Re: HIFU has a 92% sucgess rate so

[Guest guest]

Harold,

I suspect the 92% average 10 year success rate for HIFU only applies to

early detection PCa patients. Most USA approved treatments (performed

at the better treatment centers) have average 10 year early detection

PCa disease free rates that range from 94% to 97%. But the challenge

for early detection patients - if they even choose to be treated - is

to avoid treatments with higher average serious (urinary, rectal and

sexual) side effect rates that range from 20% to 80%. Of course, if an

early detection PCa patient successfully avoids PCa treatment their

"treatment" success rate will be 100% and their serious side effect

rate will be 0%.

Carl

Harold wrote:

Why is HIFU not

FDA approved for U.S. treatments - I could

go to Canada's Cleveland Clinic

-- Pay $25,000 + for a 3 hour procedure as

an outpatient & if all

went well be back home in a couple of days with no cancer - sounds to

me like the answer.

[Guest guest]

Harold wrote:

> Why is HIFU not FDA approved for U.S. treatments - I could go

> to Canada's Cleveland Clinic -- Pay $25,000 + for a 3 hour

> procedure as an outpatient & if all went well be back home in a

> couple of days with no cancer - sounds to me like the answer.  

Harold,

The numbers I've seen for HIFU results are significantly worse

than for surgery or radiation, and nowhere near 92%.  Here are

two recent studies:

http://www.ncbi.nlm.nih.gov/pubmed/22487909

    Quoted from that abstract:

    " Disease-free progression rates at 5 and 7 years were 64% and

    54%, respectively. "

http://www.ncbi.nlm.nih.gov/pubmed/18829078

    And from that one:

    " The actuarial disease-free survival rate at 5 years was 66%,

    with salvage treatment initiated for 12% of the patients. "

In order to fully understand these numbers we have to know what

kinds of patients were treated.  These are good numbers for high

risk patients and pretty bad numbers for low risk patients.  The

two abstract describe the patient populations to help with this.

My understanding is that, overall, radiation and surgery both

have better long term outcomes than HIFU.

Incidentally, does the fact that the Canadian Cleveland Clinic

charges $25,000 mean that Canada's health insurance won't cover

HIFU?

Also, I know the urologist has to split the $25K with a bunch

of people, but it still looks like I made a big mistake going

into computer programming.  I could have done a lot better

cooking prostates

    Alan

[Guest guest]

I was just curious about HIFU - basically asking a question. I'm sorry if you took it personally.

Harold

To: "ProstateCancerSupport " <ProstateCancerSupport > Sent: Saturday, June 2, 2012 11:14 PMSubject: Re: HIFU has a 92% sucgess rate so

Harold wrote:> Why is HIFU not FDA approved for U.S. treatments - I could go> to Canada's Cleveland Clinic -- Pay $25,000 + for a 3 hour> procedure as an outpatient & if all went well be back home in a> couple of days with no cancer - sounds to me like the answer. Harold,The numbers I've seen for HIFU results are significantly worsethan for surgery or radiation, and nowhere near 92%. Here aretwo recent studies:http://www.ncbi.nlm.nih.gov/pubmed/22487909 Quoted from that abstract: "Disease-free progression rates at 5

and 7 years were 64% and 54%, respectively."http://www.ncbi.nlm.nih.gov/pubmed/18829078 And from that one: "The actuarial disease-free survival rate at 5 years was 66%, with salvage treatment initiated for 12% of the patients."In order to fully understand these numbers we have to know whatkinds of patients were treated. These are good numbers for highrisk patients and pretty bad numbers for low risk patients. Thetwo abstract describe the patient populations to help with this.My understanding is that, overall, radiation and surgery bothhave better long term outcomes than HIFU.Incidentally, does the fact that the Canadian Cleveland Cliniccharges $25,000 mean that Canada's health insurance won't coverHIFU?Also, I

know the urologist has to split the $25K with a bunchof people, but it still looks like I made a big mistake goinginto computer programming. I could have done a lot bettercooking prostates Alan

[Guest guest]

Alan --

Speaking as a Canadian citizen and resident:

a) If any US resident comes here for treatment, he'll be charged by the

treating institution (or doctor). He's not covered by the Canadian provincial

insurance plan. [The legal situation involves Federal/provincial split

responsibilities and other complexities, but basically: If you don't pay

Canadian taxes, you don't get free Canadian medical care.]

I think that HIFU is _not_ covered by any of the provincial medical insurance

plans. I believe the reason is " no proven superiority over other treatments " .

Surgery (both robotic and open) and radiation _are_ covered.

>

> > Why is HIFU not FDA approved for U.S. treatments - I could go

> > to Canada's Cleveland Clinic -- Pay $25,000 + for a 3 hour

> > procedure as an outpatient & if all went well be back home in a

> > couple of days with no cancer - sounds to me like the answer.  

