Diagnosed two weeks ago.

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

Oncology (Williston Park). 2008 Feb;22(2):123-9;
Emerging role of HIFU as a SCAM ablative method to treat localized prostate cancer.Barqawi AB, Crawford ED.
Section of Urologic Oncology, University of Colorado Health Sciences Center, Aurura, CO 80010, USA.

The use of high-intensity focused ultrasound (HIFU) as a method for ablation of a localized tumor growth is not new. Several attempts have been made to apply the principles of HIFU to the treatment of pelvic, brain, and gastrointestinal tumors. However, only in the past decade has our understanding of the basic principles of HIFU allowed us to further exploit its application as a radical and truly SCAM, intent-to-treat, ablative method for treating organ-confined prostate cancer. Prostate cancer remains an elusive disease, with many questions surrounding its natural history and the selection of appropriate patients for treatment yet to be answered. HIFU may play a crucial role in our search for an efficacious and safe primary treatment for localized prostate cancer. Its SCAM and unlimited repeatability potential is appealing and unique; however, long-term results from controlled studies are needed before we embrace this new technology. Furthermore, a better understanding of HIFU's clinical limitations is vital before this treatment modality can be recommended to patients who are not involved in well-designed clinical studies. This review summarizes current knowledge about the basic principles of HIFU and its reported efficacy and morbidity in clinical series published since 2000.
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John

lauriejo · Posted: Sat Aug 29, 2009 5:17 pm Post subject: HIFU

So what are you saying? You agree with me? We can always do the radical procedure afterward if HIFU doesn't work. We can't do the HIFU procedure afterward if the radical procedure doesn't work.
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55 years old, PSA 6, Gleason 6, T1c, 6 of 10 cores positive HIFU 9/25/09

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

The literature suggests that currently, a surgical procedure (transurethral resection of the prostate) is often done before HIFU treatment to reduce the high incidence of urinary problems after HIFU. This doesn't help with the significant risk of erectile dysfunction after HIFU, however.

Question for those of you who have had, or will have HIFU treatment: did or will you also have a TUR surgical procedure before or after the HIFU treatment?

Curr Urol Rep. 2003 Jun;4(3):248-52.
The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection.Chaussy C, Thüroff S.
Department of Urology, Krankenhaus München-Harlaching, Sanatoriumsplatz 2, 81545 München, Germany. chau1@aol.com

To decrease side effects observed after high-intensity focused ultrasound (HIFU) treatment for localized prostate cancer and to re-establish normal micturition in a patient population that often presents with concomitant prostate enlargement, the impact of a combined transurethral resection of the prostate (TURP) and HIFU has been evaluated. TURP and HIFU treatments were performed under the same spinal anesthesia. For the HIFU treatments, the Ablatherm device (EDAP SA, Lyon, France) was used. Selection criteria for HIFU treatment were localized prostate cancer, no previous treatment for prostate cancer, and prostate-specific antigen (PSA) pound 15 ng/mL at diagnosis. All patients meeting these criteria were considered for treatment and analysis. PSA nadir and stability, histology, International Prostate Specific Score (IPSS) and IPSS-quality of life, and morbidity were assessed during follow-up; 271 patients were selected: 96 in the HIFU group and 175 in the TURP plus HIFU group. A statistically significant impact was observed on catheter time (40.0 days versus 7.0 in median), incontinence (15.4% versus 6.9%), urinary infection (47.9% versus 11.4%), and the evolution of the post-treatment IPSS (8.91 versus 3.37 in average) in favor of the TURP plus HIFU group. No significant changes were observed regarding efficacy during short-term follow-up when considering a 25% retreatment rate in the HIFU group versus a 4% retreatment rate in the TURP plus HIFU group. The combination of a TURP and HIFU treatment reduces the treatment-related morbidity significantly. The patient management after a combined TURP and HIFU treatment is comparable with the management after a single TURP.
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John

notme · Guest

You can't read, I just need to keep repeating myself it appears.

Your data is from France, and using the Ablatherm.

TURP is necessary before the Ablatherm, because the Ablatherm is set for only a small gland. Sonablate can treat a gland twice as large, so no TURP is needed. (unless the gland is over 40cc) So, if your gland is larger than 25cc--the above report is correct--you would need to be retreated (if you are using the Ablatherm).

No TURP here, and no one I know has had one. No pain involved in HIFU, no cutting, no down time, no hospital stay, and if you follow the rules and go with the Sonablate then no side effects, no complications, .....it's the future folks, and we are the pioneers.... HIFU has been perfected by Dr. Scionti and International HIFU.

