tag:blogger.com,1999:blog-5068743626565397624.post8532039037440628495..comments2024-03-19T13:15:57.087-07:00Comments on Prostate Cancer News, Reviews & Views: Whole gland TULSA-PRO and HIFU outcomes: Is it time to give up on thermal ablation for prostate cancer? Allenhttp://www.blogger.com/profile/02930631057044153073noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-5068743626565397624.post-71409118401940066602023-12-13T04:47:37.201-08:002023-12-13T04:47:37.201-08:00PSMA can help tell you where you're at. Deciph...PSMA can help tell you where you're at. Decipher and germline testing can help tell you where you may be headed. Adding all three (In addition to other fundamentals / imaging) may lead to a better informed decision regarding treatment. For those in the radiation camp, prostox might be worth investigating before deciding on a coarse of radiation. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-50636273716860210982023-10-05T23:05:06.827-07:002023-10-05T23:05:06.827-07:00A distinction without a difference. They BOTH abla...A distinction without a difference. They BOTH ablate tissue using high-frequency ultrasound (HIFU) inside the gland.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-38420325795023439622023-10-05T22:02:35.849-07:002023-10-05T22:02:35.849-07:00Tulsa pro is transurethral while HUFU is trandrect...Tulsa pro is transurethral while HUFU is trandrectal. TULSA works inside the gland. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-90609287375340215302023-10-02T16:03:13.979-07:002023-10-02T16:03:13.979-07:00TULSA is too new/early/unproven for my comfort zon...TULSA is too new/early/unproven for my comfort zone. <br />As you are more than well read on PCa, I am terrified of ADT. Thinking/hoping with my 30cc volume, twin brother had CK w/o ADT 7 years ago and is truly "fine", and I have a 3+4 with PSA of 15, I could forego ADT with CK. Any thoughts/data? Thank you!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-50536471077211637232023-10-02T15:50:41.741-07:002023-10-02T15:50:41.741-07:00Thanks! Pretty awful (Table 2)!Thanks! Pretty awful (Table 2)!Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-40992698721559492302023-10-01T13:06:01.460-07:002023-10-01T13:06:01.460-07:00Perhaps I wasn't clear. We are ONLY discussing...Perhaps I wasn't clear. We are ONLY discussing TULSA-PRO here. The whole-gland TULSA-PRO failure rate was 35%, as described in the review above. Of those getting whole-gland TULSA-PRO, only 16% (about half of all failures) had so far received salvage therapy. The other half have not yet had salvage therapy for whatever reason.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-60941721286944512132023-10-01T12:13:34.013-07:002023-10-01T12:13:34.013-07:00So with HIFU failure rate of 35%, and TULSA's ...So with HIFU failure rate of 35%, and TULSA's 16%, perhaps the failure rates are figured differently? Or, going thru the Urethra is better at effectively delivering Ultrasound. Or, __________ ? And, please tell your LA Rams to lighten up on my Colts today. Thanks, ScottAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-44236146521815900882023-10-01T10:19:47.400-07:002023-10-01T10:19:47.400-07:00TULSA-PRO is just HIFU delivered with MRI feedback...TULSA-PRO is just HIFU delivered with MRI feedback. Ehdaie used a similar device. They hoped that by using MRI to monitor tissue temperature while undergoing HIFU, they could provide higher temperatures where needed to kill any cancerous tissue.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-23927423103631355252023-10-01T09:50:32.977-07:002023-10-01T09:50:32.977-07:00I thought HIFU and TULSA were totally different? A...I thought HIFU and TULSA were totally different? And thank you for your comments!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-83373888635860498082023-10-01T09:37:04.606-07:002023-10-01T09:37:04.606-07:0035% had residual cancer after WHOLE GLAND HIFU! Ju...35% had residual cancer after WHOLE GLAND HIFU! Just because only half of them (16%) had received salvage radiation after 3 more years, doesn't make them in any way "fine." PCa is slow to progress, but most of the remainder probably will need salvage treatment eventually, and how do you think that will go for them when they only have 2.8 cc left of their prostate? The urethral damage will be very risky.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-88980735198098310372023-09-30T22:42:30.962-07:002023-09-30T22:42:30.962-07:00You mentioned HIFU ablation in your last post. Sor...You mentioned HIFU ablation in your last post. Sorry, I was speaking of the 4-year TULSA TACT trail update that you provided from AUA showing 84% were fine: "By 4 years 18 men (16%) received salvage treatment (8 radical prostatectomy, 8 radiation therapy, 1 androgen deprivation therapy, 1 surgery plus radiation) without unexpected complications." In conclusion: "Effective disease control is durable to 4 years, with continued recovery of quality of life and a favorable safety profile after whole-gland ablation with TULSA." Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-91380090758827697972023-09-30T15:58:55.740-07:002023-09-30T15:58:55.740-07:00It depends what you mean by "fine." With...It depends what you mean by "fine." With 35% residual cancer in whole gland HIFU ablation, you are certain to have a very high risk of residual cancer with focal HIFU ablation. In fact, when Behfar Ehdaie tried a similar MRI-targeted technique:<br />• 20% still had cancer in the ablation zone, 12% Grade Group 2 or higher<br />• 60% still had cancer in the prostate, 40% Grade Group 2 or higher<br />• PSA reduced from 5.7 to about 3.1<br />• Among men with good erectile function at baseline, erectile function dropped by 40%, but only by 10% with ED meds.<br />• Urinary function was maintained.<br />• Transient hematuria (24%) and urinary retention (15%) were common immediately following treatment<br />https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00251-0/fulltext<br /><br />So it doesn't "kick the can down the road." It doesn't do much of anything. You are quite wrong to suppose that salvage treatment is as good as original primary radiation - the expected side effects are much worse, and the odds of getting a cure are not as good. With cribriform and a very high Decipher score, it would likely fail and leave you with worse side effects than if you had done it right in the first place.<br />Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-66811018000697324912023-09-30T14:20:09.299-07:002023-09-30T14:20:09.299-07:00Thank you very much for the post and link. I am re...Thank you very much for the post and link. I am reading that after 4-years 16% that had salvage procedures after TULSA. Or, 84% are doing fine. Versus "35% had residual cancer at biopsy" after 1 -year. If 84% are doing fine, why shouldn't I consider TULSA to hopefully kick the can down the road for another 4+ years? <br /><br />About me. I am 68 and have been on AS since 2016. I have had 3 MRI's on my (1) 3+4 lesion the is 1.6cm. Per Johns Hopkins review last week of my slides from July '23, "the 3+4 has 20% Gleason pattern 4. The pattern 4 in this case lacks cribriform morphology." But, the 2 bad numbers are that my PSA has gone from 5 to 15 in the past 3 years. And my decipher grade from July is .84. I understand PSA has a 78% false negative and is not a gold standard of detection. <br /><br />Had a CK meeting with Dr John Kresl in Phoenix. He's well credentialed. Wants me to do CK+ADT. Not excited about ADT, which I am likely to decline. Then I started reading about TULSA. Would rather not nuke the prostate. Bone scan negative, have a PASMA PET scan appointment.<br /><br />Welcome your thoughts.<br />Thanks!<br />ScottAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-75171159190077972442023-09-29T19:14:17.159-07:002023-09-29T19:14:17.159-07:00I wrote the article. It reviews the TACT trial. Up...I wrote the article. It reviews the TACT trial. Updated results cannot have been better as of 4 years post-treatment , because they only biopsied men at 1 year (which is reviewed above). 35% had residual cancer at biopsy - IDK how you interpret it to mean "20% non-cure rates." Here's the 4-year update: https://www.auajournals.org/doi/abs/10.1097/JU.0000000000003341.05<br />Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-18942921923528745862023-04-05T15:18:54.789-07:002023-04-05T15:18:54.789-07:00100% It fails to do job #1 - get rid of the cancer...100% It fails to do job #1 - get rid of the cancer. I've asked for randomized trials. The response I get is "patients don't want to be randomized." I think that's because patients are not informed about the high failure rates.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-10689950818853235272023-04-05T14:35:11.535-07:002023-04-05T14:35:11.535-07:00HIFU (High Intensity Focused Ultrasound using high...HIFU (High Intensity Focused Ultrasound using high frequency soundwaves to ablate tumors) has a range of success from 61% to 95% or 24%, 37% and 43% depending who you read. <br /><br />A study was published online in 2022: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877347/#:~:text=In%20our%20study%2C%20HIFU%2DFT,provided%20significantly%20better%20functional%20outcomes.<br /><br />The authors conclusions:<br />"In our study, HIFU-FT was associated with a higher rate of treatment failure than laparoscopic radical prostatectomy. However, it provided significantly better functional outcomes. Based on the presented results, we believe that HIFU-FT remains a viable treatment option in selected patients motivated to preserve their erectile function and urinary continence yet accepting a slightly increased risk of compromised oncologic results."