Practical aspects of deciding whether HIFU is an appropriate treatment “for you”

An article by Julie Appleby of Kaiser Health News, posted yesterday on the STAT health news web site, asks whether high-intensity focused ultrasound (HIFU) is being “over-sold” to prostate cancer patients based on the limited outcome data currently available. (We would emphasize that Kaiser Health News is not associated in any way with the HMO Kaiser Permanente. Kaiser Health News is a publication of the independent Henry J. Kaiser Family Foundation.)

The “New” Prostate Cancer InfoLink would make a number of key points related to the appropriate selection of HIFU as a treatment for prostate cancer:

  1. First and foremost, if a patient is considering HIFU as a form of treatment for his prostate cancer, he would be wise to make very sure he is talking to a highly experienced HIFU practitioner — and there aren’t a lot of those here in America yet! This is a technique (like every other technique used to treat localized prostate cancer) that takes time and experience to learn to do well.
  2. For some low-risk patients who are unwilling or pyschologically unable to deal with the idea of “living with” a low-risk form of prostate cancer on active monitoring of some type, HIFU may well be one of the least risky forms of treatment currently available — but it can and does have side effects, in the short and the long term, in some patients, and it cannot be guaranteed to cure every individual prostate cancer.
  3. Currently available data suggest that HIFU may well not be the most appropriate form of therapy for men with unfavorable, intermediate-risk and high-risk forms of prostate cancer, but the available data are limited.
  4. Currently available data suggest that HIFU can be used as a form of second-line therapy for some men with radiation-recurrent prostate cancer (i.e., a rising PSA after first-line radiation therapy for localized prostate cancer) that is confined to the prostate, the prostate bed, and (maybe) the seminal vesicles. However, these data are again limited, and there are no guarantees of efficacy.
  5. We recommend that patients considering HIFU treatment be treated exclusively by HIFU specialists who have agreed to submit all relevant outcome data to one of the recognized HIFU registry databases, so that as much data is being captured about the short- and long-term outcomes of HIFU treatment for prostate cancer as quickly as possible.

Every individual is, of course, fully entitled to make his own decisions about how he wants to manage a diagnosis of prostate cancer and whether and how he wants to get it treated (and by whom). However, …

If HIFU is to become an approved form of treatment for well-defined forms of prostate cancer that is covered by Medicare and commercial health insurance companies, patients and physicians need to work together to build a database to support the belief that this form of therapy really works for well-defined and categorized types of patient.

3 Responses

  1. Amen to that skepticism!

    We need to keep in mind that that recent FDA approval of HIFU technology in the US was not exactly a ringing endorsement. HIFU was approved as a way of “ablating” prostate tissue (such as benign growth), but there was no endorsement of its effectiveness against prostate cancer. In fact, an FDA advisory panel voted against approval of HIFU for prostate cancer in the summer of 2015. However, with the more recent approval for ablation, HIFU technology can now be used “off-label” for prostate cancer in the US.

    To many of us the only HIFU team that is apparently achieving success comparable to other established therapies is the Uchida team in Japan, with many teams worldwide recording discouraging rates of recurrence after HIFU after 3 to 5 years of follow-up. (Almost every treatment looks good for the first year or two of reported follow-up.) While the Uchida team did not succeed with earlier forms of technology using Sonablate 500 as a base, their more recent work with improved Sonablate 500 technology (and know-how) seems competitive with results from established therapies, particularly surgery and radiation. Here is a link to the key Uchida paper from last summer. If it were me being treated with HIFU for an intermediate-risk case (would choose active surveillance for low risk), I would at least make certain the doctor was using the same kind of technology that was successful in Japan, getting key facts in writing and signed. I would be wary of a public relations “snow job”.

    Here’s hoping that effective HIFU technology and expertise will one day be available throughout the world so that it will no longer be what it too often seems to have been in recent years, a walletectomy with arguably scant benefit! (But “repeatable if it doesn’t do the job the first time”. Ugh! Give me a break!)

  2. If you are looking for long-term data on HIFU take a look at the articles at this link.

  3. About 7 months ago I had checked out about HIFU from a personal friend who had had the procedure. This was before the treatment was allowed in the USA. He had done this several years before we had the discussion.

    Several months after the treatment, this person admitted to me he did have some serious side effects from his HIFU procedure, and he ended up in the hospital emergency room because his urethra had collapsed and he was unable to empty his bladder. In order for a remedy to work, it also involved this person having to order and insert catheters himself to keep the urethra from collapsing. The permanent successful procedure had to be done where this friend lived here in the USA. He had to go out of the country to receive the original procedure, and I am guessing returning to the original medical facility was not an option for correcting the problem, which would continue to be on going? I was not told by this person in regards to a clear explanation of how the procedure he ended up having was done, but he did tell me the procedure did fix the problem.

    When I gathered information from a legally allowed medical facility after the procedure was approved in the United States, that indeed this collapsed urethra was a known possible side effect. I did not receive any information from my friend about extra costs. However, during this time of my research about the extra problems that he went through, he said that it was so painful from not being able to empty his bladder and he never had this type of pain in his entire life.

    I really feel the reason men were having this procedure is because the removal of the prostate usually had two major side effects — incontinence and erectile dysfunction — which both can be permanent, basically meaning no more intercourse without an aid or medication. The incontinence could also mean wearing a pad in your underwear for the rest of your life. With the removal of the prostate including the nerve bundles on each side of the prostate, I was told by a physician assistant who worked with a urologist surgeon at Duke University, who I had made an appointment for consultation and she was authorized by her surgeon to explain this to me and my wife that there was really no way that devices or medications would make any improvement for being able to have any type of sexual intercourse because the removal of the nerve bundles would affect blood flow and muscles in the location of the penis forever. I did not discuss about penile implants, as I had decided not to have the radical removal of the entire prostate at the Duke University facility.

    One other point for me was all other procedures would leave the prostate in your body, and I decided to have mine completely removed because this was the only way to know for sure if you no longer had prostate cancer after the removed organ was examined by a pathologist and all the cancer was contained inside of the prostate capsule.

    I elected to have a urologist/surgeon do the removal of the entire prostate gland locally where I live. This surgeon agreed that he only practiced robotic surgery and to use the procedure of “minimal evasive surgery“ and “sparing of the nerve bundles”. There were no guarantees but when I had asked, “How many of these procedures have you done now?” he said he had completed 22 surgeries in the week before we met with him. He also had been doing these robotic-only procedures for 18 years and received intensive training about these procedures during a Tulane University Fellowship. By the way it has been about 3 months or so since I had a complete prostate removal and about 3 weeks ago I was only using a pad every 4 days. Right now (September 22nd) I am only using a pad every week. Never had leakage at night since the catheter was removed about 10 days after the June 6th surgery. Have also been using a basic light-days men’s incontinent pad. Have had some half erections in the last month of August. As it has been said the success of prostate radical removal with side affects depends on the skill of the surgeon. This seems to be coming true for me.

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