Anyone have HIFU procedure for PC?

[Mustang18]

Hi, I am 67 and recently diagnosed with 3+4 (7 Gleason score), group 2. My wife and I have met with a surgeon, a radiologist, and a urologist who specializes in HIFU (High Intensity Focal Ultrasound). Has anyone in the group had the HIFU procedure and if yes, how successful was it? I met with a urologist Dr. Vahan Kassabian who has performed over 500 of these with I believe he said 78% success. After the procedure there would be active monitoring, and blood test. A MRI in a year. My PC is on one side of the prostate, so only one side would be treated. The side effects are minimal with this procedure. No ED or incontinence.

Currently the cost is $25K out of pocket and he believes that Medicare is scheduled to provide a code in 2023 to cover the cost. We are waiting to see what happens in January. If they do not cover then the cost again would be $25K out of pocket, and if needed again, the cost would be about $15K out of pocket.

Would be curious to see if anyone has had this done and your success rate.

Thanks,

Mustang18

[Tall_Allen]

It works poorly (only 65% are cured, even with whole gland HIFU). Read this:

prostatecancer.news/2021/03...

It has never been FDA-approved for the treatment of prostate cancer because of its poor results. It is only FDA-approved for the removal of prostate tissue (like a TURP).

In contrast, SBRT had 100% 5-yr cure rate and minimal side effects for favorable intermediate risk PCa in this clinical trial:

prostatecancer.news/2016/09...

[Mustang18 in reply to Tall_Allen]

Thanks Tall_Allen

[Hidden in reply to Tall_Allen]

If it works so poorly why does Mayo now offer it at their Rochester facility? I would think that their endorsement pretty much settles the issue.

mayoclinic.org/medical-prof...

They talk about focal ablation. I recommend the more thorough full gland ablation.

[Tall_Allen in reply to Hidden]

It was full-gland ablation discussed in that article.

Mayo offers it for one reason - greed. (Just as the continued to push C11-Choline long after it was proved inferior)

[Hidden in reply to Tall_Allen]

LOL. You are right and one of the most respected medical providers in the world are just a bunch of greedy so and so's. Got it. Let's believe you rather than Mayo.

[Tall_Allen in reply to Hidden]

How else to explain why they would offer it as a cure for prostate cancer, when the FDA (who doesn't have an economic stake) looked at the evidence and found no benefit. The FDA has only approved it for ablation of prostate tissue, not prostate cancer. It is often used (by Mayo and others) off label, but insurance will not reimburse it. Evidence has repeatedly shown it to be inferior to approved therapies.

[Hidden in reply to Tall_Allen]

The FDA, like most government agencies, are subject to politics. I suspect a strong reluctance to countenance the newcomer, the new technology, something none of their members studied in school, or practice themselves. I object to your extreme hostility towards something you have zero personal experience with. Here's another take on HIFU, from another well respected Medical organization:

mskcc.org/news/high-intensi...

I wonder how many men you have convinced that HIFU is so terrible are now dealing with the nasty side effects of radiation or conventional surgery.

[Tall_Allen in reply to Hidden]

The FDA is charged with making a recommendation based on the evidence. A similar conclusion was reached in Canada, which allowed it for years. The NHS in the UK only allows it in clinical trials. The world-wide conspiracy you imagine doesn't exist.

I have dealt with the aftermath of patients being duped into it by greedy urologists. You were one of the lucky ones.

[Hidden in reply to Tall_Allen]

Anything you say. You are obviously smarter than any of us and always ready to put us in our place. The 40,000+ men around the world who have already chosen HIFU are obviously damned fools.

[Tall_Allen in reply to Hidden]

I wouldn't go that far. I'd say the ones who were treated outside of a clinical trial have been tragically deluded by unscrupulous urologists. The data speak for themselves.

[Yearofthecow in reply to Hidden]

most every major comprehensive cancer center offer HIFU and or TULSA. I do not subscribe that they do it because of greed. No doubt in my view that those who do the procedure, do it with the view that they are helping people.

I think the problem is that there is not enough data available, since it is too new, and no actual double blind studies that I am aware that compare it against other treatment options. In other words, it looks good theoretically, but we just don’t have enough data to make a fair evaluation.

Whether we use radiation, high frequency ultrasound, freezing, other types of heating such as lasers, etc. and surgery, the propose of all is to remove the cancer with hopefully less side effects.

I also think in most places, at least as far as TULSA is employed, it is done on a focal basis. At least when I was exploring options that is what the doctors in urology and radiology were suggesting to me. The advantage was that all options would still be available if it comes back, and the side effect profile of the procedure was very good.

The reason I choose MRI guided SBRT was because I wanted to theoretically be done with it, even though all options require follow up monitoring, it seemed less intrusive with SBRT

[Hidden in reply to Yearofthecow]

Yes it is relatively new, in this country anyway. Years ago, Mayo took the position that they wouldn't pursue any treatment that didn't have a ten year track record with which to evaluate it.

[1Ubspaine]

I did strongly consider this procedure back in 2021 when I decided upon radiation and ADT therapy. The same Dr. you are talking to in fact, he has a good “sales pitch”, but the final results didn’t line up for me.

[CarverD]

I also had this at the top of my list of treatments for 7(3+4) favorable intermediate PCa. After meeting with surgeons and doing more research on the efficacy of HIFU I took it off my list. Instead I went with HDRBrachytherapy and am very pleased with the results. Minimal side effects, no ED, no incontinence. 2+ years out and all indications are I am a "one and done" survivor. Best of luck.

[Hidden]

I received full gland HIFU ablation from a surgeon in the SF area in 2016. I had to go out of state and out of pocket. Six years later I am a happy camper. No ED, no incontinence. My PSA has leveled off at 1.8. What's not to like? As I mentioned above, Mayo Rochester now offers this. Do find a practitioner with plenty of experience. PM me if you want the name of my surgeon.

[Yearofthecow in reply to Hidden]

WSO, if you had whole gland HIFU, why would you have have a PSA level that high. Doesn’t the description whole gland mean the whole gland is treated, which implies the entire Prostate is heated away by ultrasound?

Thanks

[Hidden in reply to Yearofthecow]

Well the prostate is still there. My local urologist (not the surgeon) thinks that maybe some of the prostate tissue has 'recovered' after being zapped. I don't know that you can zap 100% of the tissue anyway. I think they intentionally skirt certain areas in the interest of sparing nerves. I'm just speculating. I'm not a doctor or medical science authority, like some here pretend to be. If I took a risk choosing HIFU so be it. I've battled the disease and am left with zero side effects and 100% QOL.