Ablatherm HIFU

Kongo said:

Ablatherm
Hi, Nana

I read the website you refer to in your post. Like you, I had not heard that HIFU was an option for dealing with a recurrence following RP. The manufacturer web site is informative but gives little details about how they would do a salvage procedure and it doesn't cite any studies that show how successful it might be when used as a secondary treatment after RP has failed. Also, when I read their references to other procedures for initial treatment, I felt they did not give a balanced perspective. For example, saying that Ablatherm HIFU is one of the only therapy options for patients seeking further treatment after RP simply isn't true. Hormone therapy, radiation (two or three different methods), or a combination of both, cyrosurgery, chemotherapy, and AS are all potential treatment methods following RP.

Also, the statistics the website cites for side effects from other treatments do not appear accurate. For example, as a side effect of RP the website states that it "usually results in impotence." While that may be true in the very near term, most men who have nerve sparing RP eventually recover much of the potency they had before surgery, so I believe this is very misleading. When they talk abour radiation, they only refer to EBRT which is seldom used anymore having been replaced by IMRT, IGRT, or SBRT methods so the side effects the mention arn't really applicable.

The Ablatherm website cites only a single study which was performed in Europe that involved 137 men where success rate was greater than 93% (I have read this study before and believe it was done in 2007). If you do a literature search on HIFU at PubMeb or Urotoday.com you will find other studies where the success rate is more like 50% and some where it is as low as 20%, although one aspect of HIFU is that you can have secondary treatments. (I don't know if you get a discount on follow-on treatment if the first try doesn't work)

Like any manufacturer, Ablatherm is posing its product in the best possible light. I don't fault them with that. DaVinci, CyberKnife, Varian, Tomo, and other manufacturers do the same although the other websites from competing technologies didn't seem as blatantly biased as this one from Canada.

In any event, I think it will be hard to get a good second opinion on that option in the United States as there are only a few places that offer it now in conjunction with ongoing clinical trials and I am not aware of any trials in the US that is using HIFU as a treatment option to address recurrence.

If you are going to investigate this properly, you probably need to travel outside the country and talk to the doctors in person and then bounce their information off what your medical team here tells you. Maybe the Ablatherm group has US representatives, I wouldn't know.

One factor that I considered when I looked at HIFU is that I was looking for a medical team that was going to be with me for the long term as I believe that a PCa diagnosis is a lifetime thing that will require monitoring and follow-up for the rest of my life. Until the FDA approves HIFU for use in the US, there just isn't an experienced team to stand by you and conduct the follow-up the way a surgeon or radiological team can do in this country. I would think this would be particularly important when dealing with a salvage therapy.

I'm not anti-HIFU and look forward to reading the results of the clinical trials underway in the USA. Like any treatment it has pros and cons. I think the ability to do repeat treatments is a big plus (as long as you don't have to pay full price over and over). But not having a US-based support system was a downside for me that became a bridge too far.

Best