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HIFU ... Whats that!

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Posted 6/28/2017 6:38 PM (GMT 0)
Hi Everyone

So when I was reading up on my husbands surgeon I come across a video from 2016 where he is promoting this HIFU as another treatment option. He explained in the video that it is not FDA approved but from what I gather it can be performed in the US once you pay out of pocket. So when I go to the website he quoted to get more information, the site has been removed. I am aware that I am making our surgeon sound like quack!!

When giving the dx and discussing our options this was never mentioned. I have typed HIFU into the search here and saw quite a few people underwent HIFU in the earlier years but not recently. As our surgeon was only posting videos about this in 2016 .... whats the deal. Can anyone enlighten me?
Posted 6/28/2017 7:30 PM (GMT 0)
From what I can understand there are many ways to kill the cells - like Cryo is freezing ...HIFU is basically sending Ultrasound ( High Frequency Ones) to burn up the cells.
Posted 6/28/2017 7:31 PM (GMT 0)
you never have to worry about it...your husband's surgeon did a great job!
Posted 6/28/2017 8:44 PM (GMT 0)
HIFU was FDA approved in late 2016. But, that was for its ability to remove cancer cells, like a high-tech scalpel. The FDA did not rule on its effectiveness in curing prostate cancer.
Posted 6/28/2017 8:46 PM (GMT 0)
As long as your husband wasn't treated with it, there are no worries.

HIFU is High Intensity Focussed Ultrasound. In the US, it is NOT approved for the treatment of prostate cancer. It is approved for the ablation of prostate tissue. It bakes the tissue using ultrasound. The HIFU manufacturers couldn't prove efficacy for prostate cancer, but they could prove that it destroys prostate tissue (e.g., as for a TURP). However, no one, to my knowledge, uses it for the approved purpose; everyone is using it for prostate cancer. Way too many, imho.

My guess is that your doctor probably received a cease-and-desist letter from the FDA for advertising HIFU on his website as a cure for prostate cancer.
Posted 6/28/2017 8:55 PM (GMT 0)
Ah TA, think you might have hit the nail on the head. I was just curious especially when it was our surgeon who was promoting it (not to us directly). Assuming cease and desist! I've not seen it mentioned here before although when I searched I found a few threads on it. Thought it weird that between all the threads here no one ever mentioned HIFU as an option. Some of the threads report horrors with it! Thanks for all the replies smile
Posted 6/28/2017 8:56 PM (GMT 0)
Dorie,

I wonder if we have the same surgeon. My surgeon likes to be an early adopter. He was one of the first guys in my part of North Carolina to use the DaVinci robot and for the last several years he's been working fairly hard to get out in front of the High Intensity Focused Ultrasound (HIFU) adoption. I think he expected HIFU to obtain FDA approval faster than has been the case.

There has been some progress made in that area in the last year or so. HIFU is now approved for "use on prostate tissue" but not specifically for radical treatment of prostate cancer. He has set up a clinic offering HIFU for prostate cancer here in the Raleigh/Durham area for a flat, all-inclusive fee of $25k for which insurance is unlikely to pay because the treatment is too new.

HIFU has been around for quite a while now internationally and it has a fair track record. There are two companies that make HIFU machines -- one in France and one in the US. I think the US machine is the better of the two and I expect that HIFU will see better results in the US than in Europe due to the differing use of the two machines.

HIFU has a couple of advantages over surgery and radiation, mostly based on the flexibility of when it can be used. HIFU can be used for salvage after surgery or after radiation or after HIFU for that matter. HIFU offers unlimited opportunities for do-overs to go after a spot that was missed.
Posted 6/28/2017 9:39 PM (GMT 0)
Tall,

We seem to be bumping heads today. I think between the two of us we have fully explored the cup half full/ half empty view of HIFU.
Posted 6/28/2017 9:55 PM (GMT 0)
Cheers Peter, our surgeons sound similar for sure but my guy is based in westchester, NY and he's been here for over 10 years but like that he seems to be out front on stuff and is also the first for da Vinci in Greenwich Ct where he operates!! It's pretty interesting how Europe have it approved and are using it as a primary treatment from what I can gather, I'm European myself! Obviously it no longer is relevant to us but hey ... in a few years it might get approved and if god forbid it's needed then as salvation. Saying that some of the stories posted here previously would Give pause! Thanks for the detailed reply, it's very interesting!
Posted 6/28/2017 11:49 PM (GMT 0)
TA,

Good point - the difference between ablating prostate tissue and treating cancer is significant.

HIFU was recommended to me by my urologist just over two years ago when I was researching treatments. At the time it was not FDA approved and would've required off shore treatment, with no guarantee of health insurance coverage.