>

> Harold,

>

> The numbers I've seen for HIFU results are significantly worse

> than for surgery or radiation, and nowhere near 92%.  Here are

> two recent studies:

>

> http://www.ncbi.nlm.nih.gov/pubmed/22487909

>

>     Quoted from that abstract:

>

>     " Disease-free progression rates at 5 and 7 years were 64% and

>     54%, respectively. "

>

> http://www.ncbi.nlm.nih.gov/pubmed/18829078

>

>     And from that one:

>

>     " The actuarial disease-free survival rate at 5 years was 66%,

>     with salvage treatment initiated for 12% of the patients. "

>

> In order to fully understand these numbers we have to know what

> kinds of patients were treated.  These are good numbers for high

> risk patients and pretty bad numbers for low risk patients.  The

> two abstract describe the patient populations to help with this.

>

> My understanding is that, overall, radiation and surgery both

> have better long term outcomes than HIFU.

>

> Incidentally, does the fact that the Canadian Cleveland Clinic

> charges $25,000 mean that Canada's health insurance won't cover

> HIFU?

>

> Also, I know the urologist has to split the $25K with a bunch

> of people, but it still looks like I made a big mistake going

> into computer programming.  I could have done a lot better

> cooking prostates

>

>     Alan

>

[Guest guest]

Harold wrote:

> I was just curious about  HIFU - basically asking a question.

> I'm sorry if you took it personally.

No problem.  I had no thought that you were saying anything that

I should take personally.  As Chuck indicated, I was just

responding to the issue of the effectiveness of HIFU.

My remark at the end about being in the wrong business was meant

as a joke - probably not a very good one.

One of the issues we face in medicine generally is a slow but

steady stream of new treatments.  This is a good thing in that,

without it, there could be no progress.  But we have a natural

tendency to think that newer is better, and that tendency can

lead us astray.  Unfortunately, I think that the majority of new

treatments turn out to be less effective than the old ones and

it's only occasionally that a new treatment really changes

things.

A lot of times, the most progress comes from gradual refinement

of existing treatments, for example, 3DCRT was better than the

radiation that came before it, IMRT is apparently better than

standard 3DCRT, and Zytiga and MDV-3100 appear to be an advance

over the earlier hormone therapies.

However, it's my impression that neither HIFU nor cryotherapy

have proven to be as good as the older treatments, and Provenge

may not be as good as Zytiga for advanced cases.

    Alan

[Guest guest]

When making a judgement about the relative effectiveness or cost of HIFU, it is a mistake to look solely at North American experience. The French and the Germans, not to mention the Italians, have infinitely more experience in this area over a period of at least 15 years. In my view it has been demonstrated to be as equally effective as more established treatments and has the advantage that the side effects are much better. As to the cost, I have just been quoted a figure of €9000 which equates to approximately US$12,000 for 10 days stay in a Munich hospital for HIFU treatment with a preliminary TURP to facilitate the excretion of the dead cancer cells. Dennis GoffinTo: ProstateCancerSupport From: ameyer2@...Date: Sun, 3 Jun 2012 13:53:46 -0700Subject: Re: HIFU has a 92% sucgess rate so

Harold wrote:

> I was just curious about HIFU - basically asking a question.

> I'm sorry if you took it personally.

No problem. I had no thought that you were saying anything that

I should take personally. As Chuck indicated, I was just

responding to the issue of the effectiveness of HIFU.

My remark at the end about being in the wrong business was meant

as a joke - probably not a very good one.

One of the issues we face in medicine generally is a slow but

steady stream of new treatments. This is a good thing in that,

without it, there could be no progress. But we have a natural

tendency to think that newer is better, and that tendency can

lead us astray. Unfortunately, I think that the majority of new

treatments turn out to be less effective than the old ones and

it's only occasionally that a new treatment really changes

things.

A lot of times, the most progress comes from gradual refinement

of existing treatments, for example, 3DCRT was better than the

radiation that came before it, IMRT is apparently better than

standard 3DCRT, and Zytiga and MDV-3100 appear to be an advance

over the earlier hormone therapies.

However, it's my impression that neither HIFU nor cryotherapy

have proven to be as good as the older treatments, and Provenge

may not be as good as Zytiga for advanced cases.

Alan

[Guest guest]

Found an interview with Dr. Walsh on the Charlie Rose Show. He talks about prostate cancer detection and treatment. Near the end of the interview, Dr Walsh states only 2 percent of his younger patients who have a radical prostatectomy have long term incontinence and less than 5 percent have erectile dysfunction.

