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HIFU for Prostate Cancer --
Survivor/Patient Perspective

I chose to have my prostate cancer treated with HIFU, high
intensity focused ultrasound.  On Sunday, July 23, I
had my prostate treated at a clinic in Toronto,
Canada.  It was necessary to go to Canada, because,
although this procedure is used around the world,
including Europe, Russia, South Korea , Japan, South
Africa and some Latin American nations it has only
just been approved by the FDA for clinical trials,
which will not start yet for half a year to two years
out.

It was an outpatient procedure which took
approximately seven hours from the time I arrived at
the clinic in the morning until I came out of the
anesthesia and was steady and sound enough to walk out
of my own accord and across the street to the hotel at
which I was staying. That night, although I felt  that
I had best stay in, I ate a light dinner and stayed up
until midnight watching TV and rather antsily pacing
the suite.

I  had traveled to Toronto four days before the
procedure in order to tour a  bit, walking this
wonderful city of endlessly captivating neighborhoods.
For folks in the West, it is done in Puerto Vallerta,
in both cases in American owned and run clinics. The
afternoon before the procedure I met with the medical
staff, which through a stroke of luck and friendship,
included a urologist from Milwaukee who had  become
interested  in the procedure and wished to view it.
(Ultimately, he was so impressed that he is thinking
of coming out of retirement and working with HIFU
himself. Neither is this urologist just anyone; under
Clinton he came close to being Surgeon General, except
that he himself had health problems at the time of his
consideration.)  The doctors and the nurse answered
any questions those of us to be treated the next day
still had; another patient for the next day, a dentist
pressed them hard because his  friends were
questioning why he was pursuing an “experimental”
intervention, not yet approved by the FDA – I will
address the lack of HIFU in the United States  below.
I felt they answered all questions so my satisfaction,
and it seemed  to his as well.  I ate a light dinner
that evening and turned in relatively early in order
to  get a good night ‘s rest before hand. 

I  awoke at 5:00 a.m. Sunday and  administered two
successive fleet enemas in order to clean out my
rectum to enable the visualization of the prostate by
the doctor. I arrived at the clinic at 7:00 a.m.,
filled out some additional paperwork largely in the
nature of a history for the anesthesiologist and
conventional  releases. 

By 7:30 a.m., I was being anesthesized with an
epidural to my lower spine to
prevent pain and movement. From what I know from
having read and been told about the procedure, a
transrectal ultrasound device was  then inserted
through the rectum and next to the prostate. As one
ultrasound beam visualized the prostate, two other
beams of ultrasound in a process called ablation were
successively pinpointed at numerous points throughout
the prostate and, where they met, they heated the
tissue to the point it was effectively destroyed.  At
the commencement of the procedure a suprapubic
catheter was inserted through my lower abdomen and
into the bladder.

This catheter, which I will utilize
for urination for the next two to three weeks, is
considerably less onerous than the usual urethral
catheter, the big nuisance being the bags into which
it drains and the constant sense of a need to urinate
which comes from the bladder wall reacting to the
water balloon which anchors the tube in.  The
sensation, however,  gradually diminished over  the
course of the next week, and I have been given
medications to hasten the process.  The whole
procedure took three and a half hours for me, because
my prostate was unusually large; ordinarily it takes 2
and a half to three hours.  I was then in the recovery
room approximately another three and a half  hours,
regaining consciousness and my land legs.

The following day, I was up at a normal hour and again
went out touring Toronto, the only real obstacle being
the awkwardness of the tube and bag taped along my
belly and to my thigh and the nuisance of having to
empty it with considerable regularity. Although I got
fatigued late in the afternoon and had to return to
the room for a nap, I otherwise was able to function
relatively normally and  flew home a day later and
returned to work Thursday. I have to follow a course
of an antibiotic and anti-inflammatory for a  month
and after  the catheter is  removed I will be given
cialis to take every other day for a month, apparently
to enhance the blood flow, because it is not necessary
for potency which returned within the week.

I was in a ready to have the catheter removed from my
belly and bladder after two weeks, but I had trouble
getting an appointment so that it stretched out to
three weeks to my chagrin. Removal is limited only by
the time it takes me to regain the ability to void my
bladder normally through my urethra, which I started
working on the weekend after the procedure. One
problem I encountered, however, was that my usual
urologist was unwilling to remove a catheter he did
not put in.  Fortunately my friend arranged with a
former partner to do it, so apparently one should line
this up in advance of the procedure if one is still
having it done out of the country. 

In three months, I  will go  to have a PSA and
continue to have one every three months thereafter to
check for the success of the intervention.  According
to the medical staff and  in particular my
professionally unbiased friend, I  should have a very
good chance of being cancer-free, the last five years
that having been the case in close to 98% of  the
cases reco HIFU cases since the equipment was improved
and reprogrammed in 2001. Only 5% suffer impotence of
any duration and only .03% experience incontinence – I
was experiencing tumescence during my sleep already
within a matter of days after the procedure and now
three weeks afterward get aroused normally.

So far I would wholeheartedly endorse HIFU, although,
because  it is not covered by insurance, it was very
costly out of pocket.  Either of the two firms doing
it in Canada charge $20,000 -23,000.  I have, however,
also been given the names of two firms which
specialize in recovering the costs of out of the U.S.
medical treatments uncovered by insurance for a 15%
commission upon and only upon recovery.  To my mind,
nevertheless, having read the literature and the
anecdotes on the other treatment modalities, it was
money  well-spent if it has beaten the cancer as it
so often does.

In fact, that it is just now approved for clinical
trials in the US strikes me as scandalous.  I myself
suspect that it was blocked by the self-serving
surgeons and the radiotherapists, especially since the
recent approval of testing curiously coincides with
GE’s decision to develop an ultrasound division. My
sister has spoken to a non-urological surgeon who even
is angrier than I, claiming that  there are fully
eleven cancer treatments used in Europe but
effectively blocked in the US by the surgical lobby.
I  hope to God he is wrong, but looking  at the stem
cell and Vioxx politics, nothing of that sort would
surprise me.

Good luck  to you all whatever treatment you choose.

Peter



last revised August 2006

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