For the Love of Mary

John Herman, 82, a retired furniture maker, remembers his 50th wedding anniversary. He and his wife, Mary, went on a 10-day cruise. Their 60th anniversary in May 2024 was different. Herman is the primary caregiver for Mary, who suffers from Parkinson’s disease, spinal stenosis, osteoporosis and balance issues. So, when Herman was told by his primary care clinician that his prostate-specific antigen (PSA) level was elevated and that he should have a biopsy, he did it right away. Because, he said, “I need to take care of my health for Mary.”  

When a biopsy confirms the presence of cancer, which it did for Herman, the next step is to determine the level of aggressiveness of the cancer cells. The cancer cells are compared to healthy cells in a lab. The degree of disease is measured using a score, ranging from 6 (nonaggressive cancer) to 10 (very aggressive cancer more likely to spread). Results showed that Herman had low-grade cancer.

He and his care team, led by urologist Angelo Baccala, MD, Deputy Physician in Chief, Innovation and Program Development, with Lehigh Valley Institute for Surgical Excellence, agreed to take a watch-and-wait approach. This consisted of checking Herman’s PSA every six months, having an MRI every 18 months and a biopsy every three years. He was stable for a year. Then his 18-month MRI showed two lesions. He was put on active surveillance for prostate cancer.

“The next time we saw John, his PSA had risen from 5.78 to 6.6, and the lesions had gotten bigger,” Dr. Baccala says. As they discussed the options, Dr. Baccala explained that surgery or radiation would be more than he needed. He believed Herman was a good candidate for a new treatment: specifically high-intensity focused ultrasound (HIFU). HIFU uses sound waves to heat the cancer tumors and kill them, “much like capturing sunlight with a magnifying glass and burning a leaf,” explains Dr. Baccala. Compared with other treatments, it’s less likely to affect the surrounding healthy tissue structures.

Wanting to avoid surgery and radiation, Herman was relieved there was an alternate treatment that was right for him. He says he didn’t have to think too long before he said to Dr. Baccala, “Let’s do it.”  

The technology that made Herman’s procedure so smooth is the Focal One® HIFU Robotic System. It allows precise targeting and destruction of part of the prostate, sparing healthy surrounding tissue and minimizing side effects. HIFU is an outpatient procedure, where the doctor navigates to the tumor in real time, directs high-speed ultrasound energy at the target area and destroys only the diseased portion of the prostate. No radiation is used, and no incisions are made.

Both Dr. Baccala and Herman were pleased to see that Herman’s PSA dropped to 0.8 after his treatment. It rose slightly by his next visit, but his most recent checkup was excellent. “Everything is very good,” Dr. Baccala says. “We’re setting him up for a biopsy per routine, but so far he seems to have responded very well. His MRI showed that the lesions we treated are gone.”

Herman was glad to return to his activities with a clear mind, taking care of his wife and maintaining the rancher that the couple bought before Herman retired 20 years ago. John and Mary are also getting back to Sunday dinners at their daughter’s home, where they sometimes see their son, five grandchildren and five great-grandchildren. He is grateful to Dr. Baccala and LVHN for allowing him to resume his life.

“The care was next to perfect,” Herman says. “Even the people who did the exams gave me information and told me what was going to happen. It went as smoothly as can be expected. Everything was great.”