In Black America; High-Intensity Focused Ultrasound, with Dr. Brian Miles and Victor Murray

From the University of Texas at Austin, KUT Radio, this is in Black America. Unfortunately, there are really very few early signs when a man sees he'll be asked questions about his urinary function. And if he has a lot of trouble with frequency and poor stream and difficulty in the bladder, men worry that that's a sign of prostate cancer. It is not. It's a sign of an enlarging prostate. It can be, but that would be very unusual. The signs of prostate cancer, if we can attribute them to prostate cancer, unfortunately, are late signs when it has spread throughout the body or has spread locally in the pelvis causing pain in the pelvis or bone pain. So unfortunately, there are no early signs that can alert a man

and he might see a urologist. The best way to do that is through that blood test called PSA or prostate specific antigen. An antigen is a protein made by various structures in the body. And the prostate gland makes this substance that's strictly specific for the prostate. Dr. Brian J. Miles, Bored Certified Urologist with Houston Methodist Hospital. In this country, one in six men will be diagnosed with prostate cancer in their lifetime. Nearly 30,000 men will die from prostate cancer. African-American men have nearly twice the risk of dying from prostate cancer as all other ethnicities. Various treatment options are now available for prostate cancer. Each with its own benefit, especially for high grade cancers, while observation car wash for waiting may be more appropriate for low grade cancers. elderly patients are patient with other medical conditions.

One of those treatment is high intensity focused ultrasound or high food. High food allows the patients to keep their prostate intact, keep a healthy sex life and maintain an active lifestyle. The procedure entails a surgeon using sound waves directed at the cancer cells. I'm Johnny O'Henson, Jr. and welcome to another edition up in Black America. On this week's program, high intensity focused ultrasound with Dr. Brian J. Miles and Victor Murray in Black America. I have annual physicals with my health plan. Every year, that's one of the checks. Over the years, my PSA was below, I guess, the threshold. It was one point something or two point something. It's just that I'm in the last year that it rose to five. At that point, my internal medicine physician suggested that I go see a urologist.

I didn't know how a urologist at all. That's the first time I've had an opportunity or a need to even think of one. So I went to my plan urologist or urologist and he gave me some options as to what the next step would be. Victor Murray, a prostate cancer patient who has undergoing the high intensity focus ultrasound procedure. The high intensity focus ultrasound procedure is a new technique approved by the FDA to remove prostate tissue. This procedure is less invasive and the recovery time is much quicker. High full use of high frequency sound waves targeted at the area of cancer cells, the wave-curried heat that damaged the cancer cells. In 2003, Dr. Brian Murray began using this procedure. He has performed over 3,000 surgeries of this type. Victor Murray, a NASA engineer for more than 50 years, says this was the best option for his prostate cancer.

That all prostate cancer patients can receive this treatment. It depends on a number of factors. Your physician would determine the best options you have. Recently in black America spoke with Victor Murray and urologist Dr. Brian Miles. My background is I was actually born in Ireland, moved to Detroit when I was 8 years old. My father wanted to get over to the United States. He was an iron worker, a construction worker. And so I grew up in the Detroit area. I went to Michigan State University and University of Michigan. And stayed at Henry Ford Hospital and Detroit Hospital for a few years before being recruited down here to Baylor University and eventually over to Methodist where I am now. So I've been a urologist for over 25 years. I love every day of it. I'd like to work 50 years if my brain stays as good as Mr. Murray.

What initially attracted you to urology? Well, basically a couple of things. One, you quickly know in medical school whether you're going to be a surgeon or not. And then urology, I like the various types of surgery we could do. And urology has always been a little technologically advanced. We had the first scopes that were used in human beings. We were the first to use the robot for radical prostatectomies for cancer. We just do a lot of interesting things. And finally, it's a nice blend of medicine and surgery. Most surgeons will do the surgery and then their patient moves on and they never see them again. In urology, we're kind of like kind of colleges in that. Like Mr. Murray, I will see him for as long as I continue to work.

