HIFU - Ablatherm or Sonablate

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JerryB-UK
Regular Member


Date Joined Jul 2009
Total Posts : 39
   Posted 7/24/2009 3:42 AM (GMT -6)   

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-UK


Age - 67

PSA (February 2009) 7.8 ug/L. This had risen from 5.3 ug/L in August 2008.

Biopsy (3rd April 2009). Number of samples 10. Number of samples containing cancer 10% on left and 20% on right. Bone marrow & MRI scans (7th May 2009) indicate no perineural or extra-prostatic spread. Gleason 7 (4+3). T stage diagnosis 2b. Prostate size - 52 cc

Was given a choice of RP or Brachytherapy and decided on Brachytherapy. However, flow test on 24th June 2009 showed flow rate to be too slow to permit Brachytherapy.

Started hormone therapy on 3rd June 2009 for 3 months (Prostap3 injection) preceeded by Cyproterone Acetate 100 mg tds. Hopefully this will shrink my prosate / improve flow rate sufficiently for Brachytherapy or maybe HIFU.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/24/2009 6:38 AM (GMT -6)   
It is way to early for independent objective judgment on this. Every thing I found, including presentations at medical meetings, is from somebody who has a dog in the race.

My advice is that it is the same as every other PC treatment – go with the skill and experience of the doctor. How could you be smarter than they are about choosing a machine? To this I would add, go with a treatment facility that has good medical review and oversight because that is where learning will occur fastest. I would be very wary of the lone doctor with his private clinic.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/24/2009 8:59 AM (GMT -6)   
Hard to say Jerry,
You do have a group in London that is performing a long term study on HIFU and to me, that sounds like an important study if you live in the UK and want to be treated with HIFU. We also have a HIFU study here in the US that is far from completed. Prostate cancer can be a 20 year disease and it simply takes time to get usable results. I applaud those who would like to be treated with an experimental therapy, but I would encourage them to be part of an unbiased study so that the next guy gets valid information to work with.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/24/2009 11:34 AM (GMT -6)   
Hi Jerry,

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 five years.

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"  


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/24/2009 12:09 PM (GMT -6)   
www.nhs.uk/news/2009/07July/Pages/Ultrasoundforprostatecancer.aspx
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 <0.01


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/24/2009 2:59 PM (GMT -6)   
Easy Sheldon,
The term "experimental" is not mine at all. And it's not a bad term necessarily. What I truly don't understand is the negative connotations towards recommended participation in clinical studies that are not influenced by vested interests. After all robotic surgery, any form of radiation or cryo therapy has indeed passed this process, and it isn't unreasonable to ask that HIFU pass through this process as well. It takes a few years, and we will know what to expect with it in terms of performance and side effects. What is unreasonable is to suggest that studies are not a good idea in medicine, or that the FDA should just read studies performed in other countries and rubber stamp them here. We have seen this time and again in cases where people went to Mexico to skirt the US law, only to completely fail. (look up Steve McQueen et. al. and Laitrile, just to name one example)

Also, you had surgery because you wanted a final pathology. I think that was a smart move. As a moderator at this site I would bet that I have seen up to 20% of guys who went into surgery 3+3 and a small tumor indicated at biopsy come out with a Gleason upgraded and/or extracapsular extentions. They too are likely better off with that final pathology report.

CapnLarry has listed a link to a clinical trial in the UK. It would be my guess that they, the UK, feel the need to get this information themselves rather than just trusting outside data. I believe that Jerry will receive great care in a study, and he will be a hero to me because he did so.

Peace...

Tony


 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 7/24/2009 3:33:11 PM (GMT-6)


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/24/2009 9:19 PM (GMT -6)   
My bias for a medical center rather than a private clinic was formed by reading the medical literature about the introduction of robotic surgery. At the clinical centers they reviewed videos of their own operations and of those done by others. They exchanged information and sat in on each others surgeries and then discussed them. Perhaps your lone doctor is a surgical genius, but I would go for peer evaluation every time.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 7/24/2009 9:20 PM (GMT -6)   
The one thing that I would like to add about HIFU, is that it is not an option for anyone with Ulcerative Colitis or IBD. This always seems to get missed whenever HIFU is discussed.
 
