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Anyone here use or know reputation of HIFU Prostate Services, Dr. Samuel J. Peretsman?

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Prostate Cancer
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Posted 6/29/2017 9:05 AM (GMT -5)
Huntersville, NC.

He does High Intensity Focused Ultrasound, and has been doing it off-shore, traveling to Bermuda with patients.

A family member is strongly considering going there.

I am recommending to the family member who is a gleason 6 that he go to Johns Hopkins for evaluation and consideration for their active surveillance program.

Any comments from people who have used Peretsman or HIFU appreciated.

Currently reading search threads on HIfU at the moment.
Posted 6/29/2017 9:15 AM (GMT -5)
How many cores were taken? How many cores were positive? Were they all Gleason 3+3? How much of each core was positive?

That sounds like a PIRADS 4 or 5 score on the MRI. Is that correct?

The PCA3 and PHI tests are OK, but not great.

I'm not recommending against active surveillance, but I would need to know more of his data before I would think it appropriate for him.
Posted 6/29/2017 10:13 AM (GMT -5)

ASAdvocate said...
How many cores were taken? How many cores were positive? Were they all Gleason 3+3? How much of each core was positive?
..................

The PCA3 and PHI tests are OK, but not great.
.....

The PCA3 and PHI tests are my signature from my earlier time here.
I went to Duke, for MultiParametric MRI, no findings, and my PSA went back down. At this time, I am not a member of the club of the greatest group of guys in the club I never want to join.

I figured if the family member made it through Johns Hopkins criteria (which I understand is pretty strict) for Active Surveillance it would be a good way to go, particularly with them monitoring.

IMO, this forum is the best one out there for PCa. A family member has been diagnosed, I am trying to help with info.

Fourteen cores, IIRC, one large one small lesion, only four cores had Gleason 3+3, two lower %, two higher percent. He appears to be a great candidate for focal treatment. He is able to pay out of pocket for his treatment of choice.

I learned a lot from this group here and am trying to help him determine the lowest side effect focal treatment of choice that will be appropriate. He is in NC.
Posted 6/29/2017 10:29 AM (GMT -5)
Samuel (Sandy) Peretsman is chief of the Urology Specialists of the Carolinas. He is one of the top 3-4 uros in this Charlotte area. He takes his standing seriously and thus tries to offer every treatment available, including HI-FU. He has been going offshore for some years. I know of one man who says he had this procedure done by this man and he was satisfied at that time. Dr. Peretsman is a general urologist.
Your person should definitely have another opinion. HI-FU itself can be successful but why pay the full cost of this treatment, plus travel, when ANY treatment would likely be as successful and NO treatment (Active surveillance) would be best?
Posted 6/29/2017 11:38 AM (GMT -5)
Ken,

You've probably seen it but there is another thread where HIFU is being discussed. www.healingwell.com/community/default.aspx?f=35&m=3873431

There are a number of links to research there that might help your family member make an informed decision.
Posted 6/29/2017 11:49 AM (GMT -5)
Please send the following to your family member before he chooses HIFU. I'm concerned that many uros out there sell HIFU like used cars without full disclosure.

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html

You are right that JH still has very strict requirements on their AS program, even with relaxations recently. But if Duke or Wake Forest is closer, I'm sure he can do just as well there. The AS decisions are ultimately the patient's to make. If he wants to, say, come off AS based on PSA kinetics, he certainly can no matter whose program he's on, irrespective of whether that's a criterion they use. NCCN thinks that AS is a good choice for any low risk patient, and based on the data I've seen, I very much agree.
Posted 6/29/2017 12:00 PM (GMT -5)
I glanced over that other thread and finding the research links takes a bit more digging than I recalled.

This seems to be the most relevant study:

Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort.

It is a European study but they use the American-made machine (as opposed to the French one) so the results should be applicable.

the study abstract said...
CONCLUSIONS:

Whole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments.

PATIENT SUMMARY:

In this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.

