HIFU - Ablatherm and Sonablate

JerryB · Regular Joined: 13 Jul 2009 Posts: 41 Location: UK

Has anyone got information comparing Ablatherm and Sonablate? Comparative reports, personal experience? Plenty of information available on each process individually, but difficult to compare accurately.

thanks. JerryB
_________________
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

The most experienced doctor with HIFU (outside Europe), the guy who teaches all the clinical doctors, in the USA, on both machines -- chooses the Sonablate. Because he said, he can see what he is doing 3-D, if cancer is outside the gland he can zap that as well. He can get every single tiny bit of the tissue inside the gland, and be sure he is sparing the nerves, quite often the cancer is in the bottom dip of the gland, which could fall outside the scope of the Ablatherm. Sometimes the gland spasms during treatment and moves, so he can move his computer mouse and be sure that gets treated as well. He also told me he could see my nerves quite well.

There were two doctors treating men with HIFU when I was there, the other guy told my wife while I was under, "you have the king of HIFU treating your husband". So, I take his word on the two machines. As he could use either, but the Sonablate allows him to look and see what he is doing. While the Ablatherm is robotic.

Bottom line though is--make sure your doc has lots of practice, as my doc said, "I feel badly for my first dozen patients". Which is also one reason some of the trial data isn't so great--the doctors were just learning.

Here are two trial data:
Ablatherm:
http://www.ncbi.nlm.nih.gov/pubmed/18581118
Oct. 2008
Department of Urology of Pitié-Salpétrière Hospital, Groupe Hospitalo-Univeristaire EST, Assistance Publique-Hôpitaux de Paris; Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.

OBJECTIVE: To assess the long term oncologic results of high-intensity focused ultrasound therapy (HIFU) as a primary and single treatment for clinically localized prostate cancer. METHODS: A total of 119 patients with clinically localized prostate cancer underwent HIFU (Ablatherm((R)), EDAP, France) as first-line treatment and were retrospectively reviewed. They were stratified according to risk groups proposed by D'Amico. No patient had undergone previous hormonal therapy. PSA level was monitored at 3, 6, 12, 18, 24 months and then yearly. According to the latest ASTRO criteria, failure was defined by a PSA rise of 2 ng/ml or more above the PSA nadir. The biochemical-free survival rate (BFSR) was calculated. RESULTS: Mean patient age was 68 +/- 7.8 years (46-83). Mean follow-up was 3.9 years (1-6.9). Overall 52 patients (43.7%) experienced a biochemical recurrence which included 26, 23 and 3 patients in the low, intermediate and high-risk groups, respectively. In univariate and multivariate analyses, there was a statistical association between preoperative PSA value > 10, a nadir PSA value > 1 and the risk of biochemical recurrence (P < 0.05). The 5-year BFSR rate was 30% with no statistical difference between low- and intermediate-risk patients. None of the 119 patients died of prostate cancer.

CONCLUSION: High-intensity focused ultrasound therapy provides efficient oncologic control only in patients with low-risk prostate cancer. However, our data could be used to improve the selection of patients who are potential candidates for HIFU therapy.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sonablate 500
http://hifu.wordpress.com/2006/11/01/outcome-analysis-of-high-intensity-focused-ultrasound-for-clinically-localized-prostate-cancer-in-japan/

Nov. 2006

Materials and Methods
This series comprises 340 patients who were treated with Sonablate® HIFU devices (Focus Surgery, IN, USA) patients with a minimum follow-up of one year. During follow-up, prostatic biopsies and PSA level measurements were performed to determine the failure as 3 consecutive rises in the PSA according to the ASTRO definition. None of the patients received androgen deprivation prior to documenting biochemical failure. Kaplan-Meier curves and log-rank test were used for analysis.

Results
The median age and PSA level were 68 years (range 45-89) and 9.5 ng/ml (range 3.1 to 154), respectively. Stage was attributed as follows: T1c in 173, T2a in 106, T2b in 47 and T3 in 14 patients. The median follow-up period for all patients was 23.2 months (range 3 to 86). The biochemical disease-free survival (bDFS) at 5 years in all patients was 70%. The bDFS at 5 years for patients with low, intermediate and high risk groups were 90%, 65% and 57%, respectively (p<0.0001). The bDFS at 5 years for patients with PSA less than 10 ng/ml, 10-20 ng/ml and more than 30 ng/ml were 88%, 68% and 17%, respectively (p<0.0001). 78% had negative biopsies from a mean of 6 cores 6 months after HIFU.