Since I have had UC since 1986, with a daily maintenance medication requirement, I would never have been a candidate.   
Age 60, PSA 2007 4.1, PSA 2008 10.0
Diagnosed April 2008, Biopsy: 6 of 12 cores positive, Gleason 4 + 5 = 9
CT and Bone Scan negative, Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared, Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th, pT2c, lymph nodes negative
PSA Sept 28, 2008 0.00, PSA Jan 22, 2009 0.00, PSA June 29, 2009 0.00
ED Status- Currently using Trimix, Levitra daily for increased blood flow.
Noctural Erections have completely returned on a nightly basis, same hardness as before.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/24/2009 11:39 PM (GMT -6)   
Jerry,
Back on topic, I don't know which is better. You certainly should look into which may be best for you, but with a lot of different pieces of information floating around, and some misinformation, it may be best to talk to doctors on both side of the equipment controversy. I would guess that they would both argue that what they use is best, but you may get a tip on what you would prefer in the discussions. Good luck in your decisions...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


JerryB-UK
Regular Member


Date Joined Jul 2009
Total Posts : 39
   Posted 7/27/2009 3:24 AM (GMT -6)   

Thanks to you all for your helpful comments. I won't attempt to reply 'individually', but will hopefully touch on the main points raised.

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.

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 all so right that the important thing - the absolutely essential thing - is that the operator has oodles of experience. Both Ablatherm and Sonablate are available at a number of centres in the UK, but so far the people I have spoken with have not carried out very large numbers of the treatment. The largest I have found 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.

Mostly, the HIFU centres in the UK are only offering the treatment privately, but I believe it is possible to obtain treatment on the National Health Service in one or two places, which I'm busy following up. However, when it comes to the crunch, I would rather pay money (a lot of it!) for private treatment with someone with extensive experience, rather than free-of-charge treatment by someone with possibly considerably less experience.

There is a HIFU study in London at the moment (at the Royal Marsden I believe), but I think this is based on using HIFU as a salvage procedure. There is another trial using HIFU as a primary treatment, but I am not eligible for this as I am on hormone treatment for three months. Again, if I had been eligible, I would need to be really confident that this trial is involving people with considerable experience, and I think that is maybe slightly doubtful?

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 (there must have been quite a steep learning curve going on at the time). Things have moved on apace.

Ablatherm claimed (in 2008) that there had been over 15,000 treatments with their equipment worldwide, but I think the majority of those were within Europe. There have been a number of papers published over the years by users of both Ablatherm and Sonablate in Europe and, generally speaking, those from the latter years have tended to assess the treatment as being comparable with non-surgical treatments, in terms of shorter term morbidity and medium-term oncological outcomes. What is currently not available are hard data on longer term oncological outcomes, particularly anything involving RCTs and peergroup review.

I am leaning towards Ablatherm at the moment, if only for the reason we all 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 to date with, apparently, a pretty good degree of success. I'm attracted towards his clinic because of the number of treatments he performed. 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, much 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.

One final question. I keep on reading at this forum that people chose radical prostatectomy because they wanted 'final pathology'. I'm not really clear what this means. I can understand that once the prostate has been removed, pathology will reveal the extent of the cancer, which will sometimes prove to be more than was indicated by biopsy. That must be of interest to the medical profession, but I'm not sure how it helps the patient. Therefore, I have to assume that pathological examination also includes tissue removed from areas around the prostate during the surgery, which will help to indicate if there are tumours beyond the capsule. This sounds well and good, and obviously is of considerable benefit if the surgeon is able to identify areas of tumour outside the capsule and remove them at the time of surgery. However, I was told by my consultant that during the surgical procedure, it would probably not be possible to identify micro-metastatic excursions, so I obtained the impression that there would still be an element of doubt remaining. Maybe someone can be kind enough to clarify things for me.

Once again, thanks your input.

Cheers,

Jerry

 

 

 

 


Age - 67

PSA (February 2009) 7.8 ug/L. This had risen from 5.3 ug/L in August 2008.

