Comment by mooreed | Hacker News Reader

Comment by mooreed | Hacker News Reader

As someone whose family member recently just received a test showing elevated PSA levels (Prostate Cancer indicator); this article is a very real blessing.

# Baseline issues with prostate cancer that suck.

1. Don't treat a benign version and possibly live with trouble urinating and follow on problems from that.

2. Don't treat a malignant version and die

3. Treat it and potentially be impotent

4. Treat it and end up with bowel dysfunction

5. Treat it and rehab through surgical scars looking like an upside down T from following from belly-button to waistline or a U shape around the rectum.

6. Of course there is some tail risk of much much worse situations; and while it's worth remembering, it's not worth enumerating.

# TULSA method

So while this method is not different - it includes things that suck... if you read further upstream of the newatlas article to RSNA primary source [1] you will find that not only do they insert a spinning ultrasound device up the urethra - but it also includes a simultaneous insertion of an endorectal cooling device(ECD)[2]. Given all that: the parts that suck about this method pale in comparison to the traditional list of 6 above.

# Conclusion

There is much to be squeamish about with this method, as with any prostate remediation methodology; but if applied under careful care of patient and doctor - this looks like a very promising prostate treatment. And as a family friend once put it to me: "Welcome to the world of cancers; where pretty much everything sucks."

[1]: https://press.rsna.org/timssnet/media/pressreleases/14_pr_ta...

[2]: https://press.rsna.org/pressrelease/2019_resources/2129/fig_...

(edited for formatting)

By the way, your family member is probably aware of this but there is another ultrasound treatment option for prostate cancer that is completely non-invasive. It is called hifu.

https://www.hifu-prostate.com/

Hifu sends ultrasound from a curved emitter from outside the body in such a manner that the ultrasound ray will be focused on the treatment area. Thus, while you have ultrasound going through your body, only in the treatment area does it become high intensity enough to actually destroy tissue. This way they can burn off cancerous parts without damaging other parts of the prostate and the rest of the sensitive parts around there.

I am not sure why the new atlas did not mention HIFU, it also uses MRI.

HIFU is already cleared by the FDA, and it will become approved by medicare very soon (this coming January, I believe), so it will be paid by medicare and probably most insurance plans (as they tend to follow medicare).

@hristov I am incredibly moved by your wonderfully thoughtful reply; we are just getting up to speed so had not heard about this at all. From the bottom of my heart, thanks for sending this.

Merry Christmas!

Can confirm and sing the praises of HiFu.

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.

For which cancers does this procedure work (assuming your wife didn't have prostate cancer)?

I understand 25 k USD feels reasonable if it saves your life without surgery and it's complications, but it steep for "just ultrasound". Do you know why it was that expensive?

MRI is probably the major technical cost. It's fairly high touch and the magnets wear out, so the capital cost of each test is fairly real. That and the professional component. Interventional radiologists are very much in the consultant/handyman/engineer business of "Treatment: $1; knowing where to put it: $9999"

In Japan an you can get an MRI for $160 US I hear

Do you get the radiologist's read for $160? Do they put an ablative ultrasound probe in you and hold it for an hour for $160?

Honestly I’m not sure with the 160 covers. It’s just another one of those things in our medical system that is priced a bit too high to make sense for a good number of folks. I would like to see healthcare be more accessible.

What's the purpose of an ablative ultrasound probe in an MRI? An MRI uses high intensity magnetic fields, not ultrasound.

Medical treatment in Japan is mostly paid for by the government with the individual co-pay being 30-0% depending on the procedure.

The cost to the patient =! the actual cost of the procedure.

I would pay £0 for spending the night in the hospital even tho the cost of the trauma bed alone is £3200 per night according to NHS England.

It’s not paid by the government, it’s paid by the health insurance system that everyone must enroll in and had to pay for every trimester. Granted, it’s not too expensive.

> (assuming your wife didn’t have prostate cancer)

I almost spewed my coffee. At McDonald’s. Thanks for making me get weird looks from other people. XD

I assume the sound waves overlap and increase in amplitude, destroying the tumor cells.

But I'm wondering why a shrinking tumor is enough - usually we cut the whole thing out so that it doesn't metastasise or regrow from small leftover parts. If the beam kills most of it, is that enough? Does it trigger a mass die-off or stimulate our immune system to do the rest of the job? Just wondering what the explanation here is.

Definitely agree that you should look into HIFU.

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.

You can get temperature readings from a higher-frequency transducer. My old lab worked with HIFU and the transducer I used was a combination 1MHz and 20MHz conical transducer, where the inner high-frequency one was used for non-invasive temperature measurement. You get comparable results to implantable thermocouples.

The damage to the rectum isn't much as it's outside the focal point of the ultrasound. The main ablation happens at the point where the ultrasound is focused.

If elevated PSA is the only real sign of cancer, then, depending on his age, it's entirely possible your family member could die _with_ prostate cancer rather than _of_ prostate cancer. According to https://www.webmd.com/prostate-cancer/prostate-cancer-surviv..., 2/3 of "very elderly" men who died of things other than prostate cancer had undiagnosed prostate cancer on autopsy. And, if the cancer is localized, the 5 year survival rate is nearly 100% (same link).

My dad got a regular PSA test from his old doctor. But that doctor retired, he got a new doctor, moved, got a new doctor again, and the guidance changed, recommending against annual PSA tests. Then my dad developed some back pain. Took it easy, went to the doc, did physical therapy, etc., but it just got worse. Turns out, he had (has) stage IV prostate cancer, with several tumors along his spine and was on the precipice of MSSC before he received a correct diagnosis at age 66. His PSA was north of 80.

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.

I skimmed all the comments, and am surprised that nobody mentioned the recent advances in radiation treatments. The cancer is modeled with MRI images, dots are tattooed on the patient's body and used to line up the patient with projected laser dots to ensure that body is in exactly the right position, and three trackers are placed into the prostate (Calypso) which allow real time tracking of prostate position. Radiation beams are targeted directly at the cancer, causing minimum damage to the surrounding tissue. The treatment takes about 15 minutes once a day for 30 days. The doctors say it has few side effects and is vastly preferable to surgery. The nurse said this procedure has been available for about 5 years.

My step dad designed the hardware that does the tracking. Had to do some pretty cool stuff to treat the microprocessors because of all the radiation ...

My very naive understanding of ultrasound techniques is that they can work very well, but in cases where they don't work they end up creating a mess of things (scar tissue, etc) that make subsequent removal pretty much impossible as the surgeon can no longer see clear boundaries. That info is several years out of date and second-hand, so perhaps by guiding the process a little better as TFA suggests they can avoid making any subsequent surgery impossible.

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