CancerCompass message board discussion started by ukguyinlv on 7/11/2008 http://www.cancercompass.com/message-board/message/all,25911,0.htm Sun, 23 Nov 2008 00:00:00 GMT Sun, 23 Nov 2008 00:00:00 GMT http://backend.userland.com/rss RSS.NET: http://www.rssdotnet.com/ Hi,I am a 53 year old white male and have just been diagnosed with prostate cancer. Right now off the top of my head I can't remember my PSA result, but can tell you that my Gleason score is 3+3=6. My urologist advised me of basically two options, either the complete removal of my prostate gland or radiation treatment / seeding. He did mention the new "HIFU" laser ultrasound treatment but said it was only available to me if I was to travel to either Mexico or the Bahamas and at a cost of $25,000. After some internet searching I am leaning to travelling to Japan as it is considerably less inexpensive..$8,000. The treatment would be with a hospital stay of three days. All of this is of course alittle new and overwhelming to me right now. If there is anyone who has had the HIFU treatment performed and can offer me any advice or insight I would be very greatfull. I may not be able to reply back right away as in the next week or so I will be in the process of changing my computer. Thanks in advance for any imput. ukguyinlv Fri, 11 Jul 2008 00:00:00 GMT hii saw your message.my husband has recently been diagnosed and we are in the process of applying for acceptance into a clinical trial for hifu. there are several locations around the country. sloan kettering and hackensack university are 2 that we are looking at getting into. i can't remember where i found the link to this study, but it may have been through cancer compass in their last newsletter. if you google hifu clinical trials, you will probably find it.good luckelise newwoman Fri, 11 Jul 2008 00:00:00 GMT  On 7/11/2008 ukguyinlv wrote:Hi,I am a 53 year old white male and have just been diagnosed with prostate cancer. Right now off the top of my head I can't remember my PSA result, but can tell you that my Gleason score is 3+3=6. My urologist advised me of basically two options, either the complete removal of my prostate gland or radiation treatment / seeding. He did mention the new "HIFU" laser ultrasound treatment but said it was only available to me if I was to travel to either Mexico or the Bahamas and at a cost of $25,000. After some internet searching I am leaning to travelling to Japan as it is considerably less inexpensive..$8,000. The treatment would be with a hospital stay of three days. All of this is of course alittle new and overwhelming to me right now. If there is anyone who has had the HIFU treatment performed and can offer me any advice or insight I would be very greatfull. I may not be able to reply back right away as in the next week or so I will be in the process of changing my computer. Thanks in advance for any imput.Hi, I had HIFU last June in Toronto, Can. with Maple Leaf HIFU with the ablatherm machine and went home the next day with some discomfort, mostly from the damn catheter. It did cost what you were quoted. I feel that I made the right decision as to which procedure to use, my only question is whether to have done anything but at 57 I thought that I had better do something; at 67 maybe not. Will give more info if asked. Vtmax Fri, 11 Jul 2008 00:00:00 GMT Elise,  Thankyou for your reply, I also did find some clinical trials taking place. I believe they were somewhere in North or South Carolina..Duke university hospital..??  Unfortunately they had already started or no longer needed volunteers. There were other trials coming up over in London, U.K. but those too certain criteria needed to be met, age, Gleason results etc.I'll definately keep searching and thanks again for your reply. Good luck to your husband, I'd be interested to follow his journey.   Alan. ukguyinlv Fri, 11 Jul 2008 00:00:00 GMT Hello vtmax,I was reading about a couple of patients who flew to Canada, can't quite remember exactly where they had the proceedure done now but..Can you advise or make any arguments +/- with going with the Ablatherm or the Sono500..??  Do you have to wear the bag externally for any short or long period ??  All the best with your recovery and keeping it at bay.   Alan.  ukguyinlv Fri, 11 Jul 2008 00:00:00 GMT  On 7/11/2008 ukguyinlv wrote:Hi,I am a 53 year old white male and have just been diagnosed with prostate cancer. Right now off the top of my head I can't remember my PSA result, but can tell you that my Gleason score is 3+3=6. My urologist advised me of basically two options, either the complete removal of my prostate gland or radiation treatment / seeding. He did mention the new "HIFU" laser ultrasound treatment but said it was only available to me if I was to travel to either Mexico or the Bahamas and at a cost of $25,000. After some internet searching I am leaning to travelling to Japan as it is considerably less inexpensive..$8,000. The treatment would be with a hospital stay of three days. All of this is of course alittle new and overwhelming to me right now. If there is anyone who has had the HIFU treatment performed and can offer me any advice or insight I would be very greatfull. I may not be able to reply back right away as in the next week or so I will be in the process of changing my computer. Thanks in advance for any imput.  