Dr. Keith Roach

DEAR DR. ROACH: I have prostate cancer. My PSA levels were as high as 48, and I’m taking medication to lower the numbers to 40. My urologist has recommended a high-intensity focused ultrasound after reviewing my MRI and biopsy results. Apparently, the cancer has not spread beyond the prostate. I was told that this procedure is much better for recovery purposes, as well as for quality of life afterward. The procedure is done via sound waves to focus on the area without having to damage anything around it. When the doctor explained to me that I would not have any of the side effects from the standard surgery, I was on board. Have you heard of HIFU, and if so, what do you think about it? — J.W.
ANSWER: High-intensity focused ultrasound uses sound waves to heat up tissues. By focusing many ultrasound beams directly on the area affected by prostate cancer, the treatment, in theory, kills cancer cells, with a minimum amount of damage to other cells. This may eventually become a standard treatment for localized prostate cancer, but as of yet, there is not strong evidence to support its use. Because of the lack of evidence comparing HIFU to standard treatments, a joint guideline recommends that prospective patients should know that the technique is unproven and approved by the FDA for destruction of prostate tissue, not explicitly for prostate cancer. I’m not sure if you knew.
I think it might’ve been an exaggeration for the surgeon to say that there is no risk of side effects. Fourty-four percent of men have sexual troubles, 17% have obstruction, 12% develop a stricture in the urethra, and 8% develop urinary incontinence after the procedure. These numbers are lower than some of the other options, but certainly not zero.
While HIFU is reasonable in men who have failed, or cannot get, standard treatment or in men who have very low-risk cancer, neither of those situations seems to apply to you. A PSA level above 40 puts you at high risk, and the standard of care at this time is surgery, if the urologist feels there is a good chance of a cure. Radiation treatment, usually with medication to help lower testosterone levels, is another standard option.
DEAR DR. ROACH: While traveling, I’ve always been careful to drink bottled, filtered water. On a recent trip to the Philippines, I was diagnosed with amoeba. I didn’t eat raw vegetables, and everything I had eaten was cooked. Does filtered water not protect us against amoeba? Is distilled water the way to go? — A.H.
ANSWER: Filtering is an effective way of removing protozoa like Entamoeba histolytica from drinking water, so I don’t think it was the bottled water that infected you. This particular parasite is very infectious (a single organism is enough to cause disease) and can be spread through hand-to-hand contact, as well as through food. It can also be spread sexually. It is uncommon in people who spend less than a month in the endemic areas.
It’s impossible to be 100% safe when you can’t cook food yourself, but drinking only bottled water (avoid ice), eating foods that are cooked and served still hot, only eating fruit you can peel yourself, and completely avoiding buffets and salad bars will help. Frequent hand hygiene by sanitizers is also a good idea.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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