HIFU-Is this the up and coming “new robotic” for prostate cancer?

Randy Owen of band Alabama treated for prostate cancer with HIFU 

Video of HIFU Procedure 

RE: HIFU Procedures / Advice 

by DocTV on Fri Jul 11, 2008 12:00 AM 

Quote | Reply I had my Sonablate HIFU treatment in Winnipeg, Manitoba, Canada. My procedure was done on March 29, 2008. This is a new Sonablate clinic that was set up in Feb of this year. I orginally was going to have the Ablatherm in Toronta, Ont. Canada but my prostate was just too large for that machine. The prostate had a volume of 43.5cc after 5 months of androgen deprivation therapy. The original volume of the prostate was 72cc. 

I tried to refer people to the sites on Cancercompass but it seems that pasting the ip address does not work so I am going to paste the entire articles. 

This is a comparison of the Sonablate and Ablatherm HIFU system that I posted on this website under 

HIFU Information & Cost Effective Treatment Locations (anyone treated in Philippines?) 

I had a Sonablate HIFU treatment on March 29th, 2008. I am in the process of recovery now. I was originally going to have the Albatherm in Toronto, Ont. Canada. It would cost $21,930 and that included them putting you up in a hotel for two nights. What happen is that my prostate had to be shrunk to 40cc or less from 72cc. After 4.5 months on Androgen deprivation therapy it only reach 43.5cc too large for their probe. They were getting a new probe that could do larger prostates but mine was at the limit of the probe so I did not want to risk having to do it again. The Toronto Albatherm clinic has good stats with only having to repeat two treatments in over 300. So I decided to go with the Sonablate which can do prostates as large as 50cc as a new clinic open in Winnipeg only a few hours drive for home, so no plane flight. The Sonablate cost was $22,000 and I had to pay for the hotel costs. 

Complications 

I had my suprapubic catheter (a catheter put through the abdomen wall above the pubic bone into the bladder) plug three times which require my having to go to the emergency to get it flushed and in third time a urethral catheter was inserted (through the penis). I did have problem with bladder spasms and pain during urination. These were all controlled with an anti spasmodic drug, Detrol LA, and anti inflammatory drug to reduce the prostate size. Apparently my large prostate with the subsequent swelling from the procedure–inflammation, cause the pain during urination. I have had no continent issues right from the beginning. The only thing which is common with HIFU is that you have a strong urgency to urinate and that is right now so you need to know where a bathroom is all the time. You will also need to go frequently as you are drinking a lot of water. These two things subside over two to four weeks. I am five weeks out of the operation and I have no catheter and only have some frequency to urinate during the night but that to will subside. The frequency is decreasing. 

Experience 

The Sonablate doctors have to go through a course and it seems that they work with another Sonablate doctor for experience, but the more experience they have the better. Don’t know about the Albatherm but I suspect it is similar. 

Differences and similarities 

Both machines include a motion detector and a rectal temperature monitor. Because the machine is taking such as small strip of tissue and heating it to 80 to 90 degrees Celius you cannot have any movement as that would cause the machine to hit the wrong target. The motion detector causes the machine to shut off thus protecting the wrong tissue from being destroyed. 

Both machines have the probe covered by a condom that has degassed water pumped in to swell the condom to make a tight fit to the rectal wall. The water is cooled to keep the transducer and rectal wall cool. This avoids any heat damage that may occur to the rectal wall. 

The Sonoblate machine has its transducer ( the sound emitting device) in a cylinder attached to the end of the probe. The transducer consists of two transducers one for deeper treatment and one for shallower treatment. The transducer moves within a cylinder at the end of the probe so the probe does not move once it is positioned. Both probes can be used to for treatment or imaging. The Sonablate machine takes images after each treatment shot so the doctor has a continuous upto date image of the prostate and any changes that occur during treatment. The prostate will swell with the first shot to increase in size about 10% at least that is what happened with my prostate. As pointed out the Sonablate has a doppler imaging system to give good color and identification of the nerve and vascular (blood vessel) bundles. 

The Albatherm has one transducer at the end of the probe and it is fixed. The whole probe moves back and forth in the rectum during the treatment phase. The Albatherm can take only one picture at the beginning of the procedure as it requires a different transducer to take the image. That transduce must slide out into position while to treatment transducer is retracted. The imaging system can identify the nerve and vascular bundles. 