That "similar to other whole-gland treatments" part is pretty debatable. The best surgeons and radiation oncologists do a lot better.
Posted 6/29/2017 12:12 PM (GMT -5)
There have been a lot of studies on HIFU and HIFU has been conducted in Europe and Asia for years. It is also true that several countries have unapproved HIFU as a treatment because of it's past record.
The biggest failure in HIFU is it's reoccurrance rate, which is the highest of all treatment options. This is particularly concerning in that it is mostly performed on low risk patients where the overall reoccurrence rates is low to begin with.
The other concerning factor is that the reoccurrance rate for all treatment options drops over time. The risk of developing a reoccurrance diminish as years from treatment progress. The opposite is true for HIFU as reoccurrance rates increase as time passes.
Posted 6/29/2017 2:09 PM (GMT -5)
Thanks guys, for the links and info.

I knew I count on getting excellent info here.

Warm regards

Ken
Posted 8/12/2018 6:00 PM (GMT -5)
An update.

My Brother In Law decided to go with Dr Peretsman and HiFu.

He had a successful early outcome, his PSA before surgery was over 10.

He had one major nodule. On one side of the prostate the DR ablated around half.

Procedure done early December 2017.

PSA in March 1.0

PSA in June .8

Rough total out of pocket was around 12,000.

He was originally quoted 25,000. Medicare paid for much or all of the surgical.

Everything went well, only real negative was dealing with the catheter for several weeks.

I want to thank everyone for their input and will continue to update over a period of time with further info as things transpire.
Posted 8/12/2018 8:11 PM (GMT -5)
The issues he has to deal with now include:

• How will he monitor PSA to track progression?
• Periodic biopsy in the ablation zone
• Periodic biopsy outside of the ablation zone
• Re-do or salvage if progression were found

In other words, he has to maintain active surveillance for the rest of his life.
Posted 8/13/2018 8:16 AM (GMT -5)
If his PSA stabilizes at a low number a regular PSA test (4 or 6 month) should be all he needs..After a year or two, an annual checkup with his Urologist or MO should be enough..The benefit being he did not have to endure the side-effects of surgery or primary radiation treatment..HiFu has been approved to treat PC in the U.S. so it's no longer necessary to go offshore for this treatment..Should he need more aggressive treatment, that option is still open...
Posted 8/13/2018 2:02 PM (GMT -5)
HIFU has not been approved in the US for treatment of prostate cancer. It has been approved for ablation of prostate tissue, for example hypertrophy (enlarged) prostate. Trials for cancer treatment were never approved. Now that ablation is an approved use doctors are free to ablate for purposes of prostate cancer if they and the patient wish. The HIFU trials were all done with patients limited to G6 who could have had any treatment with a high degree of success in cancer control. They now would have been steered toward AS or NO direct treatment. I hope doctors performing HIFU inform their patients of these issues.
Posted 8/13/2018 3:55 PM (GMT -5)
As usual, it all boils down to what the patient wants and what his insurance company is willing to pay for..For those of us who don't need insurance (self-insured) they can get any treatment they want anywhere they want...
Posted 8/13/2018 4:43 PM (GMT -5)
+1 @ tarhoosier. Fairwind got it wrong.
Posted 8/13/2018 6:49 PM (GMT -5)
I wonder, today, how many Urology Clinics are equipped with HiFu machines..? How many doctors are willing to ablate PC tumors regardless of whether or not it's the best treatment choice..The OP was willing to leave the country to be treated using this method. That is no longer necessary so I expect there is a fair number of people seeking this option regardless of whether the FDA approves it or not..
Posted 8/13/2018 7:17 PM (GMT -5)
I think a lot of unscrupulous Uro's are making money off the loophole - and they aren't giving full disclosure.
Posted 8/14/2018 1:21 AM (GMT -5)
The presentation of HIFU made to me when I was first researching treatment (2009) included a package of home mortgage requests written for cancer folks. There was also a vacation resort package for the town where (in Mexico) the doc would do the procedure.

My SCAM / THIEF alarm went off early, and I am still turned against it by the hype and money sucking attempts at the time.
Posted 8/16/2018 4:06 PM (GMT -5)
The decision was made and if the patient and the family are happy that is all that matters at this point. But please stay vigilante... cancer is a thief and when given opportunity it will take your life.
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