Author: Dr. Frank L. Simoncini

Pro-Nox Nitrous Oxide Delivery System

Southeast Valley is excited to introduce Pro-Nox to our medical devices used at our urology clinic in Gilbert, AZ. Pro-Nox uses nitrous oxide as an anxiety-reducing method and can lessen discomforts felt during procedures such as cystoscopies, vasectomy, and biopsies. If you have an upcoming procedure with Southeast Valley Urology ask about how Pro-Nox can help you with pre-procedure anxiety.

Pro-Nox Patient Consent Form

Pronox Patient Brochure

 

 

When Is The Right Time To Get A Vasectomy?

A vasectomy may seem like a permanent fix to most men as it shuts the door on having any or more children. The truth is, that is not the whole story. Half a million men decide to have a vasectomy each year in the US. The decision begins with when is the right time to get a vasectomy and more importantly, is it right for you?

Continue reading “When Is The Right Time To Get A Vasectomy?”

6 Signs of Low Testosterone

According to the urology care foundation, approximately 40 percent of men over 45 years of age have low testosterone. When people think of testosterone, they often assume it only is used for building muscle and fueling sex drive. While testosterone plays a crucial role in these functions, low T can have an impact on several other areas of a man’s health.  Continue reading “6 Signs of Low Testosterone”

Urinary problems: Tips to help

Many people don’t think of healthy urinary function as interesting, at least not until they have an issue. But urinary problems from BPH or benign prostatic hyperplasia can be annoying,patient discussing BPH with doctor uncomfortable, and embarrassing. BPH is an enlarged prostate gland. BPH occurs in almost all men as they age. BPH is usually not a serious problem, but it can affect your health and your mood. Learn about the symptoms of BPH and the cause. Lifestyle changes, such as cutting back on caffeine and alcohol, can sometimes be enough to reduce your symptoms. Get more tips on treating BPH here.
Contact expert urologists Dr. Shaba or Dr. Simoncini if you are experiencing urinary problems. Call (480) 924-7333 to schedule an appointment at our urology  office in Gilbert, AZ today!

Should I Get Tested for Prostate Cancer?

Prostate cancer is common in men older than 65, but it grows slowly and can take years to cause symptoms. Most men don’t even know they have it until it’sDoctor and patient found during a regular medical exam. Trouble urinating can be one sign, but this can also be a symptom of other problems, like an enlarged prostate. Read more to learn about treatment options and to decide whether the blood test is right for you.

Contact expert urologists Dr. Shaba or Dr. Simoncini for prostate cancer testing and treatment. Call (480) 924-7333 to schedule an appointment at our urology clinic in Gilbert, AZ today!

 

The Guy’s Guide To Male Incontinence

Let’s face it. As a man, there are probably things you just do NOT want to talk about. Incontinence is probably one of those topics, but the truth is that if you are suffering with incontinence, you must deal with it. So continue reading and consider it the guy’s guide to male incontinence. Then your next step will be to talk to a urologic specialist at Southeast Valley Urology about it!

Continue reading “The Guy’s Guide To Male Incontinence”

4 Common Causes of Erectile Dysfunction

Erectile dysfunction can affect self-confidence and create tension in a relationship. Because of the nature of the condition, it can be a difficult issue for men to talk about, but it’s important to remember that you’re not alone. In fact, approximately half of the male population will be affected in their lifetime and 40% will be affected by the age of 40.

In order to treat erectile dysfunction, it is vital that you understand what causes the condition.

Continue reading “4 Common Causes of Erectile Dysfunction”

High Intensity Focused Ultrasound

HIFU

(HIGH INTENSITY  FOCUSED  ULTRASOUND)

HIFU  PROSTATE CANCER 

HIGH INTENSITY FOCUSED ULTRASOUND

NO BLADE NO INCISION NO SCAR NO RADIATION

CANCER CONTROL

QUALITY OF LIFE PRESERVATION

LOW RISK OF DEBILITATING SIDE EFFECTS

LESS TIME AWAY FROM WORK AND LEISURE

NO SCAR

NO INCISION

NO RADIATION

SOUND TOO GOOD TO BE TRUE?

 

WHAT IS HIFU?

High Intensity Focused Ultrasound

Over the past 20 years, thousands of men suffering from Prostate Cancer have benefited from HIFU or Robotic HIFU in greater than 300 centers worldwide. HIFU has been cleared for use in the USA for the ablative treatment of prostate cancer since 2015. Traditional treatment for Prostate Cancer in the United States includes the following:

Robotic Assisted Radical Prostatectomy

Open Radical Prostatectomy

External Beam Radiotherapy

Cryoablation

Active Surveillance

My personal belief, as a physician, surgeon and cancer survivor is that prostate cancer treatment in the United States is very good.  Most likely the best the world has to offer is in the United States.  I do not believe in a “one size fits all” approach to prostate cancer. For example, a young, otherwise healthy male with moderately aggressive prostate cancer might be better served having a robotic radical prostatectomy than radiation therapy or active surveillance.  Why?  A young healthy male has many good healthy years ahead of him, which also translates into many years of potential recurrence after external radiation therapy or many years to progress and become incurable with active surveillance.   Furthermore, if a patient fails radiation therapy, surgical intervention has a very high complication rate, nor can one simply have more radiation therapy because of side effects and sequelae. On the other hand, an elderly patient with multiple concomitant medical problems might be best served with active surveillance.  The risk to benefit ratio of having surgical intervention for a patient in that situation is too high.  My personal opinion is each patient/person is an individual.  Each patient’s presentation and wishes, desires and goals are unique and there is not a one size fits all solution to prostate cancer. Lastly, I am not a big fan of active surveillance.  Why?  there was a big push for this in the early 1990’s and again recently.   Without going into a great amount of detail I can tell you in my experience I saw many patients go from being curable to incurable. Further, many patients in the hospital with sequelae of locally advanced prostate cancer.