Biopsy (3rd April 2009). Number of samples 10. Number of samples containing cancer 10% on left and 20% on right. Bone marrow & MRI scans (7th May 2009) indicate no perineural or extra-prostatic spread. Gleason 7 (4+3). T stage diagnosis 2b. Prostate size - 52 cc

Was given a choice of RP or Brachytherapy and decided on Brachytherapy. However, flow test on 24th June 2009 showed flow rate to be too slow to permit Brachytherapy.

Started hormone therapy on 3rd June 2009 for 3 months (Prostap3 injection) preceeded by Cyproterone Acetate 100 mg tds. Hopefully this will shrink my prosate / improve flow rate sufficiently for Brachytherapy or maybe HIFU.


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 7/27/2009 5:16 AM (GMT -6)   
You're right about the pathology. Surgeons don't see micro-mets, which is part of the reason they take wide margins for higher Gleasons. However the pathologist ought to be able to detect them in the removed tissue, but even then might miss them, since they obviously can't look at all the cells.

For this reason, with surgery, there is always an element of doubt remaining. Even with negative margins, we can never be sure that no micros remain.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.

Post Edited (Piano) : 7/27/2009 11:57:26 PM (GMT-6)


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/27/2009 9:23 AM (GMT -6)   
Hi Jerry, sounds like you're making good progress on your investigations. In a previous thread you mentioned you were on hormones because of a very large prostate. I'd forgotten this when I made my last post on this thread, but if I'd been sharp enough to remember I'd have mentioned in regard to your Ablatherm or Sonablate question that Sonablate is able to handle larger prostates than the Ablatherm. The Ablatherm people sometimes will handle this with a transurethral resection of the prostate prior to the HIFU.

As you know from my post above, if I'd gone for HIFU I'd have opted for the Ablatherm in Toronto, with Dr. Bill Orovan rather than Sonablate here in my home town simply because Orovan had done far more treatments than the local doctor, although they are both well respected urologists here in Caanada. (Oronvan is an MD Anderson trained urologist, head of surgery at McMaster University Medical School --- one of Canada's leading medical schools --- and a former President of the Ontario Medical Association.) However, one of the interesting things about HIFU is that the treatment is very much softwear driven both in planning and the actual treatment. One of the "gold standards" of prostate treatment is to go with the practitioner who has the most experience. That's what I was going to do. However, given the role of the softwear in both mapping and then generating the treatment sequence, experience may count for less with HIFU than other PCa treatments. That said, why wouldn't you go with experience?


I agree with Piano on the pathology. That's why even when the pathology indicates all the PCa is contained and has been removed they'll still be watching my PSA.

If you're willing to leave the U.K. and be HIFUed elsewhere you might want to check out possibilities in France and Germany. Or, even come to Canada! Lord knows we need the money. Fair warning though. Orovan's clinic is right in the heart of Toronto's most trendy, expensive, shopping district. Rumor has it that some American wives have spent more out shopping while their husbands are being HIFUed than the cost of the HIFU ! !

I wish you well with whatever cure route you settle on be it HIFU or otherwise. Please keep us posted on your journey.

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"  


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 7/27/2009 9:40 AM (GMT -6)   
Ok, both Sleepless09 and JerryB-UK are starting to sound like commercials for HIFU. Sorry guys, but most people never post that much info about their docs or the clinics.
 
Neither one of you ever post the negatives about HIFU. It's just the positives. If you are going to post a long reply, I think you need to bring up the issues that some guys from Canada have had. Their advice would be totally opposite yours.
Age 60, PSA 2007 4.1, PSA 2008 10.0
Diagnosed April 2008, Biopsy: 6 of 12 cores positive, Gleason 4 + 5 = 9
CT and Bone Scan negative, Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared, Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th, pT2c, lymph nodes negative
PSA Sept 28, 2008 0.00, PSA Jan 22, 2009 0.00, PSA June 29, 2009 0.00
ED Status- Currently using Trimix, Levitra daily for increased blood flow.
Noctural Erections have completely returned on a nightly basis, same hardness as before.