If I was wrong there would be men here saying so. Not just guys who read data put out by inexperienced doctors -- as no trial has a doctor in it with experience (it's called "conflict of interest")

notme · Guest

John,
You posted something from Dr. Crawford in Denver above....Here's another account from the same guys.....

....................................................................................
Hou AH, Sullivan KF, Crawford ED.
University of Colorado Health Sciences Center, Department of Urology, Aurora, Colorado 80045, USA.

PURPOSE OF REVIEW: Prostate cancer screening has shifted the diagnosis of prostate cancer to lower grade, organ confined disease....

Radical prostatectomy or radiation therapy has been shown to be overtreatment in 30% of patients. ...

TFT(targeted focal therapy or HIFU) uses 3-D mapping biopsies to guide treatment so lesions of interest are ablated whereas sparing surrounding healthy tissues, avoiding the side-effects associated with more invasive treatments.

In recent years, improvements in cryotherapy and HIFU have increased efficacy whereas decreasing complications.

Prostate cancer control reported following TFT is promising.

SUMMARY: With data demonstrating effective treatment in select patients, physicians can better inform their patients of the options available to eradicate their prostate cancer.
TFT provides an alternative to active surveillance and more aggressive treatments for patients with low-risk tumors. As studies mature, more information regarding long-term survival and benefit will become more evident.

PMID: 19357510 [PubMed - indexed for MEDLINE]

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

That's great. The key sentence is,

"As studies mature, more information regarding long-term survival and benefit will become more evident. "

The point is, that HIFU is a procedure that is evolving. It has not yet been shown to be an effective longterm treatment for prostate cancer. The published literature shows significant risks of urinary symptoms and erectile dysfunction. Professional societies call it an experimental procedure.

No doubt, no doubt, that people are working hard to perfect the technique and this will reduce the side effects of treatment. No doubt that individual people like you can have a good experience with this method. No doubt, that someday we will have long term studies that will tell us whether or not it can actually reduce the risk of dying for prostate cancer someday. Until that day comes, anyone who gets HIFU should be told, up front, that this is an investigational technique, and that the facts are not all in yet.

To post testimonials and phone numbers on the internet, to encourage people to get off-shore treatment with this method, without making it clear that this is still an unproven method is unethical. You may believe deeply that this is a superior way to treat prostate cancer, but the proof is still out. Tell people that it is an unproven, experimental method that you think is very promising and ask them to consider enrolling in a clinical trial, and leave it at that.
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John

lauriejo · Posted: Sat Aug 29, 2009 8:15 pm Post subject: HIFU

John, No one said that it isn't in the clinical trial stages, but we are willing to take the risk so that we may preserve our quality of life. It's our money and our quality of life. If it doesn't work out then so be it, but at least we will have tried to preserve our quality of life. There has never been a clinical trial for any of the other treatments for prostate cancer, only HIFU. This doesn't make sense when you think that it is the only one that is minimally invasive. The insurance companies are already starting to pull back from coverage of the the radiation procedure because they are finding that it causes anal and bladder cancer down the road. Why does HIFU scare people. It is minimally invasive. MY husband's doctor told him that he will want to take me out to dinner the night of the procedure. What other treatment is that minimally invasive?
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55 years old, PSA 6, Gleason 6, T1c, 6 of 10 cores positive HIFU 9/25/09

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

To notme/lauriejo:

"There has never been a clinical trial for any of the other treatments for prostate cancer, only HIFU. "

You keep saying this. Repeating a falsehood over and over doesn't make it any less false. There are many clinical trials for radiation and surgery, and references to them are posted all over this forum. There is even a randomized controlled comparison of surgery vs no treatment with 12 years of followup. The problem is, that there are no published controlled. clinical trials of HIFU, only short term followup of case series.

"The insurance companies are already starting to pull back from coverage of the the radiation procedure because they are finding that it causes anal and bladder cancer down the road."

Really? Insurance companies are not paying for radiation treatment? Prove it! Show one piece of evidence that this is true.

"Why does HIFU scare people. It is minimally invasive. MY husband's doctor told him that he will want to take me out to dinner the night of the procedure. What other treatment is that minimally invasive?"

How about proton beam radiation or the cyberknife? Your husband will be wearing a catheter and a leg bag to the restaurant.
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John

lauriejo · Posted: Sat Aug 29, 2009 8:49 pm Post subject: HIFU

I'm fully aware of the catheter. That doesn't bother me. He would have a catheter with surgery and we certainly wouldn't be going out to dinner and I know for sure that our insurance company won't pay for cyberknife because of the radiation.
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55 years old, PSA 6, Gleason 6, T1c, 6 of 10 cores positive HIFU 9/25/09

notme · Guest

lauriejo---John M thinks that you & I are one person....he thinks I am the only person to be HIFUed, well, I agree, I am one of a few to stay and try to spread the word....men need to know there's another option out there besides surgery and radiation. Heck, I'd rather go cryosurgery than those two!

