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HIFU: high-intensity focused ultrasound

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Posted 8/3/2017 11:48 PM (GMT 0)
Transurethral MR-HIFU for the treatment of prostate cancer.

Has anyone done this, know any one that has done this? There are Clinical trials being done in the USA. Note that the clinical trials I am looking at go through in through the URETHRA---NOT THE RECTUM to do this.

It can be focused on just the cancerous parts of the Prostate or the entire prostate. The whole procedure is MRI guided with their software that monitors the temperature of the probe and the prostate.


They go in with their probe and ablate the cancer out, it's an out patient procedure. They claim good results: Minimal down time, does not harm erection nerves----erections go back to baseline, no incontinence.

This sounds to good to be true. I guess this has been widely done outside the USA.
I am 56, gleason of 6, been doing active surveillance since 2014, PSA has been slowly creeping up, every 6 months. My PSA is now at 5.8. I figure it's just a matter of time before I have to do something radical, this procedure sounds the "least radical".
Any comments?
Posted 8/4/2017 12:08 AM (GMT 0)
Here, read this:

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html
Posted 8/4/2017 2:02 PM (GMT 0)
And read this: www.bradenton.com/news/local/crime/article162921028.html

...
Posted 8/4/2017 2:31 PM (GMT 0)
<<<This sounds to good to be true>>>

If it sounds too good to be true, it usually is! Caveat Emptor!
Posted 8/4/2017 2:34 PM (GMT 0)
There is another website where a thread on HIFU has been going on for about four years, with comments being added almost daily. It seems to strongly favor HIFU, so you have to factor that bias into your reading. I'm not sure that I can provide a direct link, but you can find the website by googling "prostate cancer inspire".

I believe that some of those posters are now promoting a very new form of HIFU, and that may be a possible game-changer. Not enough data yet to persuade me that it's a reliable form of treatment.
Posted 8/4/2017 4:53 PM (GMT 0)
The FDA has begun to crack down on doctors making unsupported claims that HIFU is a cure for prostate cancer. Sonablate or Ablatherm got a "back door" FDA approval after being rejected as a prostate cancer therapy. By "back door," I mean they got it approved as a method of ablating prostate (not prostate cancer) tissue, as a TURP type of procedure. With that approval, many doctors were able to move their off-shore practices to the US. The more scrupulous ones are using it in the context of clinical trials to see whether it is an effective therapy for prostate cancer. The Ahmed/Emberton group in the UK have published their clinical trial results with 5 years of follow-up so far, but because ablation is incomplete, it will require longer to see if it is effective.
Posted 8/4/2017 5:53 PM (GMT 0)
Not yet ready for prime time. In all the studies I have seen HIFU has the worst record of reocurrance. As time passes the reocurrance rate actually increases, in all other treatments the rate of reocurrance drops with the passage of time. There have been several Asian and European countries that have discontinued using it because of it's poor record.
The main advantage is that treatment can be done multiple times
Posted 8/5/2017 2:40 PM (GMT 0)
HIFU was a urologist recommended treatment for me when I was exploring options after being diagnosed two and a half years ago. At the time HIFU was not USDA approved and would've required being treated outside the US.

I ultimately decided against HIFU as HDR Brachytherapy seemed to show better results. See the table in the link on Tall Allen's post. Summaries of European HIFU studies I had seen had also not shown stellar results.

At your relatively young age if you are going to treat is a focused treatment the best way to go? I was a little older than you and still figured a focused treatment would likely result in having to treat again at some point.

Dr. Karamanian commented in response to the link on TA's post that HIFU is most often actually used for whole gland treatment. But if treatment is going to be whole gland are there compelling reasons to use HIFU over other methods such as HDR Brachytherapy?

Post Edited (Works Out) : 8/6/2017 11:32:29 AM (GMT-6)

Posted 8/5/2017 10:15 PM (GMT 0)
When I was diagnosed with PCa, my oncology urologist (trained at MD Anderson) explained all of the options. He said the one option that he would "NEVER" suggest is HIFU. He told me that the long term cure rate from HIFU was dismal, and wondered why it was popular in Europe.
Posted 8/6/2017 3:05 PM (GMT 0)
HIFU is not popular in Europe. The guidelines call it an "unestablished alternative treatment" and recommend: "only offer cryotherapy and HIFU within a clinical trial setting."

