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TULSA, targeted ultrasound, promising treatment

User
Posted 02 Dec 2019 at 16:41

From today's Times. 

'Using targeted ultrasound to attack prostate cancer can eliminate the disease entirely in 65 per cent of cases with minimal side-effects, a study has found.

Researchers said that MRI scans can be used to focus pulses of ultrasound to treat prostate cancer with no need for surgery, finding that it eliminated most signs of cancer in 80 per cent of cases and all signs in 65 per cent.

The technique is known as MRI-guided transurethral ultrasound ablation (Tulsa), sending “precise doses of sound waves to diseased prostate tissue while sparing the healthy nerve tissue surrounding the prostate”.

The research will be presented today at the annual meeting of the Radiological Society of North America (RSNA). Scientists said that using surgery or radiotherapy is not always effective and can result in incontinence, impotence and bowel dysfunction.'

...................................................................................................

'A clinical trial examined 115 men with a median age of 65 who had localised low or intermediate-risk prostate cancer that had not spread. The gland was treated with the Tulsa technology for an average of 51 minutes.

The study found that prostate volume decreased on average from 39 cubic centimetres to 3.8 cubic centimetres.

The researchers said: “Overall, clinically significant cancer was eliminated in 80 per cent of the study participants. Seventy-two out of 111 men, or 65 per cent, had no evidence of any cancer at biopsy after one year.” They added that there were “low rates of severe toxicity and no bowel complications”.

Overall survival rates for prostate cancer indicate that 94 per cent of men diagnosed will still be alive after a year, 85 per cent after five years and 84 per cent after 10 years.'

Edited by member 02 Dec 2019 at 17:07  | Reason: Not specified

User
Posted 02 Dec 2019 at 18:51
Is this HIFU?

Cheers, John.

User
Posted 02 Dec 2019 at 22:45

Hi John, 

It seems like it is reading some of the comments under the article and it says it's been approved in Europe since 2016. 

I was unaware of the test results which appear good.

User
Posted 02 Dec 2019 at 23:36

John,

You must have been on one of your many overseas jaunts when I posted this back in July.  The Heidelberg link compares Tulsa Pro with HIFU :-https://community.prostatecanceruk.org/posts/t21556-TULSA-PRO-V-HIFU

ExAblate is another variation being trialed in the USA.

Edited by member 03 Dec 2019 at 02:39  | Reason: Not specified

Barry
User
Posted 03 Dec 2019 at 10:21
😂
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 03 Dec 2019 at 23:58

Andrew,

TULSA PRO is being trialed at some of the major hospitals in the USA, Canada, Germany and elsewhere and I think it highly unlikely that all these (if any) would subject their patients to a treatment you describe so flippantly in the last sentence of your post. This is the trial https://clinicaltrials.gov/ct2/show/NCT02766543

The link I gave from Heidelberg/DKFZ (the latter being the German Cancer Research Facility) showed the advantages of TULSA PRO over HIFU. Furthermore, should any claims by PROFOUND be overstated, I would expect the hospitals conducting the Trials to say so. Here is part of a report worth noting "The 20.6% rate of residual clinically significant prostate cancer in an intermediate-risk patient population is similar or better than that reported in prospective studies of modern external beam radiation therapy and other ablation technologies3,4. In addition, the TACT patients remain amenable to re-treatment with TULSA-PRO® or standard of care therapies."

The above is from the TACT trial as here:- https://www.globenewswire.com/news-release/2019/04/04/1797449/0/en/Profound-Medical-Announces-Positive-Topline-Results-from-TACT-Pivotal-Clinical-Trial-of-TULSA-PRO-in-Patients-with-Prostate-Cancer.html

Of course it is too early for the procedure to be Peer reviewed but that is no reason to dismiss it. Some men are prepared to participate in advanced forms of treatment and this is looking very promising.

 

Edited by member 04 Dec 2019 at 00:05  | Reason: Not specified

Barry
User
Posted 04 Dec 2019 at 11:34

Interesting Barry. I'll take a look at those.

It looks like the main selling point is fewer side effects.  If you have a low grade lesion you may elect for this to extend the time to more radical treatment.

Meanwhile further advances may improve or couple this with other treatment to extend the range of patients.

The article in the paper has had this added:

 

 'A Nice spokesman said that it had been notified of the procedure and would examine its safety and efficacy.

Simon Grieveson, of Prostate Cancer UK, said: “Whilst novel treatments like this could potentially cause fewer side-effects, we cannot tell from these results alone whether this could be as effective as the treatment options that are currently available and, if so, which men could benefit.'

 

User
Posted 04 Dec 2019 at 22:33

I would say for the 65% who have their cancer under control and no impact upon their quality of life it’s a good outcome.

For the other 35% disappointment that they have to have a second treatment for sure but as long as nothing is off the table are they really worse off?

it all depends on the individual and with the tried and tested approaches having such major impact on QOL we surely should be grateful to the pioneers prepared to volunteer for clinical trials. I can’t see any value in mockery in this context. 

 

Edited by member 04 Dec 2019 at 22:34  | Reason: Double word

User
Posted 04 Dec 2019 at 23:19

Andrew,,

It is not unusual for preliminary reports to be issued at a stage well in advance of final results and analysis as is the case here. I remember this happened in the CHHiP trial for example which I followed having been offered to participate in it. It is far too early at this stage to make any judgement, so to say "This sounds like HIFU in a sixth form audio lab - Heavy metal music with the dial turned to 11 and pointed vaguely at your prostate" is as I said flippant.

The quote "65 per cent had no evidence of any cancer at biopsy after one year" - that means that 35%+ DID have cancer after one year. 35% of men with ≤T2b PCa. After one year? Do you really think that's good?" unquote: You should understand that HIFU Therapy previously has not set out to eradicate every contained tumour in the Prostate, only what are considered significant ones. (If complete eradication of all tumours within the Prostate is the objective, then your best chance is to have a Prostatectomy as even with RT some cancer cells can survive if radio resistant or outside the target area.) TULSA PRO is now being trialed as full gland ablation. The hospitals involved in the trial have vast experience in administering and evaluating cancer treatment, far more than anybody on this forum trying to interpret results from a few preliminary figures. Let's see what the professionals say after the trial ends in 2023. Every innovation that can be found to improve treatment or reduce it's side effects is to be welcomed but it is too early to say whether this will be a better alternative to HIFU or may be more suitable in some other cases.

NB Exablate is another Focal treatment being evaluated :- https://clinicaltrials.gov/ct2/show/NCT02968784

Edited by member 05 Dec 2019 at 12:14  | Reason: Not specified

Barry
User
Posted 06 Dec 2019 at 02:38

Reference has been made to TULSA PRO on another forum where I am a member. I am not sure how much can be gleaned from this forum as a non member in the link I will give later on but this is a very interesting talk by a Professor involved on the subject who has a very impressive CV. https://www.youtube.com/watch?v=WXyl2iI34yM&feature=youtu.be

More information on the forum post with several links is here :- https://www.inspire.com/groups/us-too-prostate-cancer/discussion/mri-guided-ultrasound-treatment-destroys-prostate-cancer-ucla-raman-rsna/

 

Edited by member 06 Dec 2019 at 02:39  | Reason: Not specified

Barry
 
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