John asked: "How about proton beam radiation or the cyberknife? Your husband will be wearing a catheter and a leg bag to the restaurant."

there are two examples of no clinical trials....show me a clinical trial for proton beam or cyberknife.

and lauriejo's husband won't have to worry about anal incontinence later on .... as radiation side effects don't show up right away. Why do you guys think they invented those two treatments??--because regular beam radiation causes cancer later on! NO, my HIFU doc didn't say this--it was my regular local urologists. (2 of them) A cyberknife place is right down the road from me.

lauriejo's husband is 10 years younger than I. Dr. Crawford in Denver said that her husband would be getting "overtreated" by going with surgery or radiation.

Those two procedures (proton beam or cyberknife) cost upwards of 100,000. I've heard of a guy paying $250,000. (insurance paid) so you would think you guys would be happy to save some money ~ maybe all of our insurance premiums will go down when they discover they can use HIFU for less than $20,000. (if it was available in the states instead of flying his team out of the country it should cost less than $20,000.)

We are the pioneers, you should say thanks.

You are welcome... Exclamation

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Can we all agree (me included) to be civil to one another, and while it's okay to argue vociferously, do all we can to avoid personal attacks? I'm not pointing fingers here, and like I say, I am including myself in this.

Ad hominem attacks (arguments against the person, rather than the message) are not effective in rhetoric, anyway. It's far more effective to dissect the other person's message.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

JustJB · Posted: Sun Aug 30, 2009 1:32 am Post subject: Enough HIFU

Since I started this thread to invite information as someone just diagnosed, I think I can pop in here with an observation or two. I've looked into HIFU. I understand that there is a desire to avoid some side-effects. I also understand that a) I am not close to any clinical trials for HIFU; and b) I am not going to put out $25,000 that I don't have for a procedure that is, in my interpretation of what I've read, not proven over a long period of time.
Personally I've ruled out HIFU as an option. I am not afraid of surgery and I believe that the side effects will be something I can deal with. I want to live a loonnnnng time, and I believe that surgery has proven to be the best way to achieve that goal for someone in my position. I can take Cialis and do kegel exercises to get over what side-effects may come my way.
Please take the HIFU discussion to it's own thread.
If anyone has any good information to offer that adds to this thread I'd appreciate it.
To those who have had or will have HIFU, I look forward to following your progress - on another thread - and wish you nothing but the best.
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Age 52
Gleason 3+3 = 6
Stage T1C
1 out of 12 cores involved
Left side, median lobe

lauriejo · Posted: Sun Aug 30, 2009 6:55 am Post subject: Sorry

Just JB and John, I am sorry if I offended you guys. I guess what is important to my husband and I is not as important to other people. It is so important to us that we are borrowing the $25000. My husband has already had 3 hernia surgeries and a heart attack. He does not want anymore surgeries. Our love life is very important to us also and we don't want to have to schedule it with a pill. We were totally devastated when my husband's urologist surgeon (da Vinci robot) told us "6 months in diapers and 2 years with no erections" his words not mine. Ultrasound treatment for us is a God send.
JustJB I wish you the best also. I hope we can all agree to disagree. I will keep you posted after my husband's treatment on September 25. Good luck and God bless.
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55 years old, PSA 6, Gleason 6, T1c, 6 of 10 cores positive HIFU 9/25/09

JustJB · Posted: Sun Aug 30, 2009 11:35 am Post subject: No offense taken

Laurejo,
I take no offense in what you wrote. I don't disagree or agree. My point is that I started the thread to collect information about options and people's experiences. In providing me with information about HIFU, 'notme' did contribute to that goal. However, the thread has become a discussion about HIFU, not different issues associated with diagnosis.
Again, no offense. It seems like there is a place for a spirited discsussion of HIFU, but my intent was not that with this thread.
Best of luck, Joel
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Age 52
Gleason 3+3 = 6
Stage T1C
1 out of 12 cores involved
Left side, median lobe

notme · Guest

more info.....

Dr. T Uchida has recently presented and published data re HIFU that showed: Biochemical Disease Free Rate After 5 Years: Low Risk 97%, Intermediate Risk 71%, High Risk 64%

Find at:
Clinical Outcome of HIFU for the Treatment of localized prostate cancer: 5-year Experience. Toyoaki Uchida, Hiroshi Ohkusa, Hideyuki Yamashita, Yoshihiro Nagata Department of Urology, Tokai University Hachioji Hospital. Abstract - ISTU 2004

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