Conclusions
HIFU appears to be both an effective and well tolerated procedure for men with localized prostate cancer.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So, happily, I fall into the 90% cancer free in five year group.

JerryB · Regular Joined: 13 Jul 2009 Posts: 41 Location: UK

Thanks for your comments Notme, and for the links.

It is a little difficult to accurately determine the technical benefits of one system compared with the other. Apart from anything else, I'm sure that they have both brought in upgraded versions (I know that Ablatherm has), and I imagine that they are pretty much 'toe to toe' in attempting to maintain technical equivalence. Certainly, the Ablatherm machine also uses an integrated 3-D imaging system, but I have heard it suggested that it may not be quite as good as the Sonablate in allowing the operator full 'access' to every part of the gland. It's interesting - and very useful - that the guy you mention says he can see nerves.

The Ablatherm is robotic, in that once the 3-D mapping has been carried out, it is left to the computer to do the ablation process. However, the process is being operator overlooked the whole time, and the operator steps in if he/she feels that human intervention is required! In one way, I can understand that someone would feel more comfortable with a human operator doing the job, but on the other hand there is that remote but possible factor of 'human error'! Mind you, I guess that robots can go wrong as well, but maybe they are less likely to be experiencing emotional problems or a hangover!

In the end, I think we have to accept that whichever system a particular doctor is using, he/she will make a good case for that system being the better one! I'm inclined to think that maybe they are both much of a muchness, but I am interested to find out any significant differences, which is why I posted the question.

You are so right that the important thing - the absolutely essential thing - is that the operator has oodles of experience. Both Ablatherm and Sonablate are being used in the UK, but so far the people I have spoken with have not carried out very large numbers of the treatment. The largest so far is about 100 (Ablatherm) over a period of about three years, which I guess isn't bad, but doesn't begin to compare with some of the people in mainland Europe using Ablatherm.

In mainland Europe, Ablatherm has been used for about 12 years, although I think it's fair to say that the experience in the earlier years was fairly limited and possibly not particularly successful (as you say, there must have been quite a learning curve going on at the time). Things have moved on apace.

Ablatherm claim (in 2008) that there had been over 15,000 treatments with their equipment worldwide, but I think the majority of those will have been within Europe.

I am leaning towards Ablatherm at the moment, if only for the reason we both consider to be very important: operator experience. There is a guy called Dr Chris D'Hont whose clinic is in Antwerp, Belgium, who has carried out over 700 Ablatherm treatments with, apparently, a pretty good degree of success. I'm attracted towards his clinic if only because of the number of treatments. I have a paper written by him which contains useful and encouraging figures, but of course this has not been peergroup reviewed, so one has to hope that it is accurate. It was written in Dutch, and I used the Google translation facility to turn it into English. The resulting translation is pretty amazing for a computer, but there is still a certain amount of gobbledygook remaining, although one can get a pretty good idea of what is being said.

I came to hear about him via someone from the West Country in the UK who was treated in Antwerp in 2003. He was very happy with everything to do with the treatment, and with his subsequent positive progress. His wife is a really enthusiastic proponent of HIFU with Chris D'Hont, and has pointed possibly 200 men from around the world towards his clinic over the past few years. She reckons that's probably a hundred or so of those people have actually had treatment there. She has a considerable amount of mail from 'happy customers'.

I'm planning to travel to see Chris D'Hont sometime within the next couple of weeks for a preliminary consultation. Of course, a lot will depend on the results of that meeting, as I tend to go a lot on the feeling I get about someone when I meet them. I certainly haven't decided not to go the Sonablate route (thus my posting), and I shall be contacting more people in the UK about this during the next few weeks. Whichever direction I go, I can't have HIFU until towards the end of September at the earliest, because I am on a three-month period of hormone treatment.

Once again, thanks your input.

