Sonoma Medicine Magazine’s Article on High Intensity Focused Ultrasound – by Dr. Michael Lazar

Michael Lazar, MDPatients diagnosed with prostate cancer are faced with treatment options. The historical remedies—radiation therapy, surgery, hormonal therapy, chemotherapy and freezing the cancerous
gland—have risks and negative side effects, especially incontinence
and impotence. A new technology, however, is coming of age in its
ability to diminish these risks and side effects. This nonsurgical
outpatient option—high intensity focused ultrasound (HIFU)—takes
approximately one to four hours to perform, depending on prostate
size, and has a relatively short recovery period.

With HIFU, most patients are up and walking around within two to three hours and may resume normal activities within a couple of days, with minimal discomfort. HIFU patients also experience fewer side effects than those receiving traditional prostate
treatments weeks after the procedure, patients may experience mild urinary symptoms,
such as frequency and/or urgency to may also pass an occasional small amount of blood or mucus-like materials, which is normal. Read the full article here …

NCMA Lazar article pic

Avoiding painful bladder stones and what to do if you get them

Dr. Lazar

Michael J. Lazar, MD – Urologist

NCMA’s Santa Rosa Urology and Dr. Michael Lazar provide diagnostics, treatment and management of a full spectrum of urologic health conditions including bladder stones.

Bladder stones are exactly what they sound like; hard stone-like pieces of concentrated urine which have crystallized and clumped together. Interestingly enough, in developing nations bladder stones are fairly common in children – and sadly as a result of dehydration, infection and a low-protein diet. In the U.S. bladder stones tend to occur primarily in adults, and men over the age of 30 are the most vulnerable.

How stones get in the bladder

While water makes up the majority of urine content, about five percent is made up of minerals and salts along with proteins and other waste products. When urine becomes overly concentrated due to dehydration, infection or other problems the color will vary from dark amber to brown depending on the types of waste and minerals it contains.

Bladder stones can become so large or numerous that they block the tube (called a urethra) that urine flows through from the bladder. A blocked urethra may cause slow and/or painful urination or it might make urination impossible. Sometimes bladder stones cause no problems at all — even when stones become quite large. However, real problems begin to develop as stones irritate the bladder wall or block the flow of urine, causing a variety of symptoms including:

  • Pain in lower abdomen
  • Painful and frequent urination
  • Difficulty urinating or interruption of urine flow
  • Blood in urine
  • Cloudy or abnormally dark-colored urine

A variety of causes

In the case where prostate gland enlargement causes bladder stones in men, the urethra has become compressed by the enlarged prostate, which in turn interrupts urine flow, causing urine to remain in the bladder, leading to bladder stones.

Sometimes damaged nerves can be the culprit. In a healthy person nerves work to carry messages from the brain to the bladder muscles, telling the bladder muscles to constrict or relax. If these nerves are damaged due to stroke, spinal cord injury, Parkinson’s disease, diabetes, a herniated disk or other health problem – the bladder may not empty completely, again leading to bladder stones.

Bladder stones can also develop if the bladder becomes inflamed due to urinary tract infections or even radiation therapy to the pelvic area. Bladder catheters can also cause bladder stones as can objects that accidentally migrate to bladder, such as a contraceptive device or stent. When this happens mineral crystals tend to form on the surface of these foreign objects, leading to stones. And finally, stones that have formed in the kidneys can occasionally travel down the ureters into the bladder and, if not expelled by natural means, can grow into larger bladder stones.


While medications are rarely used to dissolve the stones, drinking eight 8-ounce glasses of water or more per day will help to increase urination, which may help smaller bladder stones pass naturally. A qualified urologist will remove larger stones using an instrument called a cystoscope, which is a small tube that passes through the urethra to the bladder – and some more troublesome stones may need to be removed by surgery. For patients with enlarged prostate and bladder stones, transurethral resection of the prostate can be performed where the stone or stones are removed.


The best way to prevent bladder stones from forming in healthy people is to be mindful to always stay hydrated and to seek early treatment for urinary tract infections or other urinary tract conditions.

In addition to bladder stones and general urologic medicine services, NCMA’s Santa Rosa Urology and Dr. Michael Lazar also specialize in urologic oncology, reconstructive urology, male infertility/erectile dysfunction and high intensity ultrasound for prostate cancer. To learn more visit our website or to make an appointment with Dr. Lazar call (707) 546-5553.

“My Advice to Any Man Diagnosed with Prostate Cancer Who Has the Opportunity to Have the HIFU Treatment: Get it!”