EAU-Guidelines-Prostate-Cancer-2016.pdf

George
Posted 8/6/2017 5:43 PM (GMT 0)
Please take this for what it is, a comment on my HIFU discussions in 2009. Things have changed, but the tactics are telling.

I was diagnosed initially with G8 (4+4), with Gleasons ranging from 4+3 to 4+4 in 9 of the 12 biopsy samples. My uro presented all of the mainstream treatments, as well as some not-so-mainstream for me to investigate, as I was (and still am) rather inquisitive about my health.

I actually investigated a HIFU practice in Mexico (doc based in the US, you went with the doc and staff to Mexico for the treatment), and one in Europe. Both implied strongly that I would have to have multiple treatments over time. My insurance would not cover it as even experimental. I did not follow up on it.

In the weeks following, the US doc's office hounded me, trying to sign me up at some $50,000 or more. They even tried to convince me that because I should be able to get a second mortgage through my bank (it was scary that they could discover where I banked, but now I realize that too much social media really is too much).

That type of tactic sealed the fate of HIFU in my mind, with a huge period.

Just my experience.
Posted 8/7/2017 11:42 AM (GMT 0)
I had a transrectal focal HIFU treatment on May 5 with Dr. Ahmed at imperial college hospital in London. I don't have the PSA follow ups yet.

The procedure ablated about 35-40% of my prostate. I had a catheter for 5 days post procedure. Now three months later I have have no side effects other than some reduced semen volume which was specific to the location of the lesion.

I am 56 years old Gleason 7 (3+4), PSA 4.8.

I think our community is subject to a medical industry that over treats prostate disease. We perform 48 RP knowing only 1 will extend a life, I indeed even if you have an RP you still have a 30% chance of recurrence. If if had a Gleason 6 I would just stay on AS as long as I could. You're effectively on AS for the rest of our lives anyway whether or not we have treatment.

I have chosen the path of treating this as a chronic illness that needs to be managed. After much reading and research I found a book 'Invasion Of The Prostate Snatchers' that helped me to process my thoughts and develop a care management plan. The data in the book is dated back to 2010 but the thoughts and insights are timeless.

Good health.

quote="brian3222"]Transurethral MR-HIFU for the treatment of prostate cancer.

Has anyone done this, know any one that has done this? There are Clinical trials being done in the USA. Note that the clinical trials I am looking at go through in through the URETHRA---NOT THE RECTUM to do this.

It can be focused on just the cancerous parts of the Prostate or the entire prostate. The whole procedure is MRI guided with their software that monitors the temperature of the probe and the prostate.


They go in with their probe and ablate the cancer out, it's an out patient procedure. They claim good results: Minimal down time, does not harm erection nerves----erections go back to baseline, no incontinence.

This sounds to good to be true. I guess this has been widely done outside the USA.
I am 56, gleason of 6, been doing active surveillance since 2014, PSA has been slowly creeping up, every 6 months. My PSA is now at 5.8. I figure it's just a matter of time before I have to do something radical, this procedure sounds the "least radical".
Any comments?
Posted 11/6/2017 5:44 PM (GMT 0)
Brian 3222, I am in a Phase 2 clinical trial for the TULSA-PRO procedure with Profound Medical out of Missisauga, Canada. I received my treatment at the University of Chicago. I was the 2nd patient to get it done there.

I'm 55 and my PSA was 6.4 and steadily rising, Gleason 6 with bilateral cancer in 10 out of 14 cores. I didn't want to get cut on and read quite a bit about the Phase 1 trial that was done on 30 patients in Europe.

I am 3 months post-op. I had a suprapubic catheter in for 10 days before I started urinating on my own. I had a small setback with bladder spasms due to tissue blocking my bladder neck and had to go to the ER to get back on a catheter for four days until I could get back to Chicago. I live four hours away in Indiana.

My one month follow-up showed a PSA of .67. I just had my 3-month follow-up four days ago and my PSA was 0.05. I have a strong stream and just a little leakage when straining or maybe with a strong cough. I can get an erection on my own but not firm enough for penetration. I am currently using Viagra (3 pills) and the sex life is great, except for the dry ejaculation. At this point, I am pretty happy and with time hope to gain full ability to get an erection on my own. I hope this helps. Sorry if I didn't follow some protocol. First time poster.
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