Physician Spotlight: Dr. Robert Pugach

Fate took an interesting turn when I was diagnosed with prostate cancer in late 2016. For almost three decades I had practiced urology, helping patients navigate the uncertainty of a threatening but treatable disease. Now, as a medical professional, I knew all too well what the results of a biopsy showed: a small focus of cancer on my prostate.

I was fortunate to have it diagnosed at a very early stage.  Since another family member had prostate cancer ten years earlier, I knew I was at increased risk of developing prostate cancer, so I made sure to have frequent PSA blood tests and prostate exams. 

My choice of treatment was based, in large part, on quality of life issues afterward. I chose to avoid invasive surgery because in my 34 years of urology practice, I had seen many men who experienced life-altering side effects including erectile dysfunction and permanent urinary incontinence. I decided against radiation because of the potential for high recurrence rates. In the end, there was only one clear path forward for me: high intensity focused ultrasound (HIFU).

This non-invasive procedure utilizes sound waves to image and eradicateprostate cancer, andI have seen first-hand the positive results of HIFU for countless patients. In 2005 I was part of a small group of urologists who traveled internationally to perform HIFU procedures because it was not available in the United States. When the FDA finally approved HIFU therapy in 2015, my practice, the Center of Excellence for Prostate Cancer at Pacific Coast Urology Medical Center, became a leader and pioneer in HIFU therapy. On May 9, 2017, I joined more than 175,000 patients worldwide who have had a HIFU procedure to eradicate cancer without significant side effects.

I count myself fortunate, but many prostate cancer patients sadly cannot say the same. In July 2017, the Centers for Medicare and Medicaid Services (CMS) issued a reimbursement code for patients seeking HIFU therapy in hospital outpatient facilities. This continued into 2018 and resulted in a dramatic reduction in the out of pocket expense for patients. However, in 2019, CMS has changed the reimbursement amount for hospitals, making HIFU economically unfeasible for hospitals to provide.  The result is that, once again, the expense of HIFU is out of reach for many patients who would otherwise likely be able to benefit from it.   

That is why I came to D.C. for the Focused Ultrasound Fly-In to meet with lawmakers to explain how effective HIFU therapy is for treating prostate cancer. This commitment is informed not just from my experience as a doctor, but also a patient. My message is this: Members of Congress should champion public policy that encourages adoption of high-value care both at the FDA and through CMS reimbursement. In a disease with so much uncertainty around both diagnosis, treatment pathways and potentially very personal outcomes, HIFU is a procedure that can deliver superior therapy, quality, and positive patient experiences at affordable cost for countless Americans.

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