Focal Treatment for Prostate Cancer Allows Patient To Continue Active Lifestyle

In 2012, Northeast Ohio native Bill Sedivy was living in Boise, Idaho, when results of a Prostate-Specific Antigen (PSA) blood test used to detect prostate cancer showed an elevated PSA. A biopsy confirmed prostate cancer, and Bill underwent radiation treatment.

Following that treatment, Bill’s primary care physician and a urologist monitored his PSA levels annually. About five years after radiation, Bill’s PSA count began to rise a bit each year. Then, during the course of his annual physical in September 2023, an elevated PSA led to another biopsy that confirmed a recurrence of the cancer.

Following a PET scan, one urologist told Bill that it appeared the cancer had spread, and that his risk of dying of prostate cancer was quite high. Bill sought a second opinion.

“I pretty much crashed emotionally with that first recurrence diagnosis and the treatment options offered, so I decided I wanted someone else to take a look,” Bill said. “Aside from prostate cancer, I was otherwise healthy, living a very active lifestyle, and wanted to keep doing it.”

Fortunately, Bill’s second urologist and the radiologist who conducted the PET scan confirmed that the second round of cancer had not spread and was contained within the prostate.

But treatment options available to Bill in Boise – removing the prostate or hormone therapy – were not appealing to him.

With 1 in 8 men being diagnosed in their lifetime, prostate cancer is quite common and is often curable with early diagnosis and treatment. Recurrences after radiation treatment, which can affect anywhere from 20-40% of men, are often more difficult to treat due to scar tissue caused by the radiation. In Bill’s case, surgery to remove the prostate could have led to urinary incontinence and loss of sexual function. Hormonal therapy – a lifelong treatment – could also lead to sexual issues, bone density loss, fatigue and more.

A passionate outdoorsman, Bill loves to canoe, float whitewater rivers in rafts, camp and bird watch. He worked most of his life as an editor for newspapers across the country, then taught journalism before switching gears to run a river conservation group in Idaho. Upon retiring, he worked summers as a river ranger for the US Forest Service, the Bureau of Land Management and for the State of Montana.

“I still have a lot of rafting, traveling and birding to do,” Bill told his new doctor, who then raised the possibility of high-intensity focused ultrasound (HIFU). This procedure, which uses beams of ultrasound to focus on the exact tissue areas requiring treatment and offers less chance of side effects, seemed like the best option to Bill. However, the nearest medical facility with HIFU technology was hundreds of miles away.

Because he grew up in Northeast Ohio and still had family in the area, Bill asked that urologist if he knew any doctors at Cleveland Clinic. In a stroke of luck, the urologist had trained with Zeyad Schwen, MD, a urologic oncologist who treats patients at Cleveland Clinic Hillcrest Hospital and Main Campus.

A quick referral, combined with encouragement from his brother in Ohio, had Bill seeing Dr. Schwen for an initial assessment in early October 2023.

“HIFU is a newer form of treatment more commonly used to treat an initial diagnosis of prostate cancer. Instead of treating the entire prostate, it’s a focal therapy that allows us to target tumors inside the prostate,” says Dr. Schwen. “In situations like Bill’s, where it’s a recurrence of prostate cancer, every case is presented at tumor board, where a team of specialists review and evaluate each patient to determine if they are a good candidate.”

That review deemed Bill to be a good candidate, and on November 1, 2023, Dr. Schwen performed the outpatient HIFU procedure, which is done under anesthesia and takes about an hour.

Bill recovered quickly and was able to go ahead with plans to lead bird watching tours in Costa Rica in December and January. He now has a home in Mentor, and continues to see Dr. Schwen for follow-up appointments, some in-person, some virtual; and will continue to have PSA tests (he’s had three since the surgery and his PSA number has remained stable). Now 68, he remains active with rafting, canoeing, golfing and bird watching. He winters in Costa Rica, where his primary mode of transport is a bicycle, and he helps guide bird watching tours.

“I’ve been wonderfully fortunate throughout my adult life to have excellent medical care, but I encourage people to inquire about other treatment options available to them,” Bill says. ”By seeking a second opinion, I was able to learn about a completely different option for treatment and get connected with Dr. Schwen.”

Dr. Schwen also encourages patients to ask questions and seek options for treatment. “Prostate cancer is slow moving which allows us to do the right treatment at the right time versus rushing into something,” he says. “ If you’re newly diagnosed with prostate cancer, ask your doctor if you’re a candidate for a focal treatment like HIFU. It may be an option if you want to avoid a whole gland treatment like surgery or radiation.”