The Sonablate procedure has the man lying on his back with his legs up in stirups. You are under a spinal but can also be under a sedation to make you sleep. However, in the Sonablate procedure a patient can in fact not take the sedation and so be awake through the whole process. I was awake during my procedure. 

The Albatherm procedure has the man lying on his right side on the Albatherm table and he has both the spinal and the sedation for the procedure. No option to be awake. 

Both have good result with incontinuence and erectile dysfunction. The Sonablate procedure has stats of 0.6% incontinuence. The Albatherm stats shows a 5 to 6% with most of that type I or II incontinuence which means the man will get a drop or two when he exerts himself in activities like lift a weight or swinging a golf club. Their stats show that a very small number may show a more serious type of incontinuence but this is very rare. Remember that Albatherm has better stats data that Sonablate as the Albatherm has been monitoring for a long time and Sonablate systems have not. Erectile dysfunction is stated at 20% but I think this is too high as the updated technology has improved the systems and the use of Cialis after the catheter is out will help regain the erectile function. I know that Sonablate treatment includes Cialis but the Albatherm as far as I have seen does not. 

The Albatherm frequently will have the patient undergo a TURP (transurethral resection of the Prostate) in order to reduce the size of the prostate and apparently this also eliminates the pain after the treatment. The Sonablate system does not use the TURP. The TURP can cause its own problems and there is a risk of damaging the sphincters that control urine flow even though this maybe a low risk 

The Sonablate machine takes a treatment strip that is 1 to 2 mm by 10 to 15 mm long while the Albatherm machine takes a strip that is 1 to 2 mm by 18 to 24mm long. The Sonablate system divides the prostate into 3 zones with each zone consisting of two blocks. The Albatherm does not appear to have zones but only blocks across the entire prostate. The Sonablate with its smaller strip length can get into tighter corners of the prostate. 

This my story from this website under 

HIFU side effects 

I was diagnosed with prostate cancer just by accident. I was in my family physician’s office for shoulder problem and I happen to notice in her office a plastic mount of the longitudinal section of a human male pelvis. I have a Ph.D in Zoology so I was interested in what the write up was about. So, I began to read about enlarged prostates and symptoms. I quickly began to realize that I had a prostate problem with intermittent urine flow and weak stream. I discussed these issues with her and she booked a blood test in Feb 2007. I discovered that the prostate was quite large but the PSA (prostate specific antigen) was only 3.3, not a problem. I was referred to an orthopedic surgeon and discovered that I need to have my right shoulder’s rotary cuff repair. After the surgery the enlarged prostate began to swell probably due to the drugs I had to take for the post operative care. The prostate closed off the urethra and within two days I was in the emergency room having a catheter inserted which I had to keep in place for five days. My family physician referred me to an urologist. The urologist routinely had a blood test done to check the PSA and had scheduled a scoping of the prostate through the urethra within a week or two. The blood test for the PSA was done in July, 2007 Several weeks later I had the scoping done but in the interim my family physician received the report on the PSA reading from the urologist’s office and contacted me saying “Your PSA is high and the urologist will likely want to have a biopsy done.” After the procedure I asked the urologist about the PSA reading but he did not know anything about it. He checked with his office about my results from the PSA testing that he had ordered and his office contacted me to let me know that they had booked a biopsy for me to be done in about two months. 

A week after the biopsy, I received a phone call from the urologist’s office informing me that I had prostate cancer and that I had an appointment the following Monday with the doctor to discuss my options. His office stated that this type of cancer was completely treatable but nothing else. When I got to the doctor’s office, the urologist came into the room and asked me what treatment I wanted. I asked for information on the possible treatments and their advantages and disadvantages only to get a reply that I was informed by his office so that I could look on the internet and research what my option were. The best that I could get from him was that there are two basic types of treatments –surgical removal and radiation treatment. He would not give me any information as to which was better or what are the side effects of each type of treatment. Due to my zoological background I was quite familiar with the anatomy of the male reproductive system, the accompanying structures, their positions in the body and the possible damage that could occur from any invasive procedure. I point blank asked about the differences between the two procedures with regard to problem of incontinence and erectile function but he stated that they are just the same and indicated that it was my decision. No further information would he offer me. I later found out from another urologist that radiation therapy is not recommended for a man of my age, 60 years old. Instead it is used for much older men (in their eighties) as the peripheral damage to tissue would not be a problem; assuming that these men would have died before the problems from that type of procedure would become an issue—not a pleasant prespective. 

