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HIFU and latest research

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User
Posted 18 May 2021 at 14:53

I have to say the whole issue around HIFU has me both confused and a little suspicious on two counts, one that the clinics that offer it seem to really sell it BUT two the NHS and UK seem to (not unusually) be  a little behind in their views.

I am 70 and have localised T2a G 7 (3+4) diagnosed 16 months ago. My PSA has jumped, after a year of around 4.1 to 5 in the last 3 months. I am having an MRI with contrast in a few days and then maybe another biopsy.

My issues are about treatment options and the side effects of RT of any kind, as i have other health conditions and neurological muscle weakness and respiratory problems of long standing since polio as a child. The radiotherapy seems to have both muscles fatiguing and weakness as well as issues around bowel problems and obviously, though the urologist said he could omit the hormone pre RT treatment as i would probably not be able to exercise to mitigate the effects of hormones outcomes seem to suggest anti-androgen is link to better long term outcome at least in the under 70s.

It seems HIFU still isn't used as a first line treatment and not popular as they say no longterm studies - but that it seems that view has moved to be positive about HIFU longer term outcomes in Japan, USA and Europe. As the latest literature review i read was published in 2020, it was using mostly studies from 2003-2013 which isn't particularly up to date.

So studies that compare treatment outcomes and side effects between HIFU and RT for low or intermediate localised PCa seem not easy to find.

Does anyone have a view, or research links to anything relevant to help me with my discussions with the consultant around treatment options if i decide to move off AS.

 

 

 

 

 

 

 

User
Posted 19 May 2021 at 17:33
I looked HFU back in February. From what I understand, but correct me if I am wrong, but it is not available on NHS and not possible for advanced PC, but privately with a cost of £13,000. This web site is informative

https://www.thefocaltherapyclinic.co.uk/high-intensity-focused-ultrasound-hifu/?msclkid=733be5eebf4a1ad7f0a1854b824d0d2f&utm_source=bing&utm_medium=cpc&utm_campaign=HIFU%20-%20Search%20-%20General&utm_term=hifu&utm_content=HIFU%20General

One of the arms if the ATLANTA trial is HFU

User
Posted 20 May 2021 at 03:07

The NHS has invested vast sums in training and equipment to treat suitable men with surgery and radiotherapy of various types. These treatments at least cover the vast majority of men with early cancer. The treaments have been given for many years so enabling long term results to be assessed. By comparison long term results of HIFU lacking. Also, it is stated in this link that NHS reimbursement for HIFU does not cover the cost, so not really an incentive to use in hospitals. Then HIFU is just a nische treatment for men with early PCa. Nevertheless, HIFU is slowly becoming more widely available and although more confined in the NHS to salvage treatment for failed RT, may be used as a primary treatment in future if long term results are good. There is also a reference in this link about being referred to those of the listed surgeons for treatment within the NHS. https://prostatematters.co.uk/prostate-cancer/where-to-access-hifu-treatment/

 

 

Edited by member 20 May 2021 at 03:13  | Reason: to highlight link

Barry
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User
Posted 19 May 2021 at 17:33
I looked HFU back in February. From what I understand, but correct me if I am wrong, but it is not available on NHS and not possible for advanced PC, but privately with a cost of £13,000. This web site is informative

https://www.thefocaltherapyclinic.co.uk/high-intensity-focused-ultrasound-hifu/?msclkid=733be5eebf4a1ad7f0a1854b824d0d2f&utm_source=bing&utm_medium=cpc&utm_campaign=HIFU%20-%20Search%20-%20General&utm_term=hifu&utm_content=HIFU%20General

One of the arms if the ATLANTA trial is HFU

User
Posted 20 May 2021 at 03:07

The NHS has invested vast sums in training and equipment to treat suitable men with surgery and radiotherapy of various types. These treatments at least cover the vast majority of men with early cancer. The treaments have been given for many years so enabling long term results to be assessed. By comparison long term results of HIFU lacking. Also, it is stated in this link that NHS reimbursement for HIFU does not cover the cost, so not really an incentive to use in hospitals. Then HIFU is just a nische treatment for men with early PCa. Nevertheless, HIFU is slowly becoming more widely available and although more confined in the NHS to salvage treatment for failed RT, may be used as a primary treatment in future if long term results are good. There is also a reference in this link about being referred to those of the listed surgeons for treatment within the NHS. https://prostatematters.co.uk/prostate-cancer/where-to-access-hifu-treatment/

 

 

Edited by member 20 May 2021 at 03:13  | Reason: to highlight link

Barry
User
Posted 20 May 2021 at 09:34

Thanks for that Barry. I have followed your posts in the past.

to be honest I am lucky enough to currently have private insurance (probably not be affordable by 2023 given my claims and age) so I am not confined to just NHS - it’s just my current private consultant dismissed HIFU for first line treatment. He was suggesting when I need treatment I have hormone and short term RT. When I ponied out my comorbidities would not make hormones a good option as my not recover from muscle and fatigue. He then said well to just use RT. Research shows that RT alone for under 70s is significantly less effective. 

so I am  unsure of the then relative risk of recurrence or side effects when making  a comparison. It’s all an individual choice and luck I know but I just like to have full up to date information- probably my obsessional psychologist background!!

User
Posted 20 May 2021 at 16:33
With a T1 / T2a G7, radiotherapy without HT may be slightly less effective but is still likely to be more effective than HIFU, unless the urologist has evidence that your cancer is concentrated in one limited area. RT will zap all cancer cells in your prostate, whether they can be seen on a scan or not. HIFU will only target the one or two most significant clusters.

The benefit of HIFU is that if / when it fails, you can at least have it done again. The test is your emotional resilience - if you went for HIFU and it failed down the line, would you be distressed and devastated ... or do you think that you could be matter of fact and robust?

I am curious - is your private consultant a urologist or an oncologist? Generally speaking, uros will be dismissive of oncology treatments, particularly those they don't know much about.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 May 2021 at 00:33

My consultant is a urologist but from the start said that thought that surgery was not appropriate for me given my co-morbidities and the recommendation that I avoid a GA if possible. He thought that if I needed treatment the best option was probably RT. I think he is quite well aware of the various RT options and their benefits over surgery in my case if at some point I need to move from AS to treatment. 

User
Posted 26 May 2021 at 10:37
Hi Nomis. Just seen your post and notice the coincidence that we are both in our 70’s had Pc.diagnosed Jan 2020 and G7.

I did go for a Primary HIFU at the UCLH ON THE NHS and have no regrets. Look me up if of interest.

 
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