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 7/27/2009 10:03 AM (GMT -6)   
hb, these guys are posting from countries where HIFU is an accepted course of treatment, well maybe not completely in England, but for them it is a normal one of several choices they have an opportunity to use. I don't think they are wandering off the beaten path, as their naming doctors and hospitals are no different, in their country, to us naming our choice for the best robotic surgeon or medical center. We do it for robotics, open, radiation oncologists, ed specialists and others here in the US, don't we? Their conversation has been mainly between themselves. I suppose we all need to remember that we have members here from all over the world, as can be seen in the "Where are you from" thread we keep here. I can promise you we are very vigilant for spammers of all stripes here....
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
21 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/27/2009 10:48 AM (GMT -6)   
Hello hb2006

Sorry ---- there are negatives about HIFU. The primary one I know of is the development of scar tissue sometimes in the urethra which has to be removed. Then, there are instances where the PSA goes up and HIFU needs to be repeated and I know of one instance where after a second HIFU the prostate was removed by daVinci surgery. And, if it's important to you, and it was to me, you don't get pathology afterwards.

I see you have been a member here since last November, much longer than I, and must have knowledge of Canadians, or Americans for that matter as I understand about half the HIFU patients done in Canada come up from the U.S., with major problems I'm not aware of. If so, for Heaven's sake, please cite the specifics so Jerry can have this information before he commits to a treatment.

I'd also point out that I do not have a HIFU doc or clinic. I chose not to do HIFU. Why? Because of the negative issue I have addressed --- no pathology.

And while most people may not post about docs or clinics, lots of members do discuss their specific docs and suggest the names of other docs to consult, be it an oncologist or where to get pathology done.

I think we can all agree that the only thing that matters, in the end, is that we share as honestly as we can our experience and understandings to help others. I don't pretend to be an expert on anything, or to be the last word. All I can do is share what I've experienced, felt, and learned, as flawed as that may be. On HIFU I have spent weeks, days, and hours reading and talking to urologists who do it, and urologists who are dubious. As a business person who has spent my career trying to separate the hype from the reality, be it a manufacturing process or a real estate investment, I like to think I know something about asking the right questions and being suspicious of the answers. But, as I've said as clearly as I can, I am not a scientist sort of person.

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"  


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/27/2009 10:50 AM (GMT -6)   
James C

I agree 100%

Bless you.

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"  


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 7/27/2009 11:13 AM (GMT -6)   
I agree with James on this...this doesn't smell or feel like a spammer thread at all.  Having recently experienced gooog and his alter-egos, I think it is refreshing and educational to have some intelligent discussion about HIFU. I am happy for the learning opportunity.
 
Also, re the post surgical pathology, I echo Piano in that even after surgery some doubt remains.  One of the big selling points of some uro-doc-surgeons is to "get it out so you will know for sure".  Yes, you will know more about your pathology post procedure with surgery but "for sure" is a gross overstatement...
 
Tudpock
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 7/27/2009 12:52 PM (GMT -6)   
Sleepless09, sorry if I offended. And yes, my son-in-law is from Canada and works in the health care industry like I do, so I do have much more knowledge of the Canadian process and practices than most people do.
 
Anyway, JerryB-UK should read the other HIFU threads on this forum as almost every one has had an experience detailed as to what went wrong with their HIFU treatment. There are at least 4 or 5 others with situations which would make you seriously question the HIFU approach.
 
There is not a "magic treatment" for Prostate Cancer other than watchful waiting, at this point. Every treatment option can have adverse reactions, or due to the Gleason scores, will not be an option for many men.
Age 60, PSA 2007 4.1, PSA 2008 10.0
Diagnosed April 2008, Biopsy: 6 of 12 cores positive, Gleason 4 + 5 = 9
CT and Bone Scan negative, Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared, Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th, pT2c, lymph nodes negative
PSA Sept 28, 2008 0.00, PSA Jan 22, 2009 0.00, PSA June 29, 2009 0.00
ED Status- Currently using Trimix, Levitra daily for increased blood flow.
Noctural Erections have completely returned on a nightly basis, same hardness as before.

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