Cancer

By STEPHANIE SAUL
Published: January 18, 2008


PUERTO VALLARTA, Mexico — Some weekends, more than a dozen American men wait at beachfront hotels, anxious for their turns in the treatment room at a small private hospital here.
They are medical tourists with prostate cancer. And they are queued up for the latest therapy — one advertised with pictures of couples strolling on the beach and pitched as a way to treat the patients’ disease while preserving their sex lives.
The treatment is called high-intensity focused ultrasound, or HIFU (pronounced HIGH-foo). And instead of using surgery or radiation, it attacks the cancerous tissue by heating the prostate to temperatures near boiling.
Tropical beaches aside, there is a reason that hundreds of American men have traveled out of the country to receive HIFU. It is not approved in the United States. And its growing popularity has some cancer experts voicing caution. They argue that there is not yet enough evidence that the treatment stops cancer over the long run and they say the side effects are not as minimal as described by US HIFU, the company sponsoring the offshore treatment weekends.
The company is attracting attention for its aggressive recruitment of American doctors who will go through training and perform the treatments. The company charges patients $25,000 to $30,000, a fee that is usually not reimbursed by insurance. Of that, the company pays the doctors $5,000 to $7,500 — several times what physicians earn for conventional prostate cancer procedures in the United States.
Critics worry that financial motives might influence medical decisions.
“The people doing the treatments down there, they’re just printing money,” said Dr. Thomas A. Gardner, an Indiana University School of Medicine urologist who has been involved in clinical studies of HIFU and who, despite his concerns, is enthusiastic about its potential. “Anytime anyone’s printing money, doing what’s right for the patient gets a little blurry.”
But Dr. George M. Suarez, medical director of US HIFU, which is based in Charlotte, N.C., defends the company’s fees, which are less than the cost of some other prostate cancer treatments. And he says he recommends the treatment because he believes that it works as well as surgery or radiation, with fewer side effects.
Nearly a quarter-million cases of prostate cancer are diagnosed in American men each year, and newer detection methods and increased vigilance mean that more cases can be caught while the disease is still curable.
Even earlier detection is expected with the advent of new genetic tests, like one announced Wednesday, that can identify which men are at high risk. Despite such advances, though, doctors still cannot predict which cases of cancer will spread. And so most cases are treated, even though most prostate cancer is slow-growing and in many cases would be harmless if left alone.
The company says it has treated more than 1,000 men in its centers since 2004. Stephen R. Puckett Sr., the company’s chairman, said that those patients “should have the right to choose their medical treatment and to choose where to have it.”
One of those patients is Gary Crissman, 54, a manufacturer’s representative from Pittsburgh, who was among five Americans treated at the small private hospital here one weekend in December.
Mr. Crissman said he had considered surgery and radiation, but worried about the common side effects of both — sexual impotence and urinary incontinence.
“I didn’t want to have the problem of potentially leaking, and I didn’t want to have the problem of erectile dysfunction,” said Mr. Crissman. Afterward, he said, his procedure was such a pain-free “breeze” that he celebrated with a Mexican buffet dinner in his hotel’s restaurant.
Positive patient testimonials can be found on the company’s Web site, which also lists the company’s treatment sites elsewhere in Latin America and the Caribbean and affiliates in Canada.
Not every customer has a good experience, though.
“The US HIFU site makes it all sound rosy; they give you none of the side effects and none of the bad results,” said Fred Gillick, a Park Ridge, Ill., real estate executive who received the treatment here in April 2006.
Mr. Gillick, 69, says the procedure left him impotent and he must wear a catheter at all times. Worse yet, he said, the treatment did not eliminate his cancer.
“Guys, there’s a reason HIFU isn’t approved here,” Mr. Gillick said in a Web posting on a cancer support site.
Even patients whose testimonials appear on the company’s Web site do not always have good outcomes.
Charles A. Reinwald of Tequesta, Fla., said Dr. Suarez treated him in the Dominican Republic in June 2004. Mr. Reinwald’s statement on the site, written a short time later, applauded HIFU for what he said were minimal side effects.