Dr. Lazar Testimonial

Temple Smith is a motorcycle enthusiast and avid cyclist who can spend all day on the saddle streaming down the highway. At age 60, he is about to become a grandfather. Over six years have passed since Dr. Lazar performed Temple’s HIFU procedure and there is no sign of his prostate cancer returning.

Temple Smith knew that prostate cancer ran in his family. His uncle died of prostate
cancer, and his twin brother underwent a prostatectomy after doctors diagnosed him
with the same disease. While the surgery saved Temple’s brother’s life, it left him incontinent, and he now has to wear special absorbent adult underwear everyday.

When Temple turned 45, he began having routine examinations from his primary care
doctor, who eventually found early signs of cancer developing in Temple’s prostate. Temple knew he didn’t want to go through the same procedure as his brother, so his doctor referred him to Dr. Lazar in Santa Rosa.

From the moment I arrived at his office, Dr. Lazar and his staff put me at ease. He took his time explaining in great detail the pros and cons of the various treatment options available,” Temple explains. He continues, “Following a thorough examination, Dr. Lazar determined that I was a candidate for the minimally invasive HIFU procedure. At first I was nervous about the procedure since HIFU is not yet FDA approved. I would have to fly to Puerto Vallarta, Mexico to have the procedure done.

Sensing my hesitation, Dr. Lazar explained that the HIFU procedure has been utilized since the early 2000s in Japan, Europe, and Canada with proven efficacy. The procedure would leave my prostate intact, and the chances of it causing incontinence or
impotence were very small. I felt that I could trust Dr. Lazar and I decided to proceed with the HIFU procedure.

The HIFU organization SonaCare made all the arrangements for my flight and lodging, which was a huge weight off my shoulders. I stayed in a fine hotel, and a HIFU surgical nurse came by and gave me a comprehensive briefing a day prior to the procedure.
I was also very impressed with the modern hospital where I had the procedure performed.
On the day of the procedure, I met up with Dr. Lazar and a team of trained HIFU professionals in the morning, and the procedure was complete three-four hours later. I felt very little pain, there were no side effects, and to this day I am completely cancer free.
My advice to any man diagnosed with prostate cancer who has the opportunity to have the HIFU treatment – get it!

Dr. Lazar Proven safe and effective in countries around the world, High Intensity Focused Ultrasound (HIFU) is a minimally invasive, out-patient, and radiation-free procedure that patients can undergo in a few hours and return home the same day. Dr. Lazar works closely with SonaCare to help bring this lifesaving procedure to eligible patients in the U.S. He has performed more than 100 successful HIFU procedures over the last 7 years. Dr. Lazar and other HIFU experts are excited about the pending FDA approval for this procedure in the U.S., which is expected to happen in the fall of 2014.
Download Testimonial

Dr. Michael Lazar is Pioneering Use of New Treatment Using Ultrasound to Deliver Minimally-Invasive Treatment for Prostate Cancer

MichaelLazarThe use of High Intensity Focused Ultrasound (HIFU) waves to treat prostate cancer without surgery on an out-patient basis moves closer to U.S. approval thanks to Dr. Michael J. Lazar, Jr. and other urologists utilizing this next-generation technology with patients in other nations.

There is a new treatment option for patients with prostate cancer that is confined to the organ, and not spread to other areas of the body. High Intensity Focused Ultrasound (HIFU) is a minimally invasive, out-patient, and radiation-free procedure that patients can undergo in a few hours and return home the same day. This advancement in the treatment of prostate cancer is making it possible for patients with earlier stages of the disease to maintain their quality of life without surgery. Even if the prostate cancer returns, no matter what form of treatment was previously used, High Intensity Focused Ultrasound can be used again for localized treatment. The use of HIFU also does not rule out other treatment options for recurring cancer.

HIFU technology achieves pinpoint accuracy using an “acoustic scalpel” that destroys prostate cancer, while sparing healthy tissue and preserving nerves, urine flow and erectile function in a majority of cases compared with traditional procedures.

U.S. Food and Drug Administration (FDA) approval of HIFU is expected following a study involving 100 men with prostate cancer recurrence after radiation. HIFU is eradicating cancer in 70 to 72 percent of these cases, compared with cryosurgery (freezing) that historically cures about 40 percent. HIFU success rates are higher in men with previously untreated cancer. The next step will be to seek a U.S. extension of the new HIFU process to non-radiation patients.

“Twenty years ago I attended a lecture sponsored by the American Urological Association telling us that HIFU would be the future for our profession. Now we are on the brink of seeing this procedure accepted,” said Dr. Lazar, an adult and pediatric urology specialist with Northern California Medical Associates, and principal of California HIFU with offices located at 1140 Sonoma Avenue, Suite A, in Santa Rosa.

