HIFU

Another new guy, GPG (Scot) was just telling me about HIFU last night. I hadn't heard of it before, perhaps he will see your post and answer you.

Thanks, Scot, for poping in here for this.

Not to be controversial but I am informed that my insurance and many others have provision to cover HIFU as it is a recognized treatment in many other countries.

Please do not discout the treatment because you are concerned your insurance might not cover it.  Ask.

Scott

Just a note: No doctors should be offering to take a patient out of the US to perform this procedure. It raises real ethics, malpractice, and insurance issues, at least in my opinion. But I have heard that doctors can be certified for doing so. You can contact PCRI and get a referral in the ongoing trial for treatment in the US.

Tony

Not to dismiss Tony, but there is not reason to think that to take someone out of the states to perform a procedure which is acceptable in many other countries is unethical.

HIFU is an accetped procedure in many countries and I am convinced in some cases it is superior to radiation and cryo.

Please do not discount it.

 

Scott

mjluke said...

Is there any way to predict with any relative  certainty how long one could maintain a decent quality of life without any treatment whatsoever. given particular Gleason scores, PSA's and overall health?

I'm sure the answer is you take your chances, however I would appreciate any comments.

 

Nope, no real way to predict, but you have hit the thorny nail on the head.

In your case if you can determine by nuc scan that your cancer is local and if you are a healthy, fit individual I would suggest either open anatomical or robotic radical by a very practiced surgeon.  But I am also convinced that HIFU is a good procedure which is being delayed approval due to ressons not to do with the efficacy of the procedure.

Scott

MJLuke- with kindness meant back to you, but the word "certainty" does not exist in the PCa world anywhere....exceptions appear in everything, you name it, it is not definitive enough or guaranteed. I have mentioned that it is the Twlight Zone of diseases, the scenarios, bizzare treatments, monitoring psa levels etc., the unknowns, the exceptions to the norms, etc. Psa cancer specific=no; biopsies totally reliable=no; scans total definitive=no, treatment types guarantees=no; Partin tables totally accurate=no; drug costs fixed levels=no; outcomes from similar patients with similar treatments the same=no ; same side effects for every patient=no

Now could some patients do well on watchful waiting or monitoring, the answer is yes they could and many have and do so. Is their some risk, of course there is. People whom do or consider such should be in the realm of "indolent or insignificant PCa" levels as defined by John Hopkins-Brady Inst. of Urology, they have some parameters to define this level. Probably person with stats close to this could also do the w.w. (aggressive surveilance is a better $20 word for it). It is written in books and discussed from doctors lips that for some patients it is an option and it is. Less agressive PCa gleason 6 (3+3) and under with low psa (2.0-say) and low percentage found (5%-say) in 1 or 2 biopsies out of 10-14 (say) are the lower risk patients, slow growing PCa. My brother has done atleast 4 yrs. of monitoring and was diagnosed with parameters very close to the Brady Urology specs., it is his call to make and I don't push him into anything, I do tell him the value of monitoring closely. So far no change in psa, never went higher and other variables no changes or unknowns. Alot of choices for patients to make at various stages and levels, this is why abstracts are interesting to read and compare data and usefullness. Of course how can you tell for certain if your biopsies are accurate enough to assess the level of 'indolent' PCa, you actually cannot have 100% certainty, biopsies can miss targets, you could have multiple gleason scores within your gland in various areas ( I had 3 different scores on both sides, too) and so on.

Gee- that was clear and hazy at the same time, such is PCa. Exceptions are the rule if you know what I'm sayin here.

Thanks guys- I think I'm starting to get the picture- my advice to myself at the moment is to " go slow".

Fair enough Tony,  you obviously have talked to a number of people educated on this issue and bring up points which I had not considered.

There are no trials at present or under consideration for which I meet the inclusion criteria.  The Dr. who performed my sat biopsy practices conventional froms of urology including surgery here in the states and does not soley recruit patients for the HIFU proceedure, he does not attempt to conceal the treatment he carries out out of the country and before I allowed him to proceed with the biopsy my family Dr. looked into his background and found nothing of concern.  Also I am insured under a personal major medical plan with United Healthcare/Goldenrule and my policy does cover this procedure done in Mexico.

A very interesting and complicated discussion this.

Scott

TC-LasVegas said...
Scott,
I bet the FDA won't agree that it isn't a question of ethics. And neither would the AMA. I do understand that HIFU is in practice in other countries. I'm not discounting HIFU. I know it works like other ablation therapies. But if a doctor came to the US to recruit patients for his over seas practice he raises real ethics issues. We had a Urologist at our Us Too chapter meeting discuss HIFU as he was gearing up for the clinical trial. The topic of going overseas to do it came up. He said in no way would he ever suggest to a patient ~ as he said "meet me in the Phillipines" because it could and likely would cost him his license here. He called it a violation in Moral Turpitude of a community that does not allow that practice. I believe that HIFU may indeed be legalized here but for now it isn't except in a clinical trial. Why would a doctor circumvent that process here during that trial when he could easily just send you to an FDA approved facility in the trial? He even should apply to be one of the trial physicians instead of telling the patients to "meet me in Cancun".

I don't question the procedure. But I think with all the recent talk here about questioning before trusting our healthcare providers would truly apply it to a doctor who is actively skirting US law by performing the procedure out of the country. Remember he took an oath which clearly says he will practice within the law. For one you can't sue him if he screws up in Mexico, second you will be paying for it because your US insurance won't be.

Can I ask why you haven't looked into the trial program?

Tony