Why does this happen? The biggest problem I see with active surveillance despite what some of the studies show: “It’s slow growing” or “You’ll die from something else,” which all sounds good on paper…..unless, of course, you happen to be the patient. The biggest problem I see with active surveillance is that when we compare the biopsy specimen with a prostate after surgery in the pathology department.  Why?  It’s rare that the biopsy result and the final pathology result are the same. There is usually a greater volume of cancer and many times a more aggressive cancer than what we saw on the initial biopsy. That being said, if you are the patient, or the physician for that matter, you have to trust that what your biopsy revealed is actually all the cancer that is truly present to trust active surveillance. I can tell you with all my years of experience and multiple prostate cancer surgeries I have performed, I am not a big believer in surveillance because of that simple fact.  Our imaging and cancer mapping technology has improved over the years, however; if biopsy and pathological specimens correlate in the future requires further study.

All that being said, patients, at times, have a reluctance to having prostate cancer treatment. The reason is there are risks and benefits to any treatment.    With prostate cancer surgery, patient’s worry is mainly incontinence and impotence.  “My prostate cancer is gone but I am wearing diapers and cannot get an erection.”  Those are very real concerns for patients.   “I had radiation therapy but what if it recurs?’  That is a real concern as well. Let me tell you a couple things about being a cancer survivor.  I hear patients say this very often…”well if I get ten years I’ll be happy with that!!!”  I can just tell you two things from my experience as a cancer survivor: First, ten years goes by in a blink of an eye. Second, surviving ten years might sound reasonable ….until about year nine.  Year nine comes around very fast.  All that being said, the majority of patients do not have major long term Complications with surgery or radiation therapy.  Most of those problems resolve over time.  Nonetheless patients do have real concerns about potential complications and are always looking for an alternative approach to treatment.

 

So will HIFU change the prostate cancer treatment paradigm?

HIFU has only recently been approved in the United States, however; has been in practice worldwide for the last twenty years.  The studies show good cancer control, comparable to traditional prostate cancer treatments.  The results of cancer control with HIFU have significantly improved over the years as the technology has improved.  I believe we will need to study HIFU more extensively in the future before we have all of the answers, however; the initial studies are favorable. What makes HIFU very attractive to patients is that it offers good cancer control with very minimal side effects when compared to more traditional prostate cancer treatments. There are no incisions, no scars, no early or late side effects of radiation therapy. HIFU is performed in outpatient surgical facilities currently (whether surgery center or hospital) there is little to no pain post operatively, very minimal chance of urinary incontinence, much better outcomes with preservation of erectile function post operatively, and you are back to work and normal activities very soon after your procedure. It is possible with MRI Fusion biopsy to isolate cancer lesions and treat half of the prostate or even just the lesion itself which have even less side effects than traditional full gland HIFU.   It is a treatment that can be repeated safely if a patient does have a recurrence of his prostate cancer. In very general terms, HIFU offers an alternative to traditional prostate cancer treatment. Studies initially have shown good cancer control, very minimal side effects, can be done as an outpatient.  If you have a recurrence years down the road the treatment can be repeated, hence the attraction to HIFU.

 

STEP BY STEP HIFU PROCEDURE SUMMARY

 

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  1. Patient has bowel prep night prior or morning of the procedure before arriving at our surgical center
  2. Patient typically will receive a general anesthesia and positioned comfortably on his side
  3. Ultrasound of the prostate with 3-D reconstruction is performed
  4. The urologist tailors the procedure millimeter by millimeter to the individual patient to achieve the best cancer control with the least possible side effects
  5. Ablation of the targeted tissue is performed with continuous monitoring of response to therapy
  6. Patient is discharged home after the procedure. (Will not be able to drive himself home because of the general anesthesia
  7. Because of temporary swelling of the prostate, patients generally will be discharged with a temporary urinary catheter
  8. Patient’s are typically monitored with PSA testing at frequent intervals thereafter.
  9. Patients are typically back to their normal life in a very short time with very minimal side effects.

In Summary, HIFU (high intensity focused ultrasound) can be an extremely attractive alternative to traditional prostate cancer treatment. HIFU is performed in an outpatient surgical setting.   To date, studies show equivalent cancer control to more traditional

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approaches.  No incision, no blade no radiation.  Minimal side effects compared to more traditional approaches.  Hence patients attraction to the procedure. It is important to understand all of your treatment options.  I have been serving the valley for twenty years now.  I have treated multiple patients with prostate cancer with all modes of therapy, and further am a cancer survivor.

Dr. Frank L. Simoncini, DO, FACOS

Southeast Valley Urology/Division of Ironwood Cancer and Research

1501 N Gilbert Rd #204 Gilbert, Arizona 85234

Call me for a consultation: 480-924-7333

Visit us on the web: drsimoncini.com

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