This had all taken place in September, 2007. I decided to look on the internet since that was the only thing this urologist offered and I stumbled upon the HIFU, specifically the Ablatherm. After reading the information on this procedure I decided to go with this method as it offered the least peripheral damage from the procedure. Incontinence was considered to be 5% of only type 1 and 2 incontinence which means that one would dribble a little urine when one would put a strain on the abdomen like golfing or lifting heavy weights. Erectile dysfunction was down to 20% or less when the nerve bundle sparing procedure was implemented. This procedure is always done unless there is an issue with the nerve bundles being to close too the prostate then it may not be possible. As far as I could ascertain, it seems as if all the Ablatherm procedures incorporate the nerve bundle sparing technique. 

I contacted the Toronto Albatherm and after some discussion my prostate which measured 72cc had to be reduced to 40cc. This was to be accomplished by the use of hormone therapy. Dr. O prescribed Zoladex implant and Casodex pills for ten weeks but I had to get my urologist where I lived to prescribe this treatment. I was surprised and happy that my urologist agreed to do it even though he did not want anything to do with the post operative care or anything at all to do with HIFU. At the end of 9 weeks I needed to have the prostate measured. So I arranged to get it measured and on December 20th, 2007 the procedure was performed. My prostate size was reduced to 45.5cc good but not low enough yet. So, after a brief discussion with Dr. O I was to continue the Casodex treatment for one more month and get measured again. Unfortunately, the prostate did not reduce very much at all, only one cc less. Dr. O changed the prescription to Avadart and I was on the combination of Avadart and Zoladex for 6 weeks. At the end of the 6 weeks the prostate was measured and again only dropped one cc and now measured 43.5cc. In all cases three sets of measurements were taken and three volumes of the prostate were calculated. The numbers I have given are the average of those three volumes. The prostate measurement was still too high but when I contacted Toronto Dr. O mentioned that they were getting a new probe which would allow them to do larger prostates. The smallest dimension of my prostate was 38mm which was the upper dimension limit of the new probe. I decided not to go with the Ablatherm as I did not want to take the chance of having to undergo the procedure a second time. Dr. O’s stats showed that he had only needed to redo the treatment in two cases in over 300 so his results were excellent but again with my prostate size at the upper limit I felt that would increase my chances significantly of needing a retreatment. 

While this was going on I continued to search the internet about treatment options and symptoms to see if something could have alerted me to the problem earlier; pain during ejaculation was one thing I had but did not realize it was an issue. In my search I came across the Sonablate system and was amazed that it had so many locations in the US and Mexico and even one in Toronto as well. I contacted the US HIFU and discovered that they were opening three more treatment centers in Canada: Winnipeg, Niagara and I think Montreal. The Winnipeg center was within a 7-hour drive for me and so no plane flight needed. I was apprehensive about this technique as I got the impression that the doctor was moving the probe manually within the rectum for each treatment. After talking to the nurse at US HIFU she made me aware that the probe in only adjusted by the doctor in order to get a complete image of the prostate. After that the probe moved mechanically within a cylinder within the condom filled with cooling water. Unlike the Ablatherm which moved back and forth in the rectum for each plane of treatment the Sonablate probe did not move again only the transducer moved in its cylinder. Also the Sonablate system has continuous monitoring of the prostate image during the procedure so that changes can be made due to the swelling of the prostate once the burning process has started. 

The nurse took my phone number and passed it to Dr. D in Winnipeg saying he would contact me later that day. That evening I received his phone call. He spent over half an hour talking to me and my wife answering questions and giving information about the procedure. I decided to go with this procedure feeling that it was even better than the Ablatherm. After reading Internet testimonials on the HIFU message site about sedation options I realized that I could get a spinal and avoid the sedation since any sedative or anesthetic tends to knock me out for a very long time. I contact the Maples Surgical unit, where the HIFU treatment was to take place and arranged to have the anesthesiologist contact me. That same day I received his phone call and we talked about my sensitivity to anesthetics and I was able to arrange to have no sedation administered. 

