Hattat Prostate Diagnosis & Treatment Center

As a pioneer in urology and sexual dysfunction, Hattat Clinic provides the latest and non-invasive treatment options for both Enlarged Prostate and Prostate Cancer.

Understanding The Prostate

The prostate is a walnut-sized gland that forms part of the male reproductive system. The prostate secretes fluid that carries sperm. It surrounds the urethra, the canal which carries urine from the bladder out of the body. With age and time, the prostate enlarges causing pressure on the urethra, similar to a clamp on a garden hose. This causes problems with urination.

Enlarged Prostate: benign prostatic hypertrophy or BPH

An enlarged prostate could be the most common and troublesome problems affecting men over the age of 50. They may not be life threatening, but it is a major quality of life problem The problem is called benign prostatic hypertrophy or BPH. The problem describes when the walnut-sized prostate, which sits at the base of the bladder, enlarges. The symptoms of BPH include frequent and the urgent need to urinate in the middle of the night. If the blockage closes up enough, patients can then experience the other morbidities or other problems of BPH, which includes not being able to urinate.

BPH symptoms:
  • Frequent urination, especially at night
  • Sudden need to urinate
  • Need to strain or push to urinate
  • Pain or burning
  • Feeling that your bladder never completely empties
  • Dribbling or leaking
  • Weak stream

What might happen at Hattat Clinic?

When your Hattat Clinic physician evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE). In addition, your Hattat Clinic physician will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation. These include:

  • Prostate specific antigen (PSA), a blood test to screen for prostate cancer
  • Urinary cytology, a urine test to screen for bladder cancer
  • A measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
  • Uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates
  • Cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope
  • Urodynamic pressure-flow study that tests the pressures inside the bladder during urination
  • Ultrasound of the kidney or the prostate

Greenlight- Hattat Clinic Treatment Protocols

Many treatment options from drug therapies to open surgeries and lasers have been used for BPH. Hattat Clinic provides a wide experience in all the treatment options including surgical options, such as TURP, TUIP,Open Prostatectomy and the latest Lazer procedure called Greenlight. What makes Greenlight so special is that it completely vaporizes the excess prostate tissue quickly, and seals the very thin (1-2mm deep) surrounding area preventing any bleeding. The benefit of immediate vaporization is that there is no tissue left behind and the cavity is clean. Sealing only a very precise, thin zone allows for quick and painless recovery for the majority of patients. As recent studies show, the procedure can be performed under a wide range of anesthesia options, from local to light IV to spinal, based on your individual conditions and preference.

A Simple and Effective Solution: GreenLight Laser System

PVP for Photoselective Vaporization of the Prostate, performed with the GreenLight laser system, offers a unique and simple solution to BPH because it combines the effectiveness of TURP, the surgical "gold standard" with the safety, comfort and ease of a therapeutic alternative. The GreenLight laser system uses a very high powered "green laser" which immediately vaporizes and precisely removes enlarged prostate tissue. Most of our patients return home a few short hours after the PVP procedure and can return to normal, non-strenuous activities within days.

The Procedure:

A thin fiber is inserted into the urethra through a cystoscope. The fiber delivers green laser energy that quickly vaporizes and precisely removes enlarged prostate tissue. Your Hattat Clinic physician is able to view safely and control the treatment area, tailoring it to each patient’s anatomy and needs. Natural urine flow is immediately restored and urinary symptoms are relieved. Patients may be released after a few hours or after an overnight stay. Many patients do not need a catheter. If one is required, it is usually removed in less than 24 hours. After the procedure you may have some mild discomfort such as slight burning during urination for a week or so. This is easily managed with mild pain medications and anti-inflammatory drugs. Most of our patients can resume normal activities like driving a car or working a desk job within the week. The GreenLight PVP Laser Procedure should not affect your ability to have an erection or an orgasm. If you are sexually active, you can look forward to remaining so.

What are the Benefits of Greenlight?