Cheers,

Jerry
_________________
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

Congratulations on living in the 21st century! that you are going the best route ~ HIFU!

although your statement, "emotional problems or a hangover".....was a bit silly. These doctors are risking everything, their professional lives are at stake ~ practicing HIFU. Our medical system is so busy pooh-poohing it. The doctor you've found sounds great for where you live (thanks for the name, so I can recommend him for Europeans). Dr Scionti, over here, in the USA, has a stellar record and the most experience (600+), and he was my doctor, as well as 3 of my personal friends (so I am biased!, he is a gem, and it's hard to believe I ever had cancer). Some forums won't allow speaking of HIFU, unless you post something bad, those forums shouldn't be trusted. As you said there are thousands of men who have been treated, if the results didn't work for these guys they'd be here and everywhere telling us. The few we have read posts from---well, inexperience doctors....and one is a case of the cooling system not working--which is doctor error, always the problems come from doctor error...inexperience.

I wish HIFU would be the best treatment for all cases, and I sure wonder why it can't replace surgery altogether, I mean, if cancer is outside the gland the Sonablate can zap it (the reason to go Sonablate over Ablatherm), if it's further - no matter what treatment - you'd need to take that next step---chemo. right??

Sure glad I didn't need any hormone drugs, which is the other reason for going Sonablate--it can treat a gland up to 60cc, while the Ablatherm can only treat a 25cc gland, so no hormone reduction is needed.

Best of luck, I am sure you will wake up everyday - post HIFU - feeling like the luckiest guy on earth, like I do.

JerryB · Regular Joined: 13 Jul 2009 Posts: 41 Location: UK

Hi notme

Aha, the problems of the written word! 'Wit' and particularly British irony just don't come across! I was, of course, being deliberately silly. I don't doubt for a minute that the doctors involved in HIFU, or any other medical procedures are generally speaking diligent and ethical people.

I'm very interested to hear some of the facts you are quoting regarding treatment with the Sonablate system, as they seem to conflict with some of the information I am being given by the company responsible for Sonablate in the UK.

I'm not sure that this forum is an ideal site to get involved with variations in opinions from other sources, but if you are at all interested to talk about it, you are welcome to contact me on jeremyb2@waitrose.com. Of course, I will understand if you'd prefer not to.

Cheers,

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

for real information, from a real nurse involved in HIFU you should contact: markkeever@internationalhifu.com

Some of what I say is second hand--as my wife talked to the two doctors while I was under. And, I talk with my friends who also had HIFU.

but I wonder if what they can publish and what they find in real life experiences is different...? lawyers get in the middle of everything!

I'd rather post here, so that others may learn.

My only goal is to hope others can be cured as easily as I was.

JerryB · Regular Joined: 13 Jul 2009 Posts: 41 Location: UK

Thanks again notme.

I quite understand your wish to keep correspondence within the forum.

I'll let you know as and when I reach a decision regarding HIFU.

Cheers,

Jerry
_________________
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

With your gland being large you will probably need a TURP prior to treatment---if you go the Ablatherm treatment.

TURP is NOT needed prior to Sonablate (because it can treat a larger gland as it is manipulated by manual).

Contact Mare Ryan, MSN 386-785-0100 mareryan@ushifu.com
or:: Susan Lutte, BSN 386-785-0100 susanlutte@ushifu.com to find out where in the WORLD you can get Sonablate treatment.

JerryB · Regular Joined: 13 Jul 2009 Posts: 41 Location: UK

Thanks again notme

As you say TURP is not usually required with Sonablate, but does seem to be standard procedure with Ablatherm.

As part of my fairly extensive exploration of HIFU as a possible treatment for PC I had made contact with the UK Sonablate company (http://www.ukhifu.co.uk/)

Resulting from that contact I have an appointment scheduled with a London-based consultant urological surgeon who many consider to be the most experienced Sonablate HIFU chap in the UK.

I probably won't have anything useful /interesting to report for a few weeks to come, but will post again when I do.

Cheers,

Jerry
_________________
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

Very glad to hear!

I'd walk a million miles to not go through a TURP, scarey! (I didn't have one)

Hope that means you can throw out those hormones, I hear they are awful.

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