Before I left for Winnipeg I needed to get my prescriptions for use after the procedure as well as a pair of anti-embolism stocking—thigh high. I went to a drug store with the idea of just picking up a pair off the counter. To my surprise there were several tensions of stocking and I had to get measured in order to get the right size. I checked back with US HIFU for specifics on tension of stocking. I was to get the lowest tension—16 to 20mm of Hg (mercury). I went back to the drug store to be measured. The drug store did not have the correct one in stock but the store would order them for me and they would arrive within a week. I still had plenty of time to wait for the order which arrived in 8 days. Now, I had everything I needed for the procedure—the four prescriptions and the anti-embolism stockings. 

I arrived in Winnipeg by myself due to some mix up. My wife was initially going to accompany me but the person who was going to look after our place could not do it at the last minute so I contacted the US HIFU to see if it would be okay for me to come alone since I was not going to have any sedation which seemed to be alright. Unfortunately, upon my arrival I discovered that legal issues make it essential that all patients must be accompanied by an adult. Everything is set for the procedure with a number of HIFU personnel having been flown in to assist the doctor. The administrator of Maples Surgical Center did some scrambling and was able to arrange through some business to have someone stay with me for the next 16 hours after my procedure. So, my treatment day remain as scheduled. 

Just before the procedure I met with the doctor and the anesthesiologist and the nurses. The doctors informed me that I must be perfectly still during the procedure as the machine takes very minute strips of prostate tissue and burns it with the ultrasound. The Sonablate machine is very sensitive to any movement as it could change the position of the probe and not hit the target prostate tissue. The anesthesiologist stated that he would not give me sedation but because the procedure can take several hours I might have some discomfort lying in one place for so long, so all I would need to do would be to ask and he would give me a very small amount of the sedation just enough to eliminate the discomfort but should not put me to sleep. As it turned out I was on the table for 5 hours and did not need any sedation. I must admit that keeping still was not as difficult as I thought that it might be. I was not supposed to move even my arms. 

The first step of Dr. D was to measure my prostate, and low and behold the prostate measured 34.5cc. I was not taking any treatment other than I still had the Zoladex implant. This measurement left me with a very unusual feeling in that God wanted me to have the Sonablate HIFU system because if my prostate measured 34.5 cc I would have gone to Toronto. The Winnipeg center did not open until February, 2008 and I had started the process of getting prepared for the procedure in October, 2007. 

The Sonablate HIFU divides the prostate into six blocks in three tiers so that the treatment strips are short and much easier to get into the smaller areas of the prostate. My cancer was centered in the apex of the prostate where the capsule is thinnest and folds so some cancer cells could escape. Dr. D completed the treatment but wanted to make sure that no cells were missed in the small neck of the apex. He stated that the hormone treatment should have destroyed any cancer cells that might have escaped as those cells require testosterone to live but the stem cancer cells within the prostate would not die with a lack of testosterone, so, he created a seventh block (which is possible since the treatment strips are much smaller then the Ablatherm) in the very apex to clean out anything that was there. 

After the procedure I was able to get dressed and sit in a recliner chair until my escort arrived. I did run into some problems with pain later in the day but Dr D and the administrator of Maples Surgical unit were keeping in contact with me. Dr. D tried to phone me the next day but I was not in the original motel room that I had stated. However, I had Dr. D’s cell phone and was able to contact him and he quickly replied to make changes and prescribe pain killers for me. Even after I got home I was able to contact Dr. D and he continued with a follow up. He also made arrangements to have another urologist available in my city that I could contact if problems arose. The pain killers eliminated my pain problems within a day or two and after a week I no longer require them. 

You can also go to http://www.yananow.net and look under HIFU and TV for the discription of my procedure. 

I hope some of this will help you with your decision. I consider HIFU the best way to go for treatment of Postate cancer. One may have some problems afterwards but they are minor and do disappear whereas some of the other treatments could have problem side effects that stay with you.