HIFU

dabaker · New User Joined: 02 Sep 2009 Posts: 1

Im considering Hifu treatment with Mapleleaf HIFU in Toronto Canada by Dr Orovan. Is there anyone who has been treated by this Dr or this office. Also they use the Ablatherm treatment as opposed to the Sonoblate. I would appreciate any and all comments and opinions , my thanks in advance

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

I have today decided to go ahead with HIFU in the UK. If you do a bit of Internet research you should be able to find information comparing Ablatherm and Sonablate, although there will often be a bias towards one or the other. My impression, despite the supposed advantages/disadvantages comparing one with the other, is that the experience of the surgeon is of greater importance than the type of equipment used. Go for the man who has done 100s of the treatment. Good luck. Jeremy
_________________
Age - 67
PSA – 7.8 ug/L. in February 2009.
Gleason – 7 (4+3). T stage – 2b. Prostate size - 52 cc
July 2009 - ADT for 3 months to shrink prostate.
September 2009 - decided on HIFU. Scheduled for 30th October 2009.

notme · Guest

I had HIFU with Dr. Scionti using the Sonablate.

I have problems with the Maple Leaf site as they say totally false things about the Sonablate. If you go to Cancer InfoLink the doctor there has talked about the false things they say on their site. There are two guys there who had problems at Maple Leaf, one had burning as the Ablatherm cooling system wasn't working, and no one noticed. He suffered a hole in the rectum. The other has ED. Don't know about Dr. Orovan though, and I agree whole heartedly with Jerry ~ the doctor's experience is of upmost importance.

Big difference in the two machines:
Ablatherm is a robotic device, it is pre set on the size (no larger than 25cc).

Sonablate is operated by the doctor, he clamps down the probe so no movement happens (the only reason we are put to sleep for this procedure) and he sees what he is doing, a huge advantage is he can see the cancer through the real time echo image on the computer screen and zap it....if cancer is outside the gland he can zap that as well. The Sonablate can treat up to 40cc (or is it 60cc...?) He can treat the entire gland or just partial (I can't figure out why you'd only treat a portion).

My cancer was in the lower tip of my prostate gland, it could have easily fallen out of the scope of the Ablatherm.

Dr. Scionti always brings a certified Sonablate mechanic to every procedure--to insure the cooling device (etc.) is working properly.

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 249

Hi,

If you google the doctors' name and city, you can usually get their credentials and experience online.

From a very quick glance, he's a urological oncologist from McMaster University Hospital, a large teaching hospital outside of Toronto.

It says he's done a lot of research but no info. about what or where.

Good luck in finding out more....always google docs or any other people to get an idea of their education/experience.

Best wishes,

Jean

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

Notme. Increasingly, surgeons using HIFU are attempting, where possible, not to ablate the entire contents of the prostate if the spread of cancer is limited only to a portion of it. This so-called hemi-ablation allows a greater chance of erectile function and continence being maintained.
This link may interest you - http://www.nature.com/nrclinonc/journal/v4/n11/full/ncponc0959.html

I recently had a procedure called Prostate Mapping which combines a multi sequence MRI scan and template prostate mapping biopsy. Both of these in combination give state of the art information about the disposition and burden of the cancer within the prostate to a high degree of accuracy that other diagnostics techniques currently do not. (http://www.prostatemapping.com/). The interesting thing about the results from my prostate mapping was that apparently one side of my prostate is clear of cancer, whereas the results from a 'simple' MRI scan I had had done previously on our National Health Service had showed shadows in that area which had been interpreted as probably being extra-capsular extension.

Now, knowing the results of the prostate mapping, the chap doing the HIFU procedure is planning to ablate the contents on only one side of my prostate. From experience to date he reckons this gives me around a 95% chance of retaining reasonable erectile function and continence. Of course, one man's definition of 'reasonable' may differ from another man's!

Jeremy

notme · Guest

Well, I had the entire thing ablated, and I am having more sex now than ever before. Very Happy

What bothers me is that cancer can be undetectable....so leaving a bit leaves the door open.....which means, I think, you will be burdened with having to have biopsys forevermore. I know a guy who had the partial done, and his PSA is 2.0 and so he needs to watch it constantly, which gives him stress, so far (a year plus) it's stayed put. He wishes he'd cooked the whole thing...now I'll go read your link.

I think--that staying away from the gland capsule is what keeps you working, and also taking cialis ~ 10mg for a month daily, and then 10mg every other day for another month, or until you feel it's all okay. It's to keep the veins open, avoiding a crimp in the line.