Greenlight PVP Procedure Is:
  • Safe - the GreenLight PV System designed for this procedure is very precise and the vaporization is limited to the excess tissue only.
  • Minimally invasive - no large openings are required to access the treatment area.
  • Various anesthetic options - to insure patients' comfort nearly any type of anesthesia can be used, from local to general.
  • No rectal thermal monitoring device necessary - due to high safety and limited injury area there is no need to monitor temperature inside the treatment area.
  • Virtually blood-free - dramatically decreased healing time.
  • Low (about 50%) incidence of catheterization - no constraints, immediate freedom of movement.
  • Short (less than 24 hours) catheterization time - for those patients who would require a catheter, the constrains are very short-term.
  • Outpatient procedure - go home the same day.
  • Immediate relief of symptoms - immediate improvement of the quality of your life.
  • Preservation of sexual functions - there is no risk of sexual dilapidation as result of the procedure.

If you are diagnosed with BPH, you should discuss all treatment options with your urologist at Hattat Clinic. Together, you can decide whether medication or surgical treatment is best for you.

Prostate Cancer

Cancer is a disease that is characterized by uncontrolled growth of abnormal cells. Normally cells reproduce themselves by dividing and replace old or injured cells. But sometimes cells grow abnormally and accumulate into a mass called a tumour. These tumours may be non cancerous (benign) or cancerous (malignant). Benign tumours are seldom life threatening although they may interfere with some organ functions. Malignant tumours have invasive characteristics, which destroy normal tissues. Prostate cancer normally grows at a very slow pace and can even grow for years without any symptoms. Nevertheless, a small proportion of the tumour may be highly aggressive, and spread rapidly to other parts of the body. The exact cause of prostate cancer remains unknown, however a number of factors increase the risk of developing prostate cancer. The most common factors are age, race and family history.

Prostate cancer rarely occurs before the age of 45. The risk of prostate cancer increases with age. Men with a family history of prostate cancer may be a higher risk group. Diet may be a factor in the incidence of prostate cancer, as incidence rates are generally greater in countries where meat and animal fat consumption is higher.

Symptoms:

Prostate cancer is a disease that normally shows symptoms only at a late stage. The tumour can be present and growing for years without any symptoms. There are no typical symptoms for prostate cancer but some men may present:

  • Frequent urination
  • A weak urinary steam
  • Interruption while urinating
  • Pain or burning while urinating
  • Inability to urinate
  • Blood in the urine

These symptoms are not specific to prostate cancer and can also be due to a benign growth of the prostate.

Early detection is essential
Early detection of prostate cancer is the key factor to initiate a proper treatment that will result in cure of the disease. As long as the cancer is limited to the prostate gland there is a good chance to eliminate it. Once it passes the boarder of the gland it gets very difficult to treat. Therefore, men at the age of 45 should undergo a yearly screening.

What might happen at Hattat Clinic?

Various diagnostic tools are used for the detection of prostate cancer. At Hattat Clinic, they are generally used in combination to achieve a high diagnostic security and early detection. In a digital rectal examination (DRE) the physician inserts a gloved finger into the rectum and palpates the prostate. Due to the close proximity of the rectum to the prostate, abnormalities of the gland can be felt. DRE is very useful in detecting prostate cancer but requires a certain size and position of the tumour. Therefore many early stage cancers are missed using this method alone. The prostate specific antigen (PSA) is a substance that is produced by the prostate. Its concentration can be measured via a simple blood test. A healthy prostate releases very little PSA into the bloodstream. A high result of PSA indicates an abnormal situation of the prostate, but does not mean automatically that prostate cancer is present. It also may be the result if a benign enlargement of the prostate or other circumstances.

If the PSA level is high additional evaluations should be performed. Via a transrectal ultrasound probe (TRUS) the prostate can be visualised on an ultrasound screen, which allows your Hattat Clinic physician to analyse the prostate tissue. It is used to further define the condition of the prostate gland. A thin ultrasound probe is inserted into the rectum to a distance that permits visualization of the prostate gland. In this way your Hattat Clinic physician obtains a precise picture of the gland, which can then be examined. During a biopsy a small amount of tissue is removed via a special needle and examined. This is the only way to definitively confirm prostate cancer.

HIFU- Hattat Clinic Treatment Protocols

Many treatment options from radical prostatectomy to radiation therapy and hormone treatment have been used for Prostate Cancer. Hattat Clinic provides a wide experience in all the treatment options including surgical options, and the latest procedure called HIFU.

