A brief review of the TACT study of TULSA ultrasound short-term efficacy and side Effects

[maley2711]

practiceupdate.com/C/113846...

There is no comparison offered re radiation and surgery treatments for similar men, and the study included just a small number of men.

[AlanMeyer]

I suppose it's useful to try out all kinds of new techniques, but it's hard to declare this one a success if only 65% of men with favorable or intermediate risk disease had no evidence of disease at one year after treatment. One of the mistakes I've seen many cancer patients make is thinking that, because a treatment is newer, it's likely better. Usually the opposite is true. Only a small percentage of new treatments turn out to be as good as the existing ones.

Alan

[maley2711 in reply to AlanMeyer]

Yes but over at Inspire.com, there are apostles for TULSA. There may actually be better longer-term numbers from Europe...have not seen......because they have done more treatments over a longer time period. Guess I need to do a little Googling. The fact that some well-respected PCa Docs here and in Canada seem to be positive on this approach is a basis for some of the patient enthusiasm. It definitely works fo some men...and not for others...just like all treatments. we just won't have long-term comparisons for many years, unfortunately.

[AlanMeyer in reply to maley2711]

There could be more to it than the disappointing results from the one trial indicates. It certainly happens that techniques can be improved over time. Both surgery and radiation are much better today than they were 20 or 30 years ago. But what I'd like to see is a justification for WHY this technique is thought to have promise.

Do the developers think it has the potential to reach more local tumor cells, or to kill more of them than the existing treatments do? Why might that be true? Do they think it can produce identical outcomes as the best modern techniques but with fewer short or long term adverse effects, or lower cost, or higher speed, or with easily and successfully repeated treatments after a failure? Or what?

I suspect that some of the urologists that specialized in HIFU or cryotherapy or laparoscopic surgery, and not a few of the too many institutions that invested in proton beam equipment, were attempting to cash in on the latest fads either in hope of making big bucks, or in fear of being left behind by other docs and hospitals. In the end, it looks like the laparoscopic surgeries worked out, proton beams - maybe so, but with a lot more bucks spent for the same bang.

Am I too cynical?

Alan

[maley2711 in reply to AlanMeyer]

" can produce identical outcomes as the best modern techniques but with fewer short or long term adverse effects, " From what I have read, that is the hope...and pitch. and I hope long-term proves correct. Google Dr. Klotz U Toronto...also John Hopkins work on this. wouldn't we all hope for equal results with better SE profile!!! I do!!

[maley2711 in reply to AlanMeyer]

Someone just posted at inspire.com that there have now been approx 50,000 HIFU procedures done inEurope.....unfortunately at many clinics and no studies were provided re outcomes overall... I'msure Google could find something about results?TULSA PRO supposedly new and improved real-time tracking of High intensity ultrasound.....with device inserted thru urethra, for better access to all prostate regions. I assume even these ablative procedures leave a safety margin? always a huge concern about damaging rectum and bladder, right? no matter the procedure?

[AlanMeyer in reply to maley2711]

"Safety margin" is an interesting term here, isn't it? Treating more tissue may deal with more tumor cells but also harm more healthy cells. Treating less tissue does the inverse of that. It's a decision that the oncologist has to make - often based on ambiguously shadowy images from CT scans, MRIs, and ultrasound.

I've wondered about how all of that is done. Since different patients are different, there isn't a one size fits all radiation, HIFU, or cryotherapy plan. The practitioners must each be making somewhat subjective decisions about radiation or ultrasound or cryotherapy doses to specific spots along specific beam vectors or with specific seed or wire placements. There are guiding principles that they learn in medical school, in journal articles, and in the many conferences and training sessions that they attend - but some of the docs are more attentive, read more, and learn more than others.

For that reason, I think the knowledge, experience, and commitment to patients of the oncologist who performs the procedures is more important than the specific technique used. I'd want the best doc I could get.

However I would still be reluctant to try a new procedure when proven ones are available. It's not just a question of how well the technique performs in clinical trials. It's also about how much individual and community experience do the docs have, and what happens when things go wrong. Where would you find a doctor that is experienced in treating TULSA ultrasound mistakes or failures?

Alan

[maley2711 in reply to AlanMeyer]

Fromwhat I have read on2 PCa forums, probably Europe! Scionti in Florida I believe jumped on the train as soon as FDA approved, also a guy, Raman?, at UCLA, and maybe 1- others here. Still, there experinece is just last year, or less. Dr. klotz in Canada. Hopkins was very active in trial. Probably the best info comes from calling TULSA PRO maker, Profound Medical.