<br />"...it provided significantly better functional outcomes..." suggests good Quality of Life. Like the authors of this study, I would like to see "data from randomized controlled trials comparing its oncological efficacy with radical treatment." And if I could be pointed to a study comparing oncological results of both HIFU and radiation in two groups of men. That would be helpful.jerrychttps://www.blogger.com/profile/08387327695691871131noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-486852609652734152023-02-17T21:05:57.169-08:002023-02-17T21:05:57.169-08:00Behfar Ehdaie tried to "crank up" the he...Behfar Ehdaie tried to "crank up" the heat. He used MRI to see and treat with unprecedented detail.The results were dismal: 20% still had cancer in the ablation zone, 12% Grade Group 2 or higher; 60% still had cancer in the prostate, 40% Grade Group 2 or higher. And among men with good erectile function at baseline, erectile function dropped by 40% https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00251-0/fulltext<br />Whether calcifications or some other reason cause the high failure rates, it is incumbent upon researchers to further investigate the physical and biochemical reasons before continuing. This, they have so far failed to do.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-873497675940013462023-02-17T19:24:23.063-08:002023-02-17T19:24:23.063-08:00Now that we have PSMA PET scans to better identify...Now that we have PSMA PET scans to better identify those who have disease spread (prior to treatment) and we know that calcifications can cause issues with HIFU or TULSA, it might be interesting to see new data where those being treated by HIFU or TULSA might be a better fit for those treatments. Additionally, newer TULSA treatment test results show that cranking up the temp by about 2 degrees c really improve outcomes in intermediate patientsAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-13572744819356977832023-01-24T09:55:34.593-08:002023-01-24T09:55:34.593-08:00None of that is incontinence. It is almost entirel...None of that is incontinence. It is almost entirely Grade 2 (annoying) irritative symptoms (i.e., frequency, urgency, retention) that are temporary and are easily treated with short-term use an alpha blocker (like Flomax). It is a price most of us would gladly pay for curative therapy.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-35136560293681018652023-01-24T07:14:46.241-08:002023-01-24T07:14:46.241-08:00The writer is biased toward radiation. 18% urinary...The writer is biased toward radiation. 18% urinary toxicity for SBRt isn’t trivial compared to 0%. Who wants to wear a diaper forever?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-67099224395032611542022-09-24T09:47:13.703-07:002022-09-24T09:47:13.703-07:00Most were high volume GS3+3 or GS3+4, but still I ...Most were high volume GS3+3 or GS3+4, but still I agree with you that most could have been on AS. I don't think that whole gland FLA is used, but focal results are similarly poor: https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000000860.01Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-76852853672798657072022-09-24T08:42:45.714-07:002022-09-24T08:42:45.714-07:00One wonders how many of the GL3+3 men could have b...One wonders how many of the GL3+3 men could have been managed with active surveillance instead. The TULSA Pro experience correlates with my experience using MRgFUS to treat uterine fibroids. I found amazing short term symptom relief in my patients who had the fibroid tumor heated to 65C. Unfortunately, the tumors only shrank about 30% in size by 6 months and many began to regrow. <br />Is there a similar analysis available for FLA and Cryo, which I expect might indicate similar findings. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-12488470592240538912021-03-19T10:59:18.917-07:002021-03-19T10:59:18.917-07:00Thanks, Allen. This is a sobering read. All of us ...Thanks, Allen. This is a sobering read. All of us on AS appreciate your bringing these studies to a wide audience.Davidhttps://www.blogger.com/profile/16948843945123850176noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-39804154525578113782021-03-18T22:32:51.590-07:002021-03-18T22:32:51.590-07:00I posted a link there yesterday.I posted a link there yesterday.Allenhttps://www.blogger.com/profile/02930631057044153073noreply@blogger.comtag:blogger.com,1999:blog-5068743626565397624.post-22413179359147468222021-03-18T21:16:16.245-07:002021-03-18T21:16:16.245-07:00Allen -
will you be posting this on Healthunlock...Allen - <br /><br />will you be posting this on Healthunlocked?dmaleyhttps://www.blogger.com/profile/17510153535190318625noreply@blogger.com