After looking at summaries of European trials, which did not have stellar results, I decided that if I was going to treat I did not want to limit to a focused treatment, reasoning that if I had two discovered areas of cancer, there was also a good chance of not yet discoverable cancer lurking, and it was better to not just treat what was known to be there, but treat throughout.

Tall Allen said...
As long as your husband wasn't treated with it, there are no worries.

HIFU is High Intensity Focussed Ultrasound. In the US, it is NOT approved for the treatment of prostate cancer. It is approved for the ablation of prostate tissue. It bakes the tissue using ultrasound. The HIFU manufacturers couldn't prove efficacy for prostate cancer, but they could prove that it destroys prostate tissue (e.g., as for a TURP).

Posted 6/29/2017 3:05 AM (GMT 0)
PDA-

I think we all can agree that there is just no place for whole gland HIFU, except possibly as salvage. That glass is all empty.

With respect to focal HIFU, I just don't see any advantage over, say, SBRT or HDR-BT (see table in the link below). There is a high re-do rate, incomplete ablation in the ablation zone, probably some toxicity limit on re-dos, and it can only be used on index tumors that are not near the urethra, the rectum or the bladder neck, and the whole theory of index tumors is on shaky ground. What's more, how does anyone use PSA as a tool to monitor success/biochemical failure afterwards? Here's what someone eyes wrote about it:

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html

(n.b.- the comments at the bottom from a HIFU practitioner and my reply. His HIFU website seems to be gone as well -- I can only find his FLA website)

One legitimate use may be for the patient who is marginal for AS - perhaps an "index tumor" with a small amount of Gleason pattern 4. By ablating that, and hopefully it would be completely ablated, he may be able to more comfortably stay on AS. But he would still need confirmatory and f/u biopsies, an expert radiologist who knows how to read an mpMRI on ablated tissue, and an expert pathologist who knows how to read a HIFU-ablated biopsy core.

I think the only way HIFU or other innovative focal ablations should be done is within a clinical trial where the patient is fully informed about all the above risks. These hot-dog urologists who are rushing in to take advantage of a loophole in the law are not doing their patients any favors. I think we need at least 10 years of follow-up to know enough about it to recommend it. So far, the leaders are the Ahmed/Emberton group in the UK who have published 5-year results that make me uneasy.
Posted 6/29/2017 7:45 PM (GMT 0)
TA

Would you put laser treatment in the same boat as HIFU - another focused method that maybe is not the best treatment for most cases, but may be a reasonable method in some circumstances? I was wondering how differently I may have thought about treatment if I had been 10 to 15 yrs older and was still not comfortable with AS, but whether I may have thought that in my mid to late 70's a focal method was not unreasonable.

Tall Allen said...
PDA-

I think we all can agree that there is just no place for whole gland HIFU, except possibly as salvage. That glass is all empty.

With respect to focal HIFU, I just don't see any advantage over, say, SBRT or HDR-BT (see table in the link below). There is a high re-do rate, incomplete ablation in the ablation zone, probably some toxicity limit on re-dos, and it can only be used on index tumors that are not near the urethra, the rectum or the bladder neck, and the whole theory of index tumors is on shaky ground. What's more, how does anyone use PSA as a tool to monitor success/biochemical failure afterwards? Here's what someone eyes wrote about it:

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html

(n.b.- the comments at the bottom from a HIFU practitioner and my reply. His HIFU website seems to be gone as well -- I can only find his FLA website)

One legitimate use may be for the patient who is marginal for AS - perhaps an "index tumor" with a small amount of Gleason pattern 4. By ablating that, and hopefully it would be completely ablated, he may be able to more comfortably stay on AS. But he would still need confirmatory and f/u biopsies, an expert radiologist who knows how to read an mpMRI on ablated tissue, and an expert pathologist who knows how to read a HIFU-ablated biopsy core.

I think the only way HIFU or other innovative focal ablations should be done is within a clinical trial where the patient is fully informed about all the above risks. These hot-dog urologists who are rushing in to take advantage of a loophole in the law are not doing their patients any favors. I think we need at least 10 years of follow-up to know enough about it to recommend it. So far, the leaders are the Ahmed/Emberton group in the UK who have published 5-year results that make me uneasy.

Posted 6/29/2017 11:23 PM (GMT 0)
Yes, FLA is definitely in the same category - it is a thermal focal ablation technique. The published studies are very small with little long-term follow-up. In the few published studies, as many as 38% had residual cancer in the ablation zone.

Cryo has more history and has a registry full of information. In the past, published results have not been all that good, but the technology is improving.
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