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    Old 07-04-2010, 08:47 AM   #1
    Netirati
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    Thumbs up High Intensity Focus Ultrasound (HIFU)

    My PSA was 6.1 a year ago. Free PSA 29. I had DREs by 3 urologists. They did not feel anything abnormal except to note that the prostate was slightly enlarged. Last August my biopsy was negative, but in March of this year my PSA was 8.6 and free PSA was lower than 25. My PCA-3 about 3 months ago was 47 (cut-off level is 35). I am completing a three week course on Cipro and will go for another PSA in a few days.

    I am preparing mentally to go through saturation biopsy and while I am reading about different treatments for Pca, I run into HIFU which is treatment by High Intensity Focus Ultrasound. HIFU is claimed to be minimally invasive with no significant problems in incontinence and impotence. This form of therapy is not yet approved by the FDA, but it is available in other countries.

    I wonder whether other healthboard participants know about this therapy. I feel that this board is a good resource. I am glad I have found it.

    Last edited by Administrator; 07-04-2010 at 02:14 PM.

     
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    Old 07-10-2010, 09:57 AM   #2
    JohnR41
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    Re: High Intensity Focus Ultrasound (HIFU)

    Have you heard of Dr. Wheeler? He has a urology practice in Florida and does HIFU outside of the U.S.. However, he makes it sound very easy. In one of his pamphlets he said that after HIFU treatment "....you can play golf the next day...." He didn't say anything about needing two or three weeks to heal.

    Last edited by JohnR41; 07-10-2010 at 10:18 AM.

     
    Old 07-10-2010, 10:02 AM   #3
    kcon
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    Re: High Intensity Focus Ultrasound (HIFU)

    Quote:
    Originally Posted by Netirati View Post
    I wonder whether other healthboard participants know about this therapy. I feel that this board is a good resource. I am glad I have found it.

    Hi, and welcome Netirati,

    I have been reading more lately about patients who have undergone HIFU that, as time goes by, rising PSA results are increasingly common. This is anecdotal evidence only, but have been reading increasingly about first-hand experiences of others. As I understand it, the doctors are telling patients in most cases that they need a re-treatment…another vacation to the Bahamas! (and another $25K cash; no insurance)

    While the short-term side effects of HIFU are mainly urinary blockage, the occurrence of impotence as a lasting-effect (lasting-effects being those which show-up a few years down the road and stick around) in the low risk cases in younger men are typical of the similar low risk cases in younger men undergoing nerve-sparing surgery. However, these effects for young men (for all men) have inverse onset curves—erectile disfunction occurs in most men right after surgery, and then the functionality improves over time with most finding complete or high recovery by the 12-24 month window. HIFU follows the opposite curve, similar to radiation, whereby (usually) nothing is noticeable in the first year or so, followed generally by a slow, steady decline. It should be noted that PDE-5 Inhibitors (Viagra, Levitra, Cialis) are often used to assist in the post surgical recovery period, and as doctors gain HIFU longer-term experience they are also prescribing PDE-5s after the erectile function decline (for the rest of the patient's sexually active days).

    The emerging problem—and the main point of this note—seems to be those increasing number of patients who are now needing HIFU re-treatment due to PSA relapse. After HIFU re-treatment, in recent reports, doctors are reporting that patients have a significant increase in urinary incontinence and impotence rates.

    However, I must confess that if I was 75 years old and had a Gleason 6 low risk case, despite these findings and lack of long-term medical studies, I would still consider HIFU treatment (or a radiation alternative) and not be very concerned about the unproven nature of it...but then again all other things being favorable would probably go the route of Active Surveillance and forego all aggressive treatment modes.

    Last edited by kcon; 07-10-2010 at 11:53 AM. Reason: "...but then again..."

     
    Old 07-10-2010, 03:19 PM   #4
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    Re: High Intensity Focus Ultrasound (HIFU)

    Hi Netirati,

    You've had some good responses, including some first hand accounts. The US NIH's National Library of Medicine offers a service known as PubMed, www.pubmed.gov, and we can discuss it per the rules of the board because it is Government sponsored.

    If you go to PubMed and do this search - " prostate cancer AND HIFU " (without the quotation marks), you will get 291 hits, many including links for free access to the complete paper.

