HIFU After Failed EBRT

[gusgold]

This looks like a promising treatment

Gus

urotoday.com/recent-abstrac...

[Hidden]

I didn't have confidence in the radiation treatments I was pointed to. I went straight to HIFU. Now if only Medicare would do the right thing and 'code' HIFU so that they will cover it.

[Hidden]

Yes HIFU is looking interesting for focal therapy.

I wish they would say how small a lesion can be targeted. And what is BFSR?

Something free survival rate.... Oh - biochemical. A stable PSA.

[Hidden in reply to Hidden]

Yes, it can be focal treatment. My surgeon recommended going 'full gland' as maybe the biopsy could have missed some spots, and don't want to have to do it again. One thing I can add is that he mentioned that there's a limit to how far the equipment can 'reach' -- he said 40cc is pretty much the limit as far as prostate size. My ADT treatment shrank it from 34cc to 27cc at the time of HIFU treatment.

[Hidden in reply to Hidden]

Articles do talk about success with whole gland ablation. I thought it wasn't done. They also talk about two generations of equipment. The more recent one, with a better focusing I imagine, but I don't know the capability of either generation or if the difference is significant.

HIFU seems so much safer. Radiation does not sound good, but I am considering it, because there is really no alternative that I can see, at any rate.

Where are you having it done?

[Hidden in reply to Hidden]

Had it done at the San Francisco Surgery Center. Dr M. Lazar. As others have mentioned the suprapubic catheter isn't fun to deal with. This was also "out of pocket" and not covered my Medicare/insurance.

[AlanMeyer]

A couple of cautions about the study.

1. There was no control group. We don't know how the results compare to other salvage treatments or to no treatment at all.

2. The abstract mentions: "... at a price of significant morbidity."

However, there aren't a lot of options for treatment with curative intent after failed EBRT, so HIFU does look like something to consider.

Alan

[Hidden in reply to AlanMeyer]

If by 'significant morbidity' you mean nasty side effects, that is where HIFU shines. It claims to have fewer side effects than RP or radiation. As with everything, lessons learned and improvement in equipment have reduced risks. Beware of studies that go back too far in time. The same applies to radiation and surgery.

[AlanMeyer in reply to Hidden]

WSOPeddie wrote:

> ... Beware of studies that go back too far in time. ...

Yes, an important point. All of the treatment modalities have evolved. As I understand it, HIFU and cryosurgery were significantly worse than standard surgery and radiation treatments when they were first introduced, but have since been developed to become competitive. Radiation has changed a lot with higher doses being delivered more precisely than was the case 15 or more years ago. I don't know if surgical outcomes have changed as much since the surgeons still cut out the same parts of the body with laparoscopic techniques that they used to cut out with open surgery, but they do have fewer side effects today.

There are other study problems too. When comparing two treatments, the patients in each group have to be well matched for age, stage, Gleason score, and health. If the two treatment groups are not matched that way, all bets are off as to why one group came out better than another. Another problem is doctors. One surgeon or radiation oncologist may have much better results than another of the same type. Worse, one may be better at concealing his failures.

Alan

[Hidden in reply to Hidden]

The discussion presented here sold me on HIFU:

greaterbostonurology.com/gb...