HIFU (Transrectal High Intensity Focused Ultrasound) is used to treat localized prostate cancer using high intensity focused ultrasound beam. Under a spinal or epidural anesthetic an ultrasound probe is inserted in the rectum to map the exact outline of the prostate gland. Using this map, high intensity ultrasound waves are delivered through the rectal wall precisely focused on the prostate. This focusing produces intense heat and causes the destruction of the tissue inside the targeted zone without damaging surrounding tissues. The treatment generally takes 1 to 3 hours depending upon the size of the prostate and is usually performed on an outpatient basis. Ablatherm® HIFU is an appropriate treatment option for essentially any male who has prostate cancer which can be cured by any other means. The stages of cancer of the prostate are:

1. T-1 Prostate cancer - This is a cancer which has no signs or symptoms and is totally unsuspected. The prostate feels normal to the physician on rectal exam. The cancer is detected either by an elevated Prostatic Specific Antigen (PSA) blood test and subsequent biopsies or by examination of tissue removed during treatment of an enlarged prostate. This tumor can be cured by surgery, radiation, and Ablatherm® HIFU.

2. T-2 Prostate cancer - This is a tumor which is suspected on rectal exam. One or both lobes of the prostate have areas of firmness and biopsies reveal the cancer. The PSA is also usually elevated. This tumor can be cured by surgery, radiation, and Ablatherm® HIFU.

3. T-3 Prostate cancer - This is a tumor that has spread outside the prostate capsule and may have reached the seminal vesicles. This tumor is not curable by surgery, radiation, or HIFU.

4. T-4 Prostate cancer - This tumor may have spread to the rectum or bladder or to distant organs or bone. This tumor is not curable by surgery, radiation, or HIFU. Patients with both T-1 and T-2 prostate cancer will have an imaging scan, such as an MRI or CT, to try to detect cancerous extension outside the prostate or to other organs (lymph nodes, liver, etc.). A Bone Scan is used to rule out spread to bone. These tests will show no spread of tumor outside the prostate in T-1 or T-2 cancer.

Patients with T-1 and T-2 prostate cancer who have had external beam radiation therapy (EBRT) and recurrent cancer, but no spread outside the prostate, can be treated for cure by Ablatherm® HIFU. The sooner a patient is treated after the diagnosis of failed EBRT the better the chance he has for cure by Ablatherm® HIFU.

Patients with T-1 and T-2 prostate cancer who have had a radical prostatectomy and have recurrent cancer localized to the area of the prostatic fossa can be treated for cure by Ablatherm® HIFU. In fact, Ablatherm® HIFU remains one of the only therapy options for these patients.

It is important to know that the ability to detect microscopic spread of the tumor beyond the walls of the prostate is limited by today's technology. It is estimated that approximately 30% of patients diagnosed as having T-2 prostate cancer actually have a spread of cancer cells outside the prostate wall (T-3) and are therefore not curable. This is particularly true if the PSA is equal to or greater than 10 or the Gleason score is greater than 7.

What are the Benefits of Ablatherm® HIFU?

In 1989, three prestigious European research groups united in their efforts and initiated a project to develop an efficient and non-surgical treatment for localized prostate cancer. After ten years of development Ablatherm® HIFU was approved for treatment in Europe. At present, Ablatherm® HIFU is being used throughout Europe, Russia and other Asian countries. To date, thousands of patients have been treated successfully in many European centers and throughout the world. Over 90% of patients undergoing Ablatherm® HIFU therapy will not require further treatment for their prostate cancer. Ablatherm® HIFU treatment has a similar success rate to radical prostatectomy but has the major advantage of using non-invasive technology with many fewer side effects.

The treatment of localized prostate cancer with High Intensity Focused Ultrasound has many advantages:

  • Destruction of the cancerous tissue with no incident of injury to the rectum since parameters were updated in 2002.
  • Patient does not undergo any radiation exposure.
  • No hospital stay is required.
  • Treatment is performed under spinal anesthesia.
  • Treatment can be repeated if necessary.
  • Other therapeutic alternatives can be considered in case of incomplete results.
  • Ablatherm® HIFU can be used for the treatment of local recurrences (i.e. after external beam radiotherapy).

Don’t forget; only you as the patient and your Hattat Clinic physician can determine the best treatment option.