And he continues to want to come up here. We follow our patients for life if they want to come with us so that we develop a long rapport with patients. We become in some ways like primary care docs. So I like that blend of the clinic and getting it close to the patients and staying close to them. And yet being able to go to the operating room and doing something technical and doing a little more for the patients and just giving them medications. Mr. Murray, tell us a little bit about your cell, where you want to raise? I was born in Barbados and I've been living with 19 years old. I'm a mother in New York and shortly thereafter I just went to Air Force. I spent four years in the Air Force and I believe in the Air Force. I moved to California where I was stationed at Edwards. And in 1968, I was offered a job at NASA as a technician. I worked in the Air Force in precious suits and parachutes and physiological training,

which we trained pilots and altitude chambers to deal with the hazards of work and altitude. And after going to school part time at JSC, I come out and graduate from University of Houston and technical education and then got my master's from University of Texas in the medical center and occupational health. And I've been working in safety for several different contractors, Rocky Martin, Brownroot Northrop, and now Jacobs Barrios. What initially attracted you to what you do? Being in the military, that was a career field I had working around planes and personnel in flying environments. So my ability to work with precious suits just fit the bill at NASA with the space program and the astronaut.

So one of my officers in the Air Force had a job as a manager with Brownroot and he recruited me to come to Houston and have me here ever since. Dr. Mouse, what is the function of the prostate? Well, the prostate is what we call an accessory sex gland. What it does is it produces seminal fluid. So the testicles produce sperm, the prostate, and what are called the seminal vesicles, which are kind of attached to the prostate, produce the seminal fluid that many ejaculate. Basically 90% of seminal fluid comes from the prostate and seminal vesicles are very small portion from the testicles. That seminal fluid is what allows the sperm to stay in a nice grouping that allows them to move up the female birth canal and to fertilize the egg. So it's an accessory sex gland that makes fluid that the sperm swim in and the energy source for sperm come from the seminal vesicles.

They make a sugar called fructose, which only sperm can use. It's not a sugar that humans can use in any other way. What are some of the signs and symptoms of prostate cancer? Well, unfortunately there are really very few early signs. When a man sees a urologist, he'll be asked questions about his urinary function. And if he has a lot of trouble with frequency and poor stream and difficulty emptying the bladder, men worry that that's a sign of prostate cancer. It is not. It's a sign of an enlarging prostate. It can be, but that would be very unusual. The signs of prostate cancer, if we can attribute them to prostate cancer, unfortunately are late signs when it has spread throughout the body or has spread locally in the pelvis causing pain in the pelvis or bone pain. So unfortunately there are no early signs that can alert a man that he might see a urologist.

The best way to do that is through that blood test called PSA or prostate specific antigen. You know an antigen is a protein made by various structures in the body. And the prostate gland makes this substance that's strictly specific for the prostate. It has a function that helps liquefy semen, but it is the best way to know whether you have the possibility of having prostate cancer. We see these commercials on TV about certain medications over the count that you can take. Are these supplements doing what they say they can do? You know that, John, that's a good question. The answer is, in general, no. In general, the substances have a little effect on the prostate. They are marketed as a prostate health agent. They contain minerals, various vitamins, and sometimes an herbal thing called sawpometto or gin sang.

And there's no question some men notice a difference in their urinary function when they take these. And that's fine. If they notice a difference, I don't care whether it's placebo effect or whether it's a real effect on the prostate. It's okay to take that as long as they can afford it. If we're looking at prostate cancer specifically, it does not have any beneficial effect there at all. The notion that I might have prostate cancer, I'll put myself on one of these supplements and that'll help. It won't. The best thing to do is find out if you have it. And as you probably know, there are a number of prostate cancers that we can follow closely without actually treating them. But these supplements will not help. Mr. Murray, when did you get your first prostate screening on that test? Oh, I have annual physicals with my health plan. And every year, that's one of the checks. And over the years, my PSA was below, I guess, the threshold, you know, is one point something or two point something.

It's just, I mean, the last year that it rose to five. And at that point, my internal medicine physician suggested that I go see a urologist. I did not have a urologist at all. That's the first time I've had an opportunity or a need to even think of one. So I went to my plan urologist. A urologist and he gave me some options as to what the next step would be. I'm a kind of a person who extrovert, who like to talk about my problems or issues with all my friends. And I was talking to one of my friends in the gym and told them that my level was up. And he said, well, I had been on a cruise. And I saw this thing where you're going and you have your prostate taken care of and you go shopping in afternoon. And he said probably it's not done in the United States, but it's probably done in Bermuda.

And I thought about that. And then another one of my golfing buddies, he said he'd had the surgery 10 years ago from Dr. Miles and that he highly recommended him. So I asked my care physician urologist for a second opinion. So at that time, then I got, I chose to visit with Dr. Miles and talk about my condition. And he then ran this specific test and we determined that I was a candidate for the high food. We're just joining us. I'm Johnny O'Henson, Jr. and you're listening to End Black America from KUT Radio. We're a speaker with Dr. Brian J. Miles urologist at Houston Methodist Hospital in Houston, Texas of course. And a prostate patient, Victor Murray. Dr. Miles, tell us about this high intensity, focused ultrasound. Well, it's in the United States, it is the newest treatment option that we've been able to add to our armamentarium or repertoire that we can offer to men.

