HIFU Medicare Coverage Insufficient

News that Medicare will begin to cover HIFU in 2021 but they are evidently being very stingy about it.

mailchi.mp/hifuprostateserv...

Can we get support for this from this site too?

[Tall_Allen]

Not from me! I think it is a bad idea until it is proven. The FDA approved HIFU to remove prostate tissue (like a TURP), not to treat prostate cancer. Unscrupulous doctors are pushing it for prostate cancer like used car salesman. It should be relegated to clinical trials.

[Hidden in reply to Tall_Allen]

Gee, color me surprised that you would object. You have no personal experience with HIFU and I'll bet that you personally know no one who has received this treatment. Yet you remain rabidly opposed to a treatment many men have benefitted from. I didn't realize there were enough used car salesmen doctors to have treated over 20,000 patients world wide. Maybe, as they say, you are too smart by half.

[Tall_Allen in reply to Hidden]

You would bet wrong. I do know people who have had HIFU. I'm glad that you did well with it, but many do not. Maybe you are ignorant of the results in those 20,000 people you said were treated. In a recent study of HIFU in the US, 1 in 4 experienced a failure - and most were low or intermediate risk. Godawful results.

[Hidden in reply to Tall_Allen]

How many experience incontinence and erectile dysfunction, as well as other problems, on the way to recurrence using standard of care treatments like RP and radiation? If this treatment is so bad why is Medicare extending any kind of coverage? Maybe some of those awful results involved focal instead of full gland ablation? Are those results representative of the latest generation equipment or do they go back to prior generation equipment? Technology evolves.

hifu.ca/hifu-clinical-resul...

Let's see your study results.

[Tall_Allen in reply to Hidden]

I never experienced incontinence or ED. Never had a recurrence. You obviously don't know what the stats actually are. I do agree that technology gets better. But good technology doesn't necessarily translate into good results. Only clinical trials can prove that results are good. So far, they don't.

Here are the results of multiple studies that I've looked at. I hope you will read them. Some of the issues only apply to focal and hemi-ablation, but some apply to full-gland ablation too (e.g., incomplete ablation, heat sink effect, Biochemical Effects, Organ-at-risk damage/toxicity, Re-do rates, Lack of long-term data, Tracking progression after therapy, Salvage after ablation, Inexperienced practitioners and practices, and Cost/Insurance.)

prostatecancer.news/2016/12...

As I wrote:

"As with all new therapies, methods and outcomes will undoubtedly improve over the years. This first wave of practitioners and brave patients are taking risks that may eventually benefit many others. It is important that patients understand those risks before making their treatment decision."

It is not ready for prime time, which is why the FDA did not approve it as a therapy for prostate cancer. If it ever will be ready depends on clinical trial results - which is what I advocate.

[Rwrpc in reply to Tall_Allen]

Why more clinical trials if plenty of data is available from Europe , am I missing something?

[Tall_Allen in reply to Rwrpc]

Not long-term data. The data so far on oncologic control are not very encouraging - ⅓ to ¼ of favorable risk men have recurrences, often in the treated areas.

[Hidden in reply to Tall_Allen]

How many RP or radiation / brachytherapy patients have recurrences?

[Tall_Allen in reply to Hidden]

Much lower recurrence rates for radiation and surgery. For radiation, 5-yr recurrence rates are less than 5% for low-risk patients, 0-10% for favorable intermediate-risk patients, 8%-20% for unfavorable intermediate-risk, and about 15-20% for high-risk patients.

For surgery, the recurrence rates are similar for favorable risk patients, about 40-60% for unfavorable risk patients.

All recurrence rates will improve as unfavorable risk patients are screened with PSMA PET scans.

You can see why the FDA continues to refuse to approve HIFU for treatment of prostate cancer - they only approve it for removal of prostate tissue (like TURP for BPH).

[Hidden]

Pretty good study out in HIFU showing good results. But you need to have favorable Gleason score to begin with.

auajournals.org/doi/10.1097...

[Tall_Allen in reply to Hidden]

Please explain how 27% failure rates within 2 years among mostly favorable risk patients "good results."

[Hidden in reply to Tall_Allen]

Its good if you’re one of the 73% and your goal was to avoid radiation or prostatectomy as well as debilitating ADT treatment . Also, some of the clinically significant cancers that constitute technical failure may be AS level. The biggest failure predictor was bilateral cancer which indicates it may not be appropriate for bilateral cancer.

[Tall_Allen in reply to Hidden]

Remember, this is only with 2 years of f/u - failure is probably higher with longer f/u. How does one know in advance if one is among the 73% or the 27% failures? The group 2 (Gleason 7+) or greater recurrence rate was most of those recurrences (24%). Since 78% of patients had favorable risk PC, very few would have had temporary adjuvant ADT, and then only if they had radiation. Why avoid, say SBRT, which has similar levels of side effects and would have much higher cure rates?

[Hidden in reply to Tall_Allen]

Some say "up to" half of RT patients have a 50% failure rate. Not exactly sure what "up to" means but to me it means about half.

[Tall_Allen in reply to Hidden]

Some say Trump is still president. Just because "some say" a thing doesn't make it true.