Man's HIFU
experience hasn't put him off the treatment
Firefighter and paramedic Eric
Sondeen is one of those patients who chose HIFU.
The Boulder, Colorado resident got the call a
year ago, on Christmas Eve. His PSA levels were
through the roof he had prostate cancer.
His urologist suggested HIFU, so Mr Sondeen did
what most patients do these days: he went online.
"I did a lot of research and
it looked like the best option," he recalls.
Since the treatment is not yet
approved in the US, though clinical trials are
underway, Mr Sondeen joined the ranks of medical
tourists and headed to the Dominican Republic
with his urologist. All was well in the
beginning, the cancer was flushed out and everything
was in working order.
But at month four, trouble struck.
Mr Sondeen developed urethral strictures
scar tissue was clogging up his urethra, making
urinating difficult and downright painful. It's
got to the point that he now has to self-catheterize
on a regular basis to empty his bladder.
He now says he wishes he'd weighed
his options a little more carefully and
not believed the hype. "The incidence of urethral
strictures is actually closer to 20% according
to one study," he says, "rather than the 2% presented
to me and my doctor."
Mr Sondeen is now looking into
repair treatments. But, despite his difficulties,
he remains optimistic about the future of HIFU.
"I think I was among the percentage of people
to take a bullet for this so we could all learn
about it," he says. "I wouldn't want to throw
the technology out with the bathwater."
For more HIFU patient stories,
see our blog exclusive at www.nationalreviewof
medicine.com/blog.
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"Is there anyone out there who
has tried HIFU?" wonders a prostate cancer patient on
cancercompass.com's message board. "I hear it's being
done in Canada," replies a fellow sufferer.
He heard right.
Though not yet approved in the
US, high-intensity focused ultrasound (HIFU), with its
vaunted minimally-invasive technique and low risks of
impotence and urinary incontinence, is gaining ground
in Canada despite its prohibitive $20,000 price
tag.
"Men are being diagnosed earlier
and earlier with prostate cancer," says urological surgeon
William Oravan, medical director of Toronto's Maple
Leaf HIFU Company. And while older patients with slow-growing
cancers may be placed on watchful waiting protocols,
the younger ones those in their fifties with
organ-confined tumours will most certainly require
some form of treatment. "There are a significant number
who won't want radiation therapy or surgery, which are
major, invasive techniques, so for them HIFU is a very
attractive alternative," he adds.
FOCUS
ON HIFU
The treatment is a one-time, outpatient procedure that
takes two to three hours and if all goes well, leaves
men free to resume their normal lives the same day
minus the cancer. It involves focusing a pulse of high-energy
ultrasonic waves onto a single area of the prostate
and cranking the temperatures to near-boiling (90°
Celsius) until the cells die.
"It's like when kids use a magnifying
glass to focus sunlight on a leaf and burn it," explains
Dr Ian Brown, medical president of the Niagara HIFU
clinic, in Niagara Falls, ON. "Only instead of sunlight,
you're focusing energy on a target."
HIFU requires only some mild sedation
and spinal anesthesia and the doctor then inserts the
device through the rectum. The transducer comes equipped
with ultrasound imaging so the physician can see the
entire prostate on a monitor and avoid damaging surrounding
structures like the nerves responsible for erectile
function.
Post-op, the downside for the patient
is that he has to wear a catheter for two to three weeks
until he can urinate on his own. And there's the slew
of potential side effects normally associated with any
prostate cancer treatments, ranging from retrograde
ejaculation to urethral fistula though reports
say the risks of any of those adverse events are minimized
with HIFU. But not eliminated, as some patients have
discovered (see "Man's HIFU experience
hasn't put him off the treatment,").
"It's a new technology and longterm
evidence is still evolving," concedes Dr Brown. His
clinic has been in operation since June of last year,
and so far only one patient has developed strictures,
he says. "He was treated with dilation a widening
of the urethra and so far, so good," he adds.
Keep in mind, it's not for all
prostate cancer patients, Dr Brown points out. "The
ideal candidate is someone with a lower risk cancer,
or someone with intermediate risk, but older. For young
intermediate risk patients, it's not the first choice."
GLAND
SIZE and Tx COST
There are two types of machine used in Canada, the Ablatherm,
the first to be developed, and the Sonablate 500.
"With Ablatherm, there are four
safety measures prior to any discharge of energy," says
Dr Oravan, who uses the machine in his clinic.
Dr Brown favours the newer Sonablate
500. "Both are similar in terms of safety, but we looked
at limitation in terms of prostate size, when we chose
to go for the Sonablate," he says. The Ablatherm can
only treat patients whose prostate size is 20 to 30
grams, whereas Sonablate can take a prostate size that's
40 to 50 grams.
If size were no obstacle, cost
probably will be. The procedure runs in the $20,000
range and it isn't covered by any province in
Canada. "Health Canada approved it back in 2004 based
on European data, but to this date no province has chosen
to pay for it through its insurance system," says Dr
Orovan.
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