RE: HIFU was.....: Little Rock Support Group (Man 2 Man)

[Guest guest]

Hi, Terry, When you consider that HIFU has been in trial here in the U.S. for over six years with what appears little interest, and then read the following reports, it appears quite obvious that this form of treatment is experiencing difficulty: Another expected blow to HIFU following earlier considerations by a study in France: http://tinyurl.com/5r32rzm http://tinyurl.com/26ss6tk as well as by Canada in an earlier post on this link: http://tinyurl.com/3x5y4st and Belgium in another earlier post on this link: http://tinyurl.com/5u6v2zc Chuck " What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others. " (Chuck) Maack/Prostate Cancer Advocate/Mentor Wichita, Kansas Chapter, Us TOOBiography: http://www.ustoowichita.org/leaders.cfm?content=bio & id=1 Email: maack1@... Chapter Website " Observations " : http://www.ustoowichita.org/observations.cfm From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Terry HerbertSent: Wednesday, February 02, 2011 10:13 PMTo: ProstateCancerSupport Subject: HIFU was.....: Little Rock Support Group (Man 2 Man) The so called “Stuttgart definition” only applies to HIFU and if this is the study that established the definition it seems a little arrogant to set up a definition of failure and then say that a treatment doesn’t meet that definition?? All the best Prostate men need enlightening, not frighteningTerry Herbert - diagnosed in 1996 and still going strongRead A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Chuck MaackSent: Thursday, 3 February 2011 4:28 AMTo: ProstateCancerSupport Subject: RE: Re: Little Rock Support Group (Man 2 Man) For all, If considering traveling outside the U.S. and paying out-of-pocket the expense of High Intensity Focused Ultrasonogaphy (HIFU), please note the following remark from this six-year study: http://tinyurl.com/26ss6tk “In our experience, Ablatherm treatment for clinically localized prostate cancer was associated with a high rate of biochemical failure as determined by the 'Stuttgart' definition, and did not achieve effective cancer control. The PSA nadir value after HIFU treatment was a significant predictor of treatment failure.” The “Stuttgart” definition is a new, more accurate, definition of biochemical failure. See: http://www.ncbi.nlm.nih.gov/pubmed/19388986 And here is more: From The “New” Prostate Cancer InfoLink (http://tinyurl.com/3x5y4st): Canadian practice guideline does NOT recommend HIFU High-intensity focused ultrasound (HIFU) is legally available in Canada as a method for the treatment of prostate cancer. However, a new Canadian practice guideline states that, “HIFU cannot currently be recommended as an alternative to accepted curative treatment approaches for localized prostate cancer.”The new guidance document has been issued by the Genitourinary Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care, and the full text of the guideline is available on line. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910764/pdf/cuaj-4-232.pdf Chuck

[Guest guest]

I’m not defending HIFU, Chuck. My personal view is that it is not a safe therapy,

but that’s my personal view.

I just felt that it was arrogant to develop

yet another definition of failure based on such a small study and compound the

current confusion regarding ‘failure’ or ‘success’ even

further. Effective Health Care published an excellent paper in February 2008 -

Comparing the Effectiveness of Therapies for Localized Prostate Cancer - the Executive

Summary (which runs to 20 pages and is in pdf format is available here http://www.yananow.org/SummaryofOptions.pdf)

The paper says that one of the problems in comparing outcomes is <snip>

There was not standardized reporting of biochemical outcomes, with more than

200 definitions of “biochemical no evidence of disease (bNED)” <snip>

Two hundred definitions!! Do we need another?

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Chuck Maack

Sent: Thursday, 3 February 2011

3:22 PM

To: ProstateCancerSupport

Subject: RE:

HIFU was.....: Little Rock Support Group (Man 2 Man)

Hi, Terry,

When you consider

that HIFU has been in trial here in the U.S. for over six years with what

appears little interest, and then read the following reports, it appears quite

obvious that this form of treatment is experiencing difficulty:

Another expected

blow to HIFU following earlier considerations by a study in France:

http://tinyurl.com/5r32rzm

http://tinyurl.com/26ss6tk

as well as by Canada in an

earlier post on this link:

http://tinyurl.com/3x5y4st

and Belgium

in another earlier post on this link:

http://tinyurl.com/5u6v2zc

Chuck

" What you leave behind is not what is engraved in stone

monuments, but what is woven into the lives of others. "

(Chuck) Maack/Prostate Cancer Advocate/Mentor

Wichita, Kansas Chapter, Us TOO

Biography: http://www.ustoowichita.org/leaders.cfm?content=bio & id=1

Email: maack1@...