I will say it's been used in Europe for decades, over 50,000 men in Europe have been treated with this with good long term results as far as cancer control. And honestly, you know, the problem with treating prostate cancer is always the concerns about the side effects. Primarily, we always worry about impotence, having a trouble getting interaction or trouble controlling the urine completely. High food is a very low risk of urinary leakage issues and it has a very acceptable risk of impotence comparable to surgery. And so it's a good option for men who don't want radiation and really don't want to go through major surgery to remove the prostate. How it works is the way I like to describe it from men in my office says, when you were a kid and you got a hold of a magnifying glass, you know, you're out on a sunny day and you take that magnifying glass and you focus the sun's rays on a piece of paper or some dry leaves, you can start a fire, right?

At the same time, if you just put your hand not under the magnifying glass just in the sun, it's warm but it doesn't burn you like it did the leaves of the paper. And that's because you really were able to focus those sun rays into a powerful beam. Well, the same thing with ultrasound, you know, when you're ultrasound like radar or sonar, it passes sound waves over the body and those are reflected back so we get an image. Well, the high intensity part of this, it's 10,000 times as powerful so it, though it is an energy source, you know, those sound waves provide energy just like the sound barrier can break glass. That energy is converted to heat in the body and so through the rectal wall, we can focus those sound waves on the prostate.

And where those sound waves are focused, you're going to get an area of tissue destruction that takes it up to 85 degrees centigrade, you know, about 185, 190 degrees Fahrenheit and so it causes tissue destruction. So we treat the whole prostate, we do it little by little because it takes a couple hours to do this, but it's very safe, it's very focused, we can focus it on the prostate, we can see where the nerves that help erections are so we can try and avoid them. And it's, again, it's an outpatient procedure and I think Mr. Murray can tell you there's really no pain associated with just the annoyance of having a catheter in your bladder. And John, I would add that the federal drug, I mean, the Food and Drug Administration, the FDA has just approved a new version of this machine that we use through EDAPS, the French company that makes it and they're based in Austin.

They have main one that's more focused so I can outline areas of concern and just treat those areas as opposed to maybe treating the whole gland. It's really kind of unique technology, but it's a great option to give to men to manage prostate cancer that we haven't had before. Does insurance cover this procedure? Ah, very good question. Medicare covers it, but at this point in time, private health insurance does not. So it's not inexpensive. It costs $25,000 and in most centers that are offering it in the country, that's fairly standard if you don't have insurance. Some health care providers are looking at this like United Health Care and the Blues are looking at this because it's a good therapy and it's compared to other treatment options.

It's certainly no more expensive and in many cases less expensive. So I honestly expect within the next few months that we'll see more of the private carriers improving this. Is there any advocacy of foot to push this along to having insurance company really consider this as an alternative treatment? Other than myself and the American, the American Hero Logical Association is looking to do that. No, I think what we need are more patient advocacy groups like us too, which is a national support group for prostate cancer patients. I'd love to see the African American community step forward. I take care of a lot of pro football players who've retired. I think through the retired football players association, these sorts of organizations I think can help us push from a different angle.

The patient point of view as opposed to my professional organization, the American Hero Logical Association, sort of nudging the organizations forward because they always tend to be reluctant to pay for anything that they can avoid paying for. Mr. Murray, were you somewhat reluctant about this procedure going in? When I looked at all the options, I was a candidate for radiation. If I had taken radiation, it's several visits. The high food was one visit. Over and a half, I was back. I went in the search for the 8 o'clock in the morning. I was back home by 130. End of story. The cure, my couple of times I've had my PSA not here down to.2, which is good. There have been some other issues, but as far as the cancer itself, that one and half always took care of it. I always wanted to have the non-invasive one-time treatment kind of an approach. When I found out that it was being done in Houston and not in Cancun or Canada or somewhere else, that was a plus for me.

