I looked at HIFU and would have likely gone that way if my second slide read was a Gleason 6 as was the first, but with a 7 I knew my personality was such that I wasn't going to be happy without the pathology. A noninvasive practitioner (seeds, radiation, HIFU etc.) would say, "Why do you care? The only thing that matters is your follow up PSA." At least, that's what they said to me. And, they're likely right. But I still wanted the pathology.
What I learned was what everyone else here has learned regardless of what therapy they're pursuing --- the key is the experience of the operator. I looked at Sonablate (available two miles from my house) and Ablatherm (available 1,000 miles east) and would have gone with the Ablatherm but only because that guy had done 400 plus treatments in the past five years and the Sonablate guy had done 15 in the past year. Each machine has it's good points. I'd be happy with either.
With respect I would disagree with geezer on a lone doctor with a private clinic. Mayo or MD Anderson may put out the studies but what you're looking for is, as they say of surgeons, good hands --- coupled, of course, with an excellent brain. This is an outpatient procedure that can be done in a small private clinic (in my not so humbel opinion) every bit as well as at a large teaching hospital. Matter of fact, at the clinic you know for sure who is doing it. At a large research teaching hospital, by definition, you don't know if it's the doctor you signed up for, or some first year surgical resident starting out. Once the anesthetist has you in la la land you're fodder for the teaching program. That's not all bad, just recognize that some dental surgery needs to be done in a hospital and some can be done equally well in a private clinic and there are trade offs with each. Unlike surgery, or radiation HIFU is ideally suited to a clinic setting and I imagine in the future it won't be found in expensive hospital settings. And it may well be done by practitioner technicians, not doctors. I can imagine a suite of rooms, not dissimilar to a dentist's office, each with a HIFU machine an anesthetist practitioner and a HIFU practitioner doing two/three cases a day. This is not going to be popular with for profit medicine people and there will be huge resistance. However, as PCa detection moves earlier and earlier and more and more men are seeking treatment, the demand for noninvasive treatments appropriate to Gleason 6 and 7 will increase and insurance companies will be pressing for cost effective delivery systems. Non hospital clinics now deliver everything from cosmetic surgery to cataract surgery and will likely be home to HIFU in the future.
I also must, with respect, decline Tony's characterization of HIFU as an "experimental therapy." Any therapy is experimental in the sense that there are always on going studies. In Canada we have very few daVinci machines and practitioners. I live in a city of 700,000 with some excellent hospitals but none have a daVinci. Here daVinci is seen as experimental in the sense that it doesn't have the 20 year track record of
open surgery. "The jury is still out," I was told. "
open surgery is still the gold standard." I doubt many American members of this group view daVinci as experimental when 60% of the radical prostatectomies at Mayo Rochester are being done via daVinci according to a Mayo urologist I spoke to.
In the U.S. HIFU can only be done in an experimental setting because it has not been approved by the FDA. Not surprisingly many Americans see HIFU as experimental. The reason it is not approved, I was told by two U.S. urologist oncologists, is that the FDA won't accept studies on safety and effectiveness not done on American soil. Canada, on the other hand, is willing to look at research from France, Japan, Germany, etc. and if the studies are by credible people, and conducted in a credible way, they are accepted. The result is that HIFU has been approved in Canada for about
As with daVinci there are no long term results available for HIFU. Like daVinci HIFU hasn't been around long enough (about
10 years) to have long term results. As with daVinci the results that are available seem to be very acceptable, certainly for the first five years, and again, as with daVinci, recent results from newer generation machines are throwing off better out-of-the-box numbers than first seen from older machines.
When Tony encourages men, "to be part of an unbiased study so that the next guy gets valid information to work with," that is fine advice for Americans wanting to be treated in the U.S. but doesn't apply as well, I believe, to much of the rest of the world, where HIFU is an option more akin to other noninvasive therapies. Tens of thousands of men have been HIFUed and, as with daVinci, short term valid information (at least valid if you're not following FDA on this) is available to work with. Are there a large number of peer reviewed and published scientific studies? No. Are there about
the number of peer reviewed and published scientific studies that might be expected at this stage? Best I can tell the answer is yes. Are the short term non published studies producing very credible numbers with solid trend lines the equal of, or better, than radical prostatectomies? Best I can tell the answer is yes.
One huge advanage of HIFU is that doing it doesn't shut any doors. All other therapies are still available. Including a second HIFU treatment. Any therapy has its failures and an important issue for me was what was my back up? I spoke to one daVinci surgeon in the U.S. who had removed a HIFUed prostate with daVinci. That HIFU left all other options
open was an important consideration for me.
I don't want to put HIFU on the same pedestal as
open surgery, or daVinci, but I do believe American protectionism in the FDA puts a spin on HIFU in the U.S. that is different than the spin seen in much of the rest of the world. In France, Germany, Japan, Russia, Italy, HIFU is, best I could tell, just another treatment option.
All of the above is a result of my own research into HIFU and I would remind the reader that I elected daVinci when HIFU would have also been an acceptable choice with statistically better side effect (incontintence and ED) results. The reader should also be aware that I am a business person whose scientific training ended with Grade 12 chemistry, in which, as I recall, I barely got a passing mark, and who is far from competent to pass judgement on anything medical. These are but the observations of a lay person in way over their head. Yet, aren't we all.
I hope this is helpful and although I disagree with geezer and Tony some, taken as non-confrontational and in the spirit of sharing understandings in which I offer it.
Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn --- perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"