Chapter Website " Observations " : http://www.ustoowichita.org/observations.cfm

From: ProstateCancerSupport

[m ailto:ProstateCancerSupport ]

On Behalf Of Terry Herbert

Sent: Wednesday, February 02, 2011

10:13 PM

To: ProstateCancerSupport

Subject:

HIFU was.....: Little Rock Support Group (Man 2 Man)

The so called “Stuttgart

definition” only applies to HIFU and if this is the study that

established the definition it seems a little arrogant to set up a definition of

failure and then say that a treatment doesn’t meet that definition??

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Chuck Maack

Sent: Thursday, 3 February 2011

4:28 AM

To: ProstateCancerSupport

Subject: RE:

Re: Little Rock Support Group (Man 2 Man)

For all,

If considering

traveling outside the U.S. and paying out-of-pocket the expense of High

Intensity Focused Ultrasonogaphy (HIFU), please note the following remark from

this six-year study:

http://tinyurl.com/26ss6tk

“In

our experience, Ablatherm treatment for clinically localized prostate

cancer was associated with a high rate of biochemical failure as determined by

the 'Stuttgart'

definition, and did not achieve effective cancer control. The PSA nadir value

after HIFU treatment was a significant predictor of treatment failure.”

The “Stuttgart”

definition is a new, more accurate, definition of biochemical failure.

See:

http://www.ncbi.nlm.nih.gov/pubmed/19388986

And here is more:

From The

“New” Prostate Cancer InfoLink (http://tinyurl.com/3x5y4st):

Canadian practice guideline does NOT recommend HIFU

High-intensity focused ultrasound (HIFU) is legally available in Canada as a

method for the treatment of prostate cancer. However, a new Canadian practice

guideline states that, “HIFU cannot currently be recommended as an

alternative to accepted curative treatment approaches for localized prostate cancer.”

The new guidance document has been issued

by the Genitourinary Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based

Care, and the full text of the guideline is available on line.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910764/pdf/cuaj-4-232.pdf

Chuck

[Guest guest]

Terry Herbert wrote:

> The so called “Stuttgart definition†only applies to HIFU and

> if this is the study that established the definition it seems a

> little arrogant to set up a definition of failure and then say

> that a treatment doesn’t meet that definition??

My reading of the article was that the " Stuttgart definition " was

based on a study of HIFU failures. What they found was that if

the PSA only got down to a certain threshold value, it would

eventually go up again with a recurrence of the cancer. So they

were saying that if the PSA only got down that far, declare the

treatment has failed because experience has shown that an obvious

failure will occur soon.

That seems reasonable to me. It gives the HIFU patient advance

warning that his treatment failed and he needs to plan on dealing

with a recurrence. The Stuttgart doctors were arguing that it

isn't necessary to wait for three PSA rises, or other definitions

of failure, before seeking more treatment options.

Incidentally, I seem to recall reading an article that claimed

that the success rate for an initial HIFU treatment was

significantly lower than surgery or radiation, but if the HIFU

was repeated, success rates went up. I don't remember if they

ever got as high as surgery or radiation and I'm sure they didn't

get higher.

I wouldn't want it myself and I suspect that a lot of the

interest patients have expressed is due to the " newer must be

better " fallacy in our thinking about cancer treatments. We've

been conditioned by our experience with computers to think that

all things high tech get better and better, but I think that

medical treatment doesn't follow that rule very well.

Alan

[Guest guest]

Terry Herbert wrote:

> The so called “Stuttgart definition†only applies to HIFU and

> if this is the study that established the definition it seems a

> little arrogant to set up a definition of failure and then say

> that a treatment doesn’t meet that definition??

My reading of the article was that the " Stuttgart definition " was

based on a study of HIFU failures. What they found was that if

the PSA only got down to a certain threshold value, it would

eventually go up again with a recurrence of the cancer. So they

were saying that if the PSA only got down that far, declare the

treatment has failed because experience has shown that an obvious

failure will occur soon.

That seems reasonable to me. It gives the HIFU patient advance

warning that his treatment failed and he needs to plan on dealing

with a recurrence. The Stuttgart doctors were arguing that it

isn't necessary to wait for three PSA rises, or other definitions

of failure, before seeking more treatment options.

Incidentally, I seem to recall reading an article that claimed

that the success rate for an initial HIFU treatment was

significantly lower than surgery or radiation, but if the HIFU

was repeated, success rates went up. I don't remember if they

ever got as high as surgery or radiation and I'm sure they didn't

get higher.

I wouldn't want it myself and I suspect that a lot of the

interest patients have expressed is due to the " newer must be

better " fallacy in our thinking about cancer treatments. We've

been conditioned by our experience with computers to think that

all things high tech get better and better, but I think that

medical treatment doesn't follow that rule very well.

Alan