That was the kicker for me. The insurance didn't cover it, but I didn't care. I thought, this is what I want. This is what I'm going to pay for. Any side effects? There's side effects. It's a surgery. I told my boss I was going to be back to work in three days. Of course, I was thinking I could get back on the golf course or wherever, but the realization is any surgery you have is a surgery. You do have to respect the difference. There was some swelling. Apparently, I affected my urine flow. I'll go a week with a catheter, remove the catheter. I'll have good urine flow. After seven days, after 28 days, I had issues where it stopped completely. Then I got back with Dr. Miles. He took a look at the bladder. He did some uncillary procedures. He had to widen the gap from the bladder to the urethra.

After that procedure, I'm doing well as far as the urine is concerned. As far as the sexual issues are concerned, I'm still working on that. I understand. Dr. Miles, when does a man needs to start having his PSA checked? Well, there's different Dr. Miles again. Different camps will tell you different things. For African-American men, I believe they should start getting tested at age 40. Some groups like the American Cancer Society will suggest age 45. That's just because for African-American men and men with a family history of prostate cancer, you have the highest risk for getting prostate cancer. Unfortunately, the highest risk of dying of prostate cancer in the world, and it's not because the disease tends to be more aggressive in African-American men. I think it is, in many ways, a reflection in the past of access to health care. If you look at Mr. Murray and the Air Force, some good papers from the military that equal access to health care and requirements to get periodic physicals in the military.

The incidence of prostate cancer is higher in African-American men, but the curate, mortality rates exactly the same in the military, where they have good care for all. For in the community, though, it's much higher mortality rate. We're seeing this, and it has something to do most likely with the genetic component of African-American men, because in Africa now, many countries are having better health care and doing PSA testing now, and they're having an absolute epidemic of prostate cancer. I think Nigeria will be number one in the world for the incidence of prostate cancer in the future, and they still have problems with mortality in Africa. For every 1.3 men with prostate cancer, one dies. In general, there are some little better in some countries, but in general, 1.3, 1.5, new cases, one man will die of it. It's something that you're going to see a lot more of in Africa, but for African-American men listening to this show, start getting tested at age 40, and if biopsies are required, I think Mr. Murray can tell you that it's never pleasant, but it's not painful and it's not bad to undergo.

Mr. Murray has stated that he, you know, get a regular annual physical. I would assume that at some age 40, 45, or 50, when one does go in for annual physical, that this will be a part of that process. Is that the case? It should be. It should be, and if not, they need to ask for it. That's correct. That's absolutely correct. It should be. It's an important part of the physical evaluation for the aging male, and it can be the difference between life and death. Is there any particular enzyme that causes the prostate to enlarge?

Boy, if I knew the answer to that, John, I would win myself a Nobel Prize. It is certainly a process. All aging, all of us guys, as we get older, will get, and in large, prostate are veritably all men, and we don't know why. It undoubtedly has something to do with the fact that as we get older, our testosterone levels begin to decrease, and it's something called the estrogen testosterone ratio, you know. Women have a little bit of male hormone. Men have a little bit of female hormone, because male hormone gets translated or changed into a little bit of female hormone in the fat and liver and lung. Women female hormone gets translated into or transformed into a male-like hormone. If you upset the balance between testosterone and female hormone estrogen, in this case, it's estradiol, there's a lot of evidence that that has a role to play in the enlarging prostate. But we do not have the definitive answer, and it happens to all guys, so don't worry about it. And it's interesting, the larger the prostate, the lower the ejaculatory volume, when men have an orgasm, when they're older, they may notice that they don't seem to make as much seminal fluid.

You'd think a bigger prostate would make more of that, but it doesn't, it makes less. If one does have an enlarged prostate, does that automatically equate to prostate cancer? Great question, and the answer is no. Dr. Brian J. Miles and Victor Murray. If you have questions, comments, let suggestions ask your future in Black America programs. Email us at inBlackAmerica at kut.org. Also let us know what radio station you heard us over. Remember to like us on Facebook and to follow us on Twitter. The views and opinions expressed on this program are not necessarily those of this station or of the University of Texas at Austin. You can hear previous programs online at kut.org. Until we have the opportunity again for technical producer David Alvarez, I'm John L. Hanson, Jr. Thank you for joining us today. Please join us again next week.

CD copies of this program are available and may be purchased by writing in Black America CDs. This has been a production of kut radio. You You

I'm John L. Hanson, Jr. Join us this week on in Black America. In the United States, it is the newest treatment option that we've been able to add to our armamentarium and repertoire that we can offer to men. Over 50,000 men that we're in here have treated with this with good, long-term results, cancer control. High Intensity Focus Ultra Sound with Dr. Brian Miles and Victor Murray this week on in Black America. You You