Ultrasound destroys 80 percent of prostate cancers in one-year study

Merry Christmas!

Went to China so my spouse could have a procedure done in 2014. HiFu took 1-2 hours and my wife walked away from the procedure. She was hiking the next day.

Tumor was shrinking almost immediately.

The alternatives we had were surgery that would have removed part of her abs or weekly treatments of https://en.wikipedia.org/wiki/Tamoxifen

Neither of which was great.

Now we had to pay for the HiFu but it was soooo worth it. I think it was about $25,000 USD so very reasonable and affordable for us.

HIFU is "competing" with transurethral focused ultrasound (TUS). HIFU works, but has its limitations. Given that it's transrectal, it will not be able to deposit ultrasound energy only into the prostate; the rectum gets hit too. Furthermore, there's no temperature feedback during the procedure; the doctor will send ultrasound energy to the target area and use ultrasound imaging to gauge the efficacy.

It's a decent alternative, but it will never be as good as TUS at targeting just due to their inherent differences. But HIFU is available today, while TUS is not, and HIFU might be "good enough" for most people that it is more commercially successful.

The good news is that treatment has shrunk the tumors dramatically and he's mostly back to normal. The bad news is that he still has stage IV prostate cancer. It'd have been great to have had it caught earlier.

Things like liver cancer you're probably better off just doing a surgery for, as you'll have more chance of getting it all, spotting metastasized offshoots, etc., and it's fairly accessible.

Thus, at least at our site, it was used to develop treatments for uterine fibroids, some types of breast cancer, and some types of brain cancer (using transcranial ultrasound, which is much harder to do because you have to go through bone and adjust for that medium). Generally, areas that you can reach from the skin and/or with a special probe, are potential treatment targets.

Lung cancers are hard to treat with ultrasound, for a few reasons. The biggest is that it moves, which makes it hell for the MRI and system as a whole to keep up without hitting unwanted areas. The other is that ultrasound doesn't travel well through air. For ultrasound ablation to work, you need a good conduction interface. That's why ultrasound technicians slather that clear gel on you when they're imaging you. It's possible to do in the lungs, just exceedingly difficult. It's unlikely that someone will commercialize something there.

The liver and kidneys won't be targeted either because the only way to reach them is by performing an incision. You might as well use other techniques like laparoscopy.

https://www.uclahealth.org/fibroids/mr-guided-focused-ultras...

When I left my Masters in 2012, the clinical trials being done still resulted in a prostatetectomy. Meaning, these generous men donated their time to allow us to use them as guinea pigs, yet received no benefit since their prostates were removed anyway. That did allow us to perform in-depth pathology reports about the efficacy of the treatment.

This paper has 115 men that were treated and allowed to not have the surgery done, so this is the first time that we were able to see what the outcomes of the treatment truly are. Based on the results in the abstract, it looks like the hypothesis that men would be "cured" and have a better quality of life (i.e. no incontinence or sexual dysfunction) seems to be well-supported.

More of these trials will need to occur before it becomes approved as a viable alternative to surgery. The big benefit though is that even if the the treatment fails to kill all of the cancer, it probably kills enough of it that you can go back to a watchful waiting approach, keep monitoring PSA levels and symptoms, and if anything was missed, follow up with full surgery. That is, surgery can become the last-ditch approach vs. being the only approach.

Any focused ultrasound tech has potential to gain wide acceptance but it is mostly the imaging component (MRI guided in most cases) that hold it back due to costs and availability.

It's less about the pain of the heat, and more about the discomfort of having probes in your genitals, and the requirement that you stay perfectly still.

There is a lot of money to be made by big healthcare in any procedure in the US, including one as described by the article. Hospitals, admin, doctors, nurses, techs, medtech, they'll all be thrilled to ring the cash register instead of big pharma.

I'm wondering if it's just that the tool scrapes it out or something. As painful as it is to think about.

That said, many cases are life threatening.

I haven't read this paper, and it's been years since my Masters when I last kept up with this, but the patients at this stage are usually getting their prostates removed. The aggressiveness of the cancer is enough to threaten their life and well-being, so they elect for this procedure. It's usually followed up with radiation and chemotherapy to kill any residual tumour cells left behind, usually at the periphery, or if metastasis has occurred.

So great, prostate and cancer's gone, everyone's happy right? Well, no. The surgery damages a lot of the surrounding tissues, so these men are left with sexual dysfunction (which sucks but you can somewhat handle since you are living) and incontinence. The urinary and bowel issues affect your quality of life immensely. If you're in your 60s, you might have another 10-20 years to live with this. But if you're in your 40s, which is a lot of the cases for aggressive cancer types, you're stuck this way for many decades.

Hence why this ultrasound technique is so appealing because you can perform a minimally-invasive procedure that destroys only what you target, and spares the urethra and other tissues. Better outcomes, and better quality of life.

Given that the gold standard is surgery, this new technique has to prove itself against that, by showing that it is actually successfully destroying the cancer. That's why these clinical trials are occurring.

As an addendum, one study in Thailand looked at a sample size of dead men, and found that 1 in 7 had prostate cancer, but died of other causes. What that means is that many men get prostate cancer and may be asymptomatic because it is not aggressive. It can manifest as localized tumours/nodules within the prostate that you wouldn't be able to detect without good palpation and/or sensitive imaging. And because you're asymptomatic, you might not even seek diagnosis, and you'll probably die of other causes.

It also means that many men get diagnosed with cancer and may seek premature treatment. Most good doctors will recommend a watchful waiting approach; regular checkups and PSA level checks to ensure that you're still in the asymptomatic area. There's other treatments that can occur before surgery. But if you end up down this path, your cancer could be very localized within the prostate.

However, surgery is an all-or-nothing approach, there's no saving the prostate. Ultrasound ablation could be a good alternative and allow targeting. We're still far off from proving that though, but it's definitely viable. It's also why ultrasound ablation is being used for things like uterine fibroids, and breast cancer. There's even use cases for brain cancers.

It's a very cool technology, and I'm very optimistic for it. But I left my Masters in 2012, and we're still conducting these clinical trials. This is exactly the pace it should be occurring at, since it needs to be ironclad. But I found it too slow for my liking, so I moved on in my career path.

My father died of cancer just before I turned 13 and he wasn't sick very long, over the course of a year or so he had a port installed, had a roughly horseshoe shaped and size scar on his scalp, had headgear bolted into his skull in multiple locations and the day we had to take him to the ER he had worked all day and by that night was effectively drowning in is own bodily fluids with his lungs mostly full of fluid at which point he went on a respirator, went unconscious and was taken off life support less than a week later.

Cancer sucks man, I'm sorry you got dealt that hand.