Prostate Cancer Treatment in Los Angeles

Prostate Cancer is Common but Treatable

Recently, there has been a movement within the urological community to not treat prostate cancer. Some cases of prostate cancer may never spread to other parts of the body, so treatment may be unnecessary. The benefits of radical surgery or radiation may not be worth the consequences if the cancer is not developing or moving.

The challenge is in knowing which cancers will not spread. No urologist knows when a prostate cancer should be treated. There is no definite signal that tells us that a prostate cancer has already spread. While PSA monitoring, repeated biopsies and MRI studies are of some benefit, the reality is that many patients, while be being “watched” can have their cancers spread so that a cure is no longer possible.

Another problem with observation or surveillance is that more than 1/3 of prostate cancers have more aggressive cell types or are more extensive than what is found from a biopsy. Not treating these larger or faster growing cancers increases the risk of cancer spread outside the prostate. This is called metastatic cancer and it is not curable.

Why Choose Western States HIFU?

At Western States HIFU, we believe that prostate cancer should be treated before it can spread outside of the prostate and is no longer curable. We don’t want you waking up every day wondering if your cancer is still confined to your prostate.

Most men fear the side effects and complications of radical surgery (robotic or traditional surgery) or the high recurrence rates from radiation treatments (of any type).  With HIFU we can usually eradicate localized prostate cancer while avoiding the typical side effects of treatment like urinary incontinence and erectile dysfunction.

What My Treatment Options?

If your prostate cancer is localized to your prostate and has not metastasized, a procedure to cure your cancer is possible. There are 4 basic options: radical surgery, radiation of different types, cryoablation and HIFU.

  • Surgical Removal of the Prostate
  • Radiation
  • Cryoablation
  • HIFU

HIFU (High Intensity Focused Ultrasound)

High Intensity Focused Ultrasound (HIFU) is a remarkable, non-invasive procedure that treats prostate cancer while usually avoiding the two most common, life-altering side effects seen with radical surgery and radiation – permanent bladder control problems and erectile dysfunction.

Dr. Robert Pugach was one of the earliest adopters of HIFU technology. He received his initial training in December 2005 and has been treating patients for more than 19 years. He is now in an elite group of less than 1% of the urologists in the world certified to perform HIFU. He is the 3rd most experienced HIFU urologist in the Western United States and in the top 10 worldwide!

Dr. Pugach uses the Sonablate® 500, a HIFU medical device, to treat men diagnosed with prostate cancer. While there is another device available for HIFU treatments, Dr. Pugach believes the Sonablate® 500 is clearly superior and uses it exclusively for his patients who expect the latest in HIFU technology.

Learn More About HIFU

Surgical Removal of the Prostate

A radical prostatectomy is the removal of the prostate and, usually, surrounding tissue, structures, and lymph nodes. There are two methods: using a traditional large incision or a robotic-assisted laparoscopic removal.

Most radical prostate surgery is done with the robotic approach. Instruments (clamps, scissors and other cutting tools and suturing and stapling devices) are passed through small holes in your abdomen to cut out the prostate and surrounding structures. The advantage to this approach is less blood loss, fewer days in a hospital, less pain and a faster return to normal activities.

However, no matter what method is used, radical surgery has the highest risk of permanent urine leakage and erectile dysfunction. Overall, approximately 30% of men will suffer urine leakage. Depending on your age and extent of your cancer, there is a 50% – 70% chance of erectile dysfunction. These 2 life-changing side effects of surgery dramatically impact a man’s quality of life every day.


There are many different types of radiation. These include proton therapy, other forms of external radiation, a cyberknife, radioactive seeds (brachytherapy) and radioactive rods. Radiation side effects can include damage to structures near the prostate (such as the rectum), skin burns and urinary incontinence. In addition, because it is important not to radiate the urethra, adjacent tissue must be spared. This can be a site of prostate cancer recurrence.

If there is a recurrence of prostate cancer after radiation, treatment can be a challenge. Additional radiation is not an option because the maximum safe radiation dose is typically used during initial treatment. Surgical removal of a prostate after radiation fails typically results in severe incontinence. While HIFU and cryoablation are options, the prostate tissue may not respond well since it has already been radiated.


Cryoablation is a minimally invasive procedure that destroys targeted tissue by freezing prostate tissue. It is possible to freeze either the entire prostate or limited areas. Cryoablation uses argon gas to form an ice ball in the prostate. The internal prostate temperature is typically -40⁰ C. Once the targeted temperature is reached, prostate cells are destroyed.

An advantage of cryoablation is that incontinence rates are typically much lower than those seen with radical surgery. Erectile dysfunction rates, however, are comparable to those seen with surgery.Pain from cryoablation is significantly less than what is experienced after radical surgery. Another advantage is that it is usually an outpatient procedure.

While Dr. Pugach, medical director of Western States HIFU, believes HIFU is a better procedure than cryoablation, he is the most experienced practitioner of cryoablation in the western United States.

Experience counts! To schedule a consultation to learn more about HIFU, just call  877-884-HIFU (877-884-4438) or email us via our secure online form. We’re here to help you!