Prostate cancer is one of the most common cancers to affect men, with about one in seven diagnosed during his lifetime. At the time of diagnosis, during treatment and after treatment, men often experience a range of emotions, including shock, fear, stress, anxiety, and feeling alone.

You are not alone! View a prostate cancer patient focus group to hear Dr. Pugach and his patients discuss a wide range of questions on how they felt about and handled their prostate cancer diagnosis, treatment, and life afterwards.

If you have any questions or would like to speak with one of our Prostate Cancer Peer Ambassadors, please contact us. You may also want to attend a support group. Visit Prostate Forum of Orange County to learn about this non-profit resource and support organization.

Patient Perspectives

HIFU Patient Story: Meet Josh Lerman, Bensalem, PA

HIFU UROLOGIST: Dr. Robert Pugach, Western States HIFU

To say that Josh Lerman is passionate about HIFU as a treatment for prostate cancer would be an understatement. When speaking to him you can feel his excitement. He has dedicated his life to helping other men who have Josh Lerman HIFU Patientreceived a prostate cancer diagnosis find their way to HIFU.

Josh lives right outside of Philadelphia, Pennsylvania, and has lived there all his life. He is a mortgage loan officer and enjoys watching basketball. However, his great passion in life is his family: his wife, Geralyn, and their three kids, daughters Kaitlyn and Kelsey, and son Sean.

When Josh was 27, his father had back pain. While at a doctor’s appointment with his dad, Josh heard the doctor utter the awful news: “your father’s PSA is 70.” (For men in their 50s or younger, a PSA (Prostate-Specific Antigen) level should be below 2.5 in most cases, with men who are older than 50 seeing a slightly higher level.) His father’s back pain was caused by a metastatic tumor on his back, originating from the prostate. Josh watched his father, his idol, wither away over the next year and a half, ultimately succumbing to his cancer.

Thinking of himself and his own son, who, then, was only one year old, Josh began educating himself. He started researching for himself and for his family. It was something that he always had in the back of his mind. Years later, he stumbled upon HIFU, which, at the time, had not yet been approved for use in the US. He believed in it wholeheartedly. He asked his doctor for a baseline PSA at age 35, due to his family history of prostate cancer. He continued to educate himself more and more.

At age 53 he received another PSA, which subsequently tripled from 1.1 to 3.1 in a year. He knew he had cancer, but Josh knew he needed to get the best diagnosis possible and he spoke to his urologist about getting a multi-parametric MRI to pinpoint the exact location of the tumor in his prostate. This enabled his physician to conduct a Fusion Targeted Biopsy instead of a standard TRUS biopsy alone. He said he was glad he did because he is confident that if he only had a standard biopsy, without the MRI images to guide the placement of the needles, they would have missed the cancer altogether.

Now was the time to put his research to good use. He reviewed his previous research and knew that it was time to treat his prostate cancer with HIFU, which thankfully, had recently been approved by the FDA for use in the US. It was, however, not covered by insurance. He had three kids in college; how would he raise the money?

Taking an innovative approach, Josh turned to crowdsourcing to raise money to help pay for his procedure, creating a GoFundMe campaign where he shared his story. Josh felt so passionate about HIFU and getting better that he treated his HIFU fundraising initiative as an awareness campaign. He spoke with his local urologist about his research and knew that his doctor was not trained to perform the HIFU treatment, but he also knew that he needed his local urologist’s support, which he got. It was time to find a HIFU doctor.

In March of 2016, Josh found Dr. Robert Pugach, the medical director of Western States HIFU located in Los Alamitos, CA in close freeway proximity to residents of Los Angeles and Orange Counties, California. He knew this was the man to perform his HIFU. Josh went online and read bios, and when he found Dr. Pugach, something just clicked for him. Dr. Pugach called him personally to discuss his case. He treated him as a person and noted every little detail of Josh’s case.

Even though Josh was very familiar with the procedure, and had so much faith in it and his doctor, he still had some concerns. Because of his Gleason score and the size of his prostate, he was worried he might not be the ideal candidate for HIFU. He was also worried about the cost of the procedure as an out of pocket expense.

Thankfully, he was deemed a candidate for HIFU, and with the help of his family and friends and careful financial planning, on September 20, 2016, with his daughter Kelsey at his side, Josh had HIFU to treat his prostate cancer.

Following the procedure, Josh felt great and had no trouble moving around. He recalls that the catheter was the worst part of the procedure. Several days later, while still in California, he and his daughter went to dinner to celebrate a successful surgery. They were sitting at the restaurant, overlooking the Pacific Ocean, and Josh thought, “this is the moment.” The moment he had been waiting for….healthy and cancer removed. A stranger comes up to them out of the blue and asks, “can I take your picture to capture the moment?”

It was all too stunning to Josh. A picture-perfect scene. And all of this, on his father’s birthday.

Josh returned home to Philadelphia to his wife and family, and his 17-year-old dog, who missed him possibly most of all. He had zero issues and no soreness. Josh feels the biggest benefit of HIFU is the fact that if you catch itJosh Lerman Prostate Cancer early, it will cure your cancer. He also appreciated the minimal side effects.

To a man recently diagnosed with prostate cancer, Josh would say to do your research. Educate yourself. He would also point them to his website,, which educates men and their loved ones about prostate cancer and their options.

Josh’s motto is “DDDDO: Due Diligence, Definitive Diagnosis, Options!” By doing his research, being proactive, and finding a cure, Josh is now able to continue his passion of raising awareness for prostate cancer and of course, enjoy his beloved family.