I really like the MRI mapping thing you had done, does that mean you didn't need a biopsy (ouch!). We are finally advancing into the 21st century?!

You won't have ANY problems with continence, that is just unheard of with HIFU.....unless your doc went to sleep in the middle of treatment..!!! I pee like a 18 year old now....awwww...fast and hard

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

not me. You are of course right that only having partial ablation gives a greater possibility that there may be some cancer remaining. Obviously, despite having total ablation, your essential nerves were able to be spared, and everything is working satisfactorily! Fantastic! I'm not sure if that is necessarily always the case with total ablation. Anyway, I don't have to make a final decision yet, and I must weigh up the potential advantages/disadvantages of hemi-ablation vs complete ablation. As the surgeon says, things will be monitored and, if necessary, a second HIFU will be done to ablate any remaining cancer.

Just to be clear, the Prostate Mapping procedure involves a multi sequence MRI scan combined with template prostate mapping biopsies. Compared with the typical 10 or 12 cores taken during a TRUS biopsy, there may be 50 or more cores taken during Prostate Mapping. So - double ouch! Having said that, the procedure is done under general anaesthetic and the biopsy cores are obtained through the perineum rather than through the rectum, so the risk of infection is rather less than with the TRUS biopsy. I have to say that the TRUS biopsy I had done last May was not in any way uncomfortable during the event (a local anaesthetic was administered before the biopsy samples were taken), and was only mildly uncomfortable afterwards.

Frankly, I'm reluctant to make comparisons, favourable or otherwise, between Sonablate and Ablatherm. Each company promulgates the supposed advantages of their product, as you would expect, but I have no real way of ascertaining whether one is superior to the other. It's mostly hearsay. I know that thousands of people have been treated with the Ablatherm process, and one particular doctor in Antwerp has carried out well over 700 procedures with Ablatherm, as have others in Lyon and Munich. On the other side, Sonablate procedures have been carried out successfully in large quantities as well. As I said in an earlier posting, I'm inclined to think that the experience of the operator is more important.

Jeremy

notme · Guest

Don't glaze over the fact that the sonablate can zap cancer OUTSIDE the gland. A huge plus! I don't believe this is written in the literature, as nothing can be guaranteed...lawyers are lurking...

Very interesting post...thanks for writing it all...

I found a guy who wrote:
I had HIFU treatment by Dr. Scionti two years ago. At the time I was age 51, with a PSA of 6.0, Gleason 3 + 3 = 6, and stage T1c. A biopsy showed one core sample with 20% cancer.

Before choosing HIFU, I read articles from Japan, France, and Germany regarding HIFU and its results. I asked USHIFU for patient references and interviewed at least a dozen men and a couple of their wives over the phone, gathered before and after stats on their treatment, etc. Talking to people one on one is the only way to get the real facts as most people don’t want to publicize their ED or urinary problems to the world, much less to admit that their treatment isn’t working and the PSA is rising. The results are not “spotless” but all of the men recommended HIFU and would do it over again. I was concerned about and aware of the marketing program USHIFU puts out, but there is plenty of information available to those that choose to investigate.

The fact is that HIFU is fairly new and it is primarily intended for early stage cancer contained in the prostate. As for my current state, my PSA is at 0.9 (the nadir was 0.6) after two years and I have no noticeable side effects. I missed one day of work while flying back from Mexico on a Monday; however, I would recommend others to take the week off to rest. The subpubic catheter is very uncomfortable and I had it for 17 days. I was able to have intercourse the day it came out and was back to all my normal routines (swimming, etc.) within 30 days.

Being a realist and having talked to many men that have had HIFU, I accept there is a chance the cancer will return at some point in my life because there is still tissue left to protect the erectile nerves. Hopefully, medical options will continue to improve over time. I submitted my story to YANANOW and it was put on line.

notme · Guest

From WebMD:

"Hello, I am a new poster here. I underwent the HIFU procedure the middle of last month and couldn't be happier. You might want to consider this as well. I'm 64, my Gleason was a combined 7 with a PSA of 4.7 and found cancer in all areas of the gland (we'd be watching the PSA rise for some years and did the ultrasound/biopsy after the latest PSA). You might want to do a search for International HIFU since this procedure must be done out of the U.S.. If you have questions I'll be happy to answer them to the best of my ability. Charles_D"

notme · Guest

Dr. Orovan from Maple Leaf is involved in the Sloan Kettering clinical HIFU trials.

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