Dr Walsh is a professor at s Hopkins. Along with co-workers, Dr. Walsh was the first to describe the 5 alpha-reductase enzyme deficiency,

to develop an experimental technique for the induction of benign

prostatic

hyperplasia, to demonstrate the influence of reversible androgen

deprivation

on BPH, and to characterize hereditary prostatic cancer. He is

on the editorial board of the New England Journal of Medicine and

is a member of the Institute of Medicine of the National Academy of Sciences. For

25 years he was the editor-in-chief of ’s

Textbook of Urology, which has been renamed Walsh in

his honor. Dr. Walsh was honored as the 2007 National Physician

of the Year for Clinical Excellence by America's Top Doctors®, and

was the co-recipient of the 2007 King Faisal International Prize in Medicine.

http://www.charlierose.com/view/interview/9016

To: prostatecancersupport Sent: Sunday, June 3, 2012 5:26 PM Subject: RE: HIFU has a 92% sucgess rate so

When making a judgement about the relative effectiveness or cost of HIFU, it is a mistake to look solely at North American experience. The French and the Germans, not to mention the Italians, have infinitely more experience in this area over a period of at least 15 years. In my view it has been demonstrated to be as equally effective as more established treatments and has the advantage that the side effects are much better. As to the cost, I have just been quoted a figure of €9000 which equates to approximately US$12,000 for 10 days stay in a Munich hospital for HIFU treatment with a preliminary TURP to facilitate the excretion of the dead cancer cells. Dennis GoffinTo:

ProstateCancerSupport From: ameyer2@...Date: Sun, 3 Jun 2012 13:53:46 -0700Subject: Re: HIFU has a 92% sucgess rate so

Harold wrote:

> I was just curious about HIFU - basically asking a question.

> I'm sorry if you took it personally.

No problem. I had no thought that you were saying anything that

I should take personally. As Chuck indicated, I was just

responding to the issue of the effectiveness of HIFU.

My remark at the end about being in the wrong business was meant

as a joke - probably not a very good one.

One of the issues we face in medicine generally is a slow but

steady stream of new treatments. This is a good thing in that,

without it, there could be no progress. But we have a natural

tendency to think that newer is better, and that tendency can

lead us astray. Unfortunately, I think that the majority of new

treatments turn out to be less effective than the old ones and

it's only occasionally that a new treatment really changes

things.

A lot of times, the most progress comes from gradual refinement

of existing treatments, for example, 3DCRT was better than the

radiation that came before it, IMRT is apparently better than

standard 3DCRT, and Zytiga and MDV-3100 appear to be an advance

over the earlier hormone therapies.

However, it's my impression that neither HIFU nor cryotherapy

have proven to be as good as the older treatments, and Provenge

may not be as good as Zytiga for advanced cases.

Alan

[Guest guest]

Dr Walsh is undoubtedly an exceptional doctor and his results reflect that. Unfortunately, not all surgeons have his skill. For a calm, measured appreciation of the relative value of HIFU, I recommend (“Robotic high-intensity focused ultrasound for prostate cancer: what have we learned in 15 years of clinical use?“)Dennis Goffin From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Charlie DeSent: 04 June 2012 10:27To: ProstateCancerSupport Subject: Re: HIFU has a 92% sucgess rate so Found an interview with Dr. Walsh on the Charlie Rose Show. He talks about prostate cancer detection and treatment. Near the end of the interview, Dr Walsh states only 2 percent of his younger patients who have a radical prostatectomy have long term incontinence and less than 5 percent have erectile dysfunction.Dr Walsh is a professor at s Hopkins. Along with co-workers, Dr. Walsh was the first to describe the 5 alpha-reductase enzyme deficiency, to develop an experimental technique for the induction of benign prostatic hyperplasia, to demonstrate the influence of reversible androgen deprivation on BPH, and to characterize hereditary prostatic cancer. He is on the editorial board of the New England Journal of Medicine and is a member of the Institute of Medicine of the National Academy of Sciences. For 25 years he was the editor-in-chief of ’s Textbook of Urology, which has been renamed Walsh in his honor. Dr. Walsh was honored as the 2007 National Physician of the Year for Clinical Excellence by America's Top Doctors®, and was the co-recipient of the 2007 King Faisal International Prize in Medicine. http://www.charlierose.com/view/interview/9016 From: Dennis Goffin To: prostatecancersupport Sent: Sunday, June 3, 2012 5:26 PMSubject: RE: HIFU has a 92% sucgess rate so When making a judgement about the relative effectiveness or cost of HIFU, it is a mistake to look solely at North American experience. The French and the Germans, not to mention the Italians, have infinitely more experience in this area over a period of at least 15 years. In my view it has been demonstrated to be as equally effective as more established treatments and has the advantage that the side effects are much better. As to the cost, I have just been quoted a figure of €9000 which equates to approximately US$12,000 for 10 days stay in a Munich hospital for HIFU treatment with a preliminary TURP to facilitate the excretion of the dead cancer cells. Dennis GoffinTo: ProstateCancerSupport From: ameyer2@...Date: Sun, 3 Jun 2012 13:53:46 -0700Subject: Re: HIFU has a 92% sucgess rate so Harold wrote:> I was just curious about HIFU - basically asking a question.> I'm sorry if you took it personally.No problem. I had no thought that you were saying anything thatI should take personally. As Chuck indicated, I was justresponding to the issue of the effectiveness of HIFU.My remark at the end about being in the wrong business was meantas a joke - probably not a very good one.One of the issues we face in medicine generally is a slow butsteady stream of new treatments. This is a good thing in that,without it, there could be no progress. But we have a naturaltendency to think that newer is better, and that tendency canlead us astray. Unfortunately, I think that the majority of newtreatments turn out to be less effective than the old ones andit's only occasionally that a new treatment really changesthings.A lot of times, the most progress comes from gradual refinementof existing treatments, for example, 3DCRT was better than theradiation that came before it, IMRT is apparently better thanstandard 3DCRT, and Zytiga and MDV-3100 appear to be an advanceover the earlier hormone therapies.However, it's my impression that neither HIFU nor cryotherapyhave proven to be as good as the older treatments, and Provengemay not be as good as Zytiga for advanced cases. Alan