    I skimmed hit #4, Transrectal high-intensity focused ultrasound for the treatment of prostate cancer: Past, present, and future. Mearini L, Porena M.
    Indian J Urol. 2010 Jan;26(1):4-11.

    Frankly, I'm still not impressed with the success rates (recurrence free disease), compared to rates for surgery and especially brachytherapy or external beam radiation. Another point is that the average follow-up for HIFU studies is still quite short - just several years, yet the success rates even at this point are clearly below many of the results from the better surgery and radiation series.

    If you do some reading, please tell us what you find.

    Take care,

    Jim

    Quote:
    Originally Posted by Netirati View Post
    My PSA was 6.1 a year ago. Free PSA 29. I had DREs by 3 urologists. They did not feel anything abnormal except to note that the prostate was slightly enlarged. Last August my biopsy was negative, but in March of this year my PSA was 8.6 and free PSA was lower than 25. My PCA-3 about 3 months ago was 47 (cut-off level is 35). I am completing a three week course on Cipro and will go for another PSA in a few days.

    I am preparing mentally to go through saturation biopsy and while I am reading about different treatments for Pca, I run into HIFU which is treatment by High Intensity Focus Ultrasound. HIFU is claimed to be minimally invasive with no significant problems in incontinence and impotence. This form of therapy is not yet approved by the FDA, but it is available in other countries.

    I wonder whether other healthboard participants know about this therapy. I feel that this board is a good resource. I am glad I have found it.

     
    Old 11-07-2010, 06:58 PM   #5
    pretty12d
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    Re: High Intensity Focus Ultrasound (HIFU)

    Hi:

    I had a salvage HIFU procedure performed here in Toronto after a failed course of radiation therapy in 2007. In addition, I've had 3 TURP's done on me in the past three years. Maybe due to the above situation (number of TURP's) my response
    to HIFU might be somewhat skewed and possably atypical. Symptoms that I've encountered post op are total urinary incontinence, urinary retention,stricture of the urethra and persistent Urinary Tract Infection. I have also been referred to another specialist to examine the feasability of implanting an artificial sphincter valve in order to address the incontinence issue. I'm also involved in a clinical HIFU Study that hopes to gather data relating to the safety and efficacy of this procedure in the hope that the F.D.A. will sanction its clinical use in the U.S. I might also note that this Study is currently on hold due to some serious and unexpected side effects-fistualas.
    Good luck!

     
    Old 11-29-2010, 01:55 PM   #6
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    Re: High Intensity Focus Ultrasound (HIFU)

    kcon,

    I called International HIFU and they told me that a second HIFU is 10k, not 25 as you said.

    Sorry to hear your story pretty12d, radiation failure, I thought, was uncommon. But the hold on the study, I was told is not due to fistulas, they are very uncommon, unheard of actually in the last few years, it is on hold because it is completed, they are awaiting data from the wait game.

    I had HIFU and it was a walk in the park, literally, in with cancer, out in a couple hours without cancer, however, I play the same game as the rest of you, testing my PSA every 3 months for 2 years, then every 6 months. But at least I dont have any other pains or trouble to deal with in the mean time.

     
    Old 11-29-2010, 03:35 PM   #7
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    Re: High Intensity Focus Ultrasound (HIFU)

    Hi kcon:

    Thank you for your thoughtful reply. I think ;however, that our wires have become somewhat crossed. Here in Canada the initial cost of the HIFU procedure was $25,000 and was subsequently reduced, due to I assume competitive pressures to $22,000 for the initial procedure. I was and am unaware of the cost here of a second HIFU treatment-you have obviously done your due diligence in this matter consequently, I fully accept the veracity and accuracy of your statement-i.e. $12,000 for a salvage HIFU.