Prostate cancer is the second leading cause of cancer death in American men behind lung cancer. The American Cancer Society estimated that about 238,590 new cases of prostate cancer would be diagnosed in 2013 and about 29,720 men would die of this disease. Approximately one man in six will be diagnosed with prostate cancer during his lifetime, and one in 36 will die as a result. Prostate cancer is rare before age 40. The average age at the time of diagnosis is about 67.

“The oncological results for HIFU are broadly comparable to radical surgery or radiation but the side effects are less, especially with regard to incontinence and erectile dysfunction. There is almost no pain or blood loss. The treatment is quick and virtually painless following spinal or general anesthesia that wears off in just a few hours,” Dr. Lazar said. “If the procedure is performed in the morning, a patient is typically up and around by dinnertime and can often return to normal activity within a few days without the use of pain killers.”

HIFU 2-2-2-2

Temple Smith, one of Dr. Lazar’s patients, knew that prostate cancer ran in his family. His uncle died of it and his twin brother also had it. His brother underwent a prostatectomy that kept him in bed three to four days, and today he is incontinent.

“When I was diagnosed with prostate cancer, I had the HIFU procedure. Last October marked my fifth anniversary after having this treatment and there has been no cancer recurrence. If you have prostate cancer and the resources to get the HIFU treatment – get it done,” Mr. Smith said.

According to Dr. Lazar, HIFU is the only non-radiation technology that requires no direct contact with the target organ while accurately zeroing-in on selected portions or destroying the entire gland. No other form of treatment gives a surgeon such precise control without damaging surrounding tissue aided by simultaneous ultrasound visual tracking.

Other prostate cancer treatment options include radical surgery, radiation, hormonal and chemo/immunotherapy.  Besides the usual risks of incontinence and erectile dysfunction, radiation can cause chromosomal changes that result in cancer of the bladder and rectum.

Dr. Lazar has performed approximately 100 successful HIFH procedures on patients who volunteer to fly south of the border. “Most months for the past seven years I have traveled to Puerto Vallarta for a long weekend of outpatient procedures at a U.S. Joint Commission approved bilingual hospital. I also serve as an HIFU instructor, am one of three FDA study proctors and have aided other doctors who have treated over 200 patients to date.”

In the Western Hemisphere, the HIFU procedure is also conducted in Bermuda, Canada, Cancun and Nassau. Some 15 years of data have been compiled from Japan, 10-12 years from the UK/Germany/Italy, and nine years from Canada focusing on the HIFU procedure and results.

Another patient of Dr. Lazar is San Francisco business owner Harlow Plimpton, who had the HIFU procedure in 2011. “Before the therapy my PSA level was between 6 and 7. Following the treatment my PSA dropped to 0.1. I did not experience any side effects or incontinence. I went to the Puerto Vallarta clinic at 7:30 a.m. and walked out three to four hours later to tour the city. The doctors offered me Cialis and Viagra, but I didn’t need it. Since then I’ve been looking for a downside, but frankly, I haven’t found any.”

The HIFU procedure costs approximately $25,000, compared with robotic prostatectomy and some forms of radiation therapy that can range in cost from $40,000 to $60,000. While a few U.S. insurance companies have covered HIFU, coverage is sporadic at this time.

Within the U.S., the American Medical Association creates Current Procedural Terminology codes (CPT) for doctors to use for billing and insurance purposes.  As yet, no CPT code has been established for HIFU. “Meanwhile I tell my patients the cost is like buying a car, and many take out a home equity loan which may be tax deductible,” Dr. Lazar said.

Dr. Lazar has been certified by SonaCare Medical, LLC, a global leader in minimally invasive HIFU technologies, based in Charlotte, North Carolina. SonaCare Medical, through its subsidiary Focus Surgery, Inc., of Indianapolis, manufactures HIFU systems, such as Sonablate®. The Sonablate unit is approved for investigational use only in the United States until the expected FDA approval.  However, it is already being used in over 30 countries outside the U.S. for the treatment of prostate cancer.

HIFU 3-3-3-3

“My advice to those diagnosed with prostate cancer is to seek medical counsel on all options, not just surgery or radiation, so you can make an informed decision and see if you are a candidate for HIFU,” he added.

Michael J. Lazar, M.D. graduated from the University of Arkansas in 1978 and completed postgraduate training in surgery and urology at LSU in 1983.  He is four-time board certified by the American Board of Urology and is Managing Physician Director of Santa Rosa Surgical Management Co., LLC, which manages Santa Rosa Memorial Hospital’s Ambulatory Surgery Center. He is also Chairman of the Board of Directors of Redwood Health Services and is a member of the American Urological Association.