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A few thoughts on HIFU for Prostate cancer

Charlesjago profile image
8 Replies

Hello Everyone

I am new to this community but wanted to say a few things about HIFU for prostate cancer.

I think HIFU works (I have had it done myself) but believe there are three essential criteria which will determine outcomes:

1. The right patient and disease characteristics. I don’t think HIFU would be my choice if the disease has got outside the prostate. Ideally a patient would be Gleason Grade 2 or less and have an index tumour on one lobe of the gland which is clearly visible on MRI.

2. The right diagnostics both before treatment and after it as follow up. It’s important that no cancer however small has escaped the gland. HIFU may still be possible but not for me. PSMA Pet is a game changer here. New genomics tests like Decipher in the US and Prostatype in Europe can also provide more confidence about the risks involved with this treatment - which at the worst I believe should be seen as a more pro-active form of Active Surveillance.

3. The right surgeon. I can’t stress this one enough. HIFU requires great dexterity and this takes time and many procedures to acquire. Quite frankly in my opinion many surgeons are keen to join the HIFU bandwagon without having the demonstrable skill sets to deliver the required results.

I believe many early attempts at HIFU (i.e 5 years ago or before) have failed because they didn’t satisfy one or more of these points above. A huge amount of knowledge has been gained and work undertaken in the past two or three years to improve HIFU and the data is very encouraging. I am certain that it works - at least as well as other treatments - out to 5+ years and more for most patients if they are carefully curated.

I have read over 100 technical research papers covering many aspects of HIFU and watched with great interest as this male form of “lumpectomy” has gathered increasing attention amongst expert prostate cancer practitioners all over the world. So for what it’s worth here are my final thoughts and advice for anyone that wants it:

1. HIFU is not going away. I believe it will become the treatment of choice for most men with small low grade non metastatic prostate cancer who want to avoid the radical treatments currently on offer. I had an extremely rare and dangerous prostate tumour - Ductal + Intraductal+ Perineural Invasion - but still chose HIFU (hemi-ablation) after extremely careful consideration which included PSMA PET, and FDG Pet scans as well as Somatic testing of the tumour and Germline testing for genetic abnormalities. I also employed the services of the best HIFU surgeon I could get my hands on. It’s far too early to say if it has cured me but I am happy with my decision so far.

2. For some patients (thankfully an ever decreasing number each year) HIFU will fail. If the failure is not related to the three points I outlined above then research into prostate cancer oncogenes may throw more light on why in due course. (You can ignore initial problems with heat delivered by the HIFU machines as that issue was addressed long ago) For the moment these patients will need to come back again for a second HIFU. So what. I wanted to avoid radical treatment so if I have to have a second HIFU with a view to kicking the prostate cancer can down the road a bit more that’s fine with me. This is because ultimately I am a firm believer that science and next generation technologies like AI and Machine Learning (an area I am actively involved in) will come to the rescue of all of us with the big C within the next few years in any case.

3. Finally I should ignore any links showing HIFU research/trials/outcomes that are more than 2 years old. They are way out of date as far as I can see and give entirely the wrong impression about this fast evolving field.

Whatever treatment you decide to have for this nasty disease I hope it works well for you and I encourage you to stay tuned in for yet more positive data about HIFU.

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Charlesjago
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8 Replies
Xavier10 profile image
Xavier10

didn't work for me and my PCa has not been proved to have left the capsule. I had a Decipher and it was low risk (39), although by the time i had it done (my original biopsy before any treatment at all) it was after the Tulsa-Pro had failed. I would just avoid the risk unless you have the least amount of cancer. Watchful waiting category, maybe. I did have 4+3 though. So hifu is just not cut out to snuff that out. Radiation is, though. Also, I don't think insurance pays for it even yet. I know I blew $30,000 on it. Wish I could do it all over again, I just would have gone straight to the IMRT and gotten it behind me a lot sooner.

Seasid profile image
Seasid in reply toXavier10

I agree.

Tall_Allen profile image
Tall_Allen

While I am glad if HIFU has worked for you, and your "3 points" may explain some of its high rate of failure, there are many other hypothetical reasons for its high rate of failure, discussed here:

prostatecancer.news/2016/12...

In the US, the FDA looked at the evidence and rejected it is a treatment for prostate cancer. They only accepted it for removal of prostate tissue, like a TURP. In Canada, it was tried and rejected. It is allowed in clinical trials, which is the legal loophole used for it.

It will not gain acceptance on this side of the pond until there are clinical trials that:

1. prove it is not inferior to radiotherapy in men with localized PCa

2. Explain why the failure rate is so high, even when the whole gland is treated

So far, the "true believers" (represented in the UK by the Ahmed/Emberton group) have been afraid to conduct such trials.

davcarv profile image
davcarv in reply toTall_Allen

Reply to TallAllen:

Thank you, TallAllen, for sharing the report and contributing to the discussion. I always value your insights and expertise in this group.

I noticed the report you linked is from 8 years ago, and while it provides valuable context, it seems like the technology and techniques for HIFU have evolved significantly in recent years, as some members here have highlighted. Given the rapid advancements in medical technology, newer data might offer a more current perspective on its efficacy and safety.

That said, your input is always appreciated, as it reminds us to critically evaluate both historical and current information. Perhaps combining insights from this older report with recent studies could give us a more comprehensive view. I’d be curious if you’ve come across any newer findings that either support or challenge the earlier conclusions.

Thank you again for sharing your knowledge—it’s contributions like yours that make this group such a valuable resource for us all!

Tall_Allen profile image
Tall_Allen

You misread that. That was the date the article was begun. Below that it says “frequently updated. “ It is current if you check the links inside.

Indy2012 profile image
Indy2012

Here is an article from May 2024 to consider: urologytimes.com/view/study...

dentaltwin profile image
dentaltwin in reply toIndy2012

This certainly is encouraging, though 30 months is not a very long followup.

CrackerOcala profile image
CrackerOcala

Great guidance. Only lacking in mention of related costs and to what degree those may or may not be covered by insurance including American Medicare.

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