[Guest guest]

Thank you Chuck that was A very interesting conversation.

Dr. Walsh shows a lot of compassion for his patients and demonstrates a lot of self confidents, which must be re-assuring to them.

To: "ProstateCancerSupport " <ProstateCancerSupport > Sent: Monday, June 4, 2012 4:26 AMSubject: Re: HIFU has a 92% sucgess rate so

Found an interview with Dr. Walsh on the Charlie Rose Show. He talks about prostate cancer detection and treatment. Near the end of the interview, Dr Walsh states only 2 percent of his younger patients who have a radical prostatectomy have long term incontinence and less than 5 percent have erectile dysfunction.

Dr Walsh is a professor at s Hopkins. Along with co-workers, Dr. Walsh was the first to describe the 5 alpha-reductase enzyme deficiency, to develop an experimental technique for the induction of benign prostatic hyperplasia, to demonstrate the influence of reversible androgen deprivation on BPH, and to characterize hereditary prostatic cancer. He is on the editorial board of the New England Journal of Medicine and is a member of the Institute of Medicine of the National Academy of Sciences. For 25 years he was the editor-in-chief of ’s Textbook of Urology, which has been renamed Walsh in his honor. Dr. Walsh was honored as the 2007 National Physician of the Year for Clinical Excellence by America's Top Doctors®, and was the co-recipient of the 2007 King Faisal International Prize in Medicine.

http://www.charlierose.com/view/interview/9016

To: prostatecancersupport Sent: Sunday, June 3, 2012 5:26 PMSubject: RE: HIFU has a 92% sucgess rate so

When making a judgement about the relative effectiveness or cost of HIFU, it is a mistake to look solely at North American experience. The French and the Germans, not to mention the Italians, have infinitely more experience in this area over a period of at least 15 years. In my view it has been demonstrated to be as equally effective as more established treatments and has the advantage that the side effects are much better. As to the cost, I have just been quoted a figure of €9000 which equates to approximately US$12,000 for 10 days stay in a Munich hospital for HIFU treatment with a preliminary TURP to facilitate the excretion of the dead cancer cells.

Dennis Goffin

To: ProstateCancerSupport From: ameyer2@...Date: Sun, 3 Jun 2012 13:53:46 -0700Subject: Re: HIFU has a 92% sucgess rate so

Harold wrote:> I was just curious about HIFU - basically asking a question.> I'm sorry if you took it personally.No problem. I had no thought that you were saying anything thatI should take personally. As Chuck indicated, I was justresponding to the issue of the effectiveness of HIFU.My remark at the end about being in the wrong business was meantas a joke - probably not a very good one.One of the issues we face in medicine generally is a slow butsteady stream of new treatments. This is a good thing in that,without it, there could be no progress. But we have a naturaltendency to think that newer is better, and that tendency canlead us astray. Unfortunately, I think that the majority of

newtreatments turn out to be less effective than the old ones andit's only occasionally that a new treatment really changesthings.A lot of times, the most progress comes from gradual refinementof existing treatments, for example, 3DCRT was better than theradiation that came before it, IMRT is apparently better thanstandard 3DCRT, and Zytiga and MDV-3100 appear to be an advanceover the earlier hormone therapies.However, it's my impression that neither HIFU nor cryotherapyhave proven to be as good as the older treatments, and Provengemay not be as good as Zytiga for advanced cases. Alan