symptoms can get so bad that some women rarely leave home because of embarrassing leakage. At Pacific Coast Urology’s Bladder Control Center for Women we have helped countless women regain bladder control and return to the activities they love. From new medications to advanced biofeedback exercises, acupuncture (PTNS) to minimally invasive outpatient surgical procedures using a battery (Interstim®), there is an answer for most women that can help.

Pacific Coast Urology Medical Center, led by Dr. Robert Pugach, is one of the leading medical practices in the US specializing in the minimally invasive treatment of urological conditions, including procedures to improve and correct bladder control.

Connect with Dr. Pugach by calling (888) 735-4336 or visit www.pacificcoasturology.com

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