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THIS INFORMATION IS FROM THE NOTES TAKEN BY LUDWICK PAPAURELIS, A LONG TIME PROSTATE CANCER SURVIVOR AT A PRESENTATION ON AUGUST 8, 2005. LUDWICK'S HOPE IS THAT THIS PROVIDES USEFUL INFORMATION FOR THOSE ASKING QUESTIONS.


This information is from a presentation at the CPCN 2005 conference in Toronto on August 8, 2005 by Dr. Edward Woods. Dr. Edward Woods is a Toronto Urologist on staff at Scarborough General Hospital since 1988. He holds certification as a Fellow of the Royal College of Physicians of Canada. He is one of 3 doctors providing the HIFU treatment under the the group practice called Maple Leaf HIFU. Website www.hifu.ca

The equipment used is the Ablatherm(R) HIFU (High Intensity Focused Ultrasound) system developed in France with a German manufacturer, a competing system to the Sonoblate(R).

The treatment is provided at one of the few private hospitals in Canada (private practice procedures are not permitted at public hospitals under Medicare in Canada. Don Mills Surgical Hospital is accredited by the Canadian Association for Accreditation of Ambulatory Surgical Facilities and in operation for more than 40 years. Procedure is principally performed by Dr Woods and Dr. M. Hassouna while Dr. John Warner has performed a few but is mainly the medical director. The total number of patients treated up to the talk was just over 20 by all the 3 doctors.

The equipment received EU approval in 2000, Health Canada approved it in 2003 and Medicare in Germany, France and Britain began paying for this treatment. FDA has not approved it but is awaiting completion of USA clinical trials.

Which patients are treated by HIFU as explained by Dr Woods?

Patients having localized cancer within the prostate, clinical stage T1 or T2. The entire prostate and the near ends of the seminal vesicles are treated. The prostate must be less than 55 cc, if not it can be downsized by a TURP (Trans Urethral Resection Procedure or ADT (Androgen Deprivation Therapy). HIFU does not replace surgery, nor is it for young patients or for over 80. Useful for patients where surgery is not acceptable and competes with cryotherapy for patients. Weakness at present is the lack of long term data. France has the longest experience, even to the point that in Lyons they are doing salvage HIFU for failed Radiation Therapy.

HIFU treatment should take 1.5 to 3 hours, currently it is 3 to 4 hours. It is done under spinal anaesthesia and relaxed muscles are critical because the patient must not move as their planning is to 1/10 of mm. The rectal wall is protected and the margin is 2.5 to 3 cm. The treatment can be repeated. The hospital stay is overnight and the catheter stays in for 3 to 7 days.

They expect the PSA nadir in 3 months with 75 percentile of patients are under 0.40 ng/ml. [One of the studies provided by this group indicates that on the basis of Dr Walsh's criteria of 0.20 ng/mlnadir, only 54% reached this level but they claim that 0.20 ng/ml is inappropriate as more of the prostate remains,] Dr. Woods said that at this time, the HIFU procedure is for pioneers where the current treatments are inappropriate for the patient.

Dr. Woods instructed that the patient should ask all the tough questions of them before proceeding.