    I'm tremendously pleased to hear that your HIFU was literally a "cake walk" and further that you experienced no adverse side effects. A very informative web site that you might wish to look at is: http://www.ncbi.nim.nih.gov/pubmed and then type in prostate cancer and HIFU. This will produce more than 300+ hits on this topic. One of the research papers that I read last night on pubmed indicated a radiation failure of 30% for prostate cancer patients using this as an initial treatment mode. Quite frankly I have a great deal of difficulty believing that the statistics are as dire as presented in the paper. Referencing HIFU let me quote from a study, which looked at both Ablatherm and Sonoblate in terms of side effects:'The common complications (medians) associated with HIFU included impotence (44% among previously potent patients) urinary track infections (7.5% of patients), urethral stricture (12.3%) stenosis (7.8%), urinary incontinence (8.1%). urinary retention (5.3%), chronic perineal pain (3.4%) and urethrorectal fistula (1%)-in other medical literature I've seen a figure of (3.0%) for fistula. The medical literature further states that careful patient selection is a requisite for HIFU treatment, plus the skill of the surgeon is a major determinant of the success or lack thereof experienced by the patient. Lastly, the concensus of the professionals is that the risks of side effects are "not insignificant".
    The reason for the current hold on the (Star Study)-prostate cancer patients who failed initial radiation therapy and were given HIFU as a salvage therapy are murky indeed. My oncologist (probably the foremost authority on prostate cancer in Canada) stated the reasons for the hold were two fold: side effects encountered by those patients presently enrolled in the Study plus questions realting to the efficacy of the proceedure. He further stated that no further patients were being accepted (possabily into the Canadian arm of the study?). This is a combined Canada-U.S. Study that hopes to win F.D.A. approval for general use of HIFU in the States (currently only in trial status). Whether the Study is on hold due to the fact that it is completed, or other factors may be at play-I won't speculate on.

    All the best,
    pretty12d

    Last edited by pretty12d; 11-29-2010 at 03:39 PM.

     
    Old 11-30-2010, 05:57 AM   #8
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    Re: High Intensity Focus Ultrasound (HIFU)

    JohnR- I am about to got to HIFU- can we chat? Am very concerned ! Was diagnosed at 49, but have been with Wheelers program for 7 yrs, now it getting aggressive and am about to do HIFU. Would love feedback!
    Thanks

    Last edited by Administrator; 12-25-2010 at 12:49 AM.

     
    Old 11-30-2010, 06:00 AM   #9
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    Re: High Intensity Focus Ultrasound (HIFU)

    Tomi, can you give me more info on where/when you had HIFU! I am about to do it and would like to hear from anyone who has had it done!
    Thanks, Jerry

     
    Old 11-30-2010, 07:00 AM   #10
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    Re: High Intensity Focus Ultrasound (HIFU)

    Hi Jerry:

    I had a salvage HIFU procedure done in Toronto in January 2010. In all fairness my case might be somewhat atypical and as such doesn't reflect the reality of many prostate cancer patients. Initially in 2007 I opted for radiation therapy as a first line therapy to deal with my cancer. By 2009 this approach failed. In the interim 2007-2009 I had two TURP procedures. Post HIFU, I had every possible side effect associated with HIFU (incontinence (total), infection, urinary stricture, urinary retention, plus) the only side effect that I've managed to avoid to this point is fistual (thankfully). In September 2010 I had another TURP done due to the fact that my bladder became completely blocked. I'm also looking at the necessity of having an artificial sphincter valve implanted sometime in 2011 due to the incontinence problem.In essence due to HIFU I'm looking at additional surgeries (TURP + Artificial Sphincter Valve)-in Florida these added surgeries would be an added financial cost that you would have to shoulder.
    Some further background in August 2010 the Ontario uro-genital cancer panel came out with a paper saying that they did not recommend the use of HIFU for the treatment of localized prostate cancer. In essence, they felt that the current existing therapies were superior to HIFU. Jerry, if I might offer a suggestion go to pubmed-www.ncbi.nlm.nih.gov/pubmed and type in prostate cancer and HIFU. You will get over 300+ hits if you do so. I think that you would find it to be a very enlightening exercise. Pay attention to the side effects-they can be significant in number and scope.
    If I can be of further assistance I'd be pleased to do whatever I can to be of assistance. I'm also part of a North American Study to gauge the efficacy of HIFU. If the Study goes well(?) Focus Surgery and USHIFU hope to gain F.D.A. approval for widespread clinical use of HIFU in the States.
    All the best,
    pretty12d

     
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