folert2 Fri, 11 Jul 2008 00:00:00 GMT Hi, I was just diagnosed with prostate cancer....I am interested in any information about HIFU.....I understand they are doing this almost everywhere in the world but here in the US....I understand they are doing it in canada also....I found that thye do the procedure in Italy for 4400 euros.....Thanks jumpin johnny Fri, 11 Jul 2008 00:00:00 GMT  On 7/11/2008 folert2 wrote: On 7/11/2008 ukguyinlv wrote:Hi,I am a 53 year old white male and have just been diagnosed with prostate cancer. Right now off the top of my head I can't remember my PSA result, but can tell you that my Gleason score is 3+3=6. My urologist advised me of basically two options, either the complete removal of my prostate gland or radiation treatment / seeding. He did mention the new "HIFU" laser ultrasound treatment but said it was only available to me if I was to travel to either Mexico or the Bahamas and at a cost of $25,000. After some internet searching I am leaning to travelling to Japan as it is considerably less inexpensive..$8,000. The treatment would be with a hospital stay of three days. All of this is of course alittle new and overwhelming to me right now. If there is anyone who has had the HIFU treatment performed and can offer me any advice or insight I would be very greatfull. I may not be able to reply back right away as in the next week or so I will be in the process of changing my computer. Thanks in advance for any imput.Hallo: Just like you I was diagnosed with prostate cancer several months ago-after much research I decided to go to munich germany for hifu treatment- the klinik in munich under professor chaussy and thueroff  -the are doing the procedure for more than 12 years- I went there about 4 weeks ago- stayed in the hospital for 7 days - excellent care- the total cost about $ 15000.- Iam back in the states for 3 weeks- no complications- my first psa test will be by the end of june- why did I decide to go to munich and not to any other places -  In my opinion they have the longest experiance and the follow up care- it is my understanding that in the bahamas -mexico and also canada  they send you home the same day after hifu-PS: Just recently the hifu procedure was approved by the FDA in the U.S for clinical trials in different locations - since your cleason score is 6 you may qualify to participate   folert2 Fri, 11 Jul 2008 00:00:00 GMT I had my Sonablate HIFU treatment in Winnipeg, Manitoba, Canada. My procedure was done on March 29, 2008. This is a new Sonablate clinic that was set up in Feb of this year. I orginally was going to have the Ablatherm in Toronta, Ont. Canada but my prostate was just too large for that machine. The prostate had a volume of 43.5cc after 5 months of androgen deprivation therapy. The original volume of the prostate was 72cc.     I tried to refer people to the sites on Cancercompass but it seems that pasting the ip address does not work so I am going to paste the entire articles. This is a comparison of the Sonablate and Ablatherm HIFU system that I posted on this website under    HIFU Information & Cost Effective Treatment Locations (anyone treated in Philippines?)I had a Sonablate HIFU treatment on March 29th, 2008. I am in the process of recovery now. I was originally going to have the Albatherm in Toronto, Ont. Canada. It would cost $21,930 and that included them putting you up in a hotel for two nights. What happen is that my prostate had to be shrunk to 40cc or less from 72cc. After 4.5 months on Androgen deprivation therapy it only reach 43.5cc too large for their probe. They were getting a new probe that could do larger prostates but mine was at the limit of the probe so I did not want to risk having to do it again. The Toronto Albatherm clinic has good stats with only having to repeat two treatments in over 300. So I decided to go with the Sonablate which can do prostates as large as 50cc as a new clinic open in Winnipeg only a few hours drive for home, so no plane flight. The Sonablate cost was $22,000 and I had to pay for the hotel costs.    Complications      I had my suprapubic catheter (a catheter put through the abdomen wall above the pubic bone into the bladder) plug three times which require my having to go to the emergency to get it flushed and in third time a urethral catheter was inserted (through the penis). I did have problem with bladder spasms and pain during urination. These were all controlled with an anti spasmodic drug, Detrol LA, and anti inflammatory drug to reduce the prostate size. Apparently my large prostate with the subsequent swelling from the procedure--inflammation, cause the pain during urination. I have had no continent issues right from the beginning. The only thing which is common with HIFU is that you have a strong urgency to urinate and that is right now so you need to know where a bathroom is all the time. You will also need to go frequently as you are drinking a lot of water. These two things subside over two to four weeks. I am five weeks out of the operation and I have no catheter and only have some frequency to urinate during the night but that to will subside. The frequency is decreasing.Experience    The Sonablate doctors have to go through a course and it seems that they work with another Sonablate doctor for experience, but the more experience they have the better. Don't know about the Albatherm but I suspect it is similar.Differences and similarities    Both machines include a motion detector and a rectal temperature monitor. Because the machine is taking such as small strip of tissue and heating it to 80 to 90 degrees Celius you cannot have any movement as that would cause the machine to hit the wrong target. The motion detector causes the machine to shut off thus protecting the wrong tissue from being destroyed.       Both machines have the probe covered by a condom that has degassed water pumped in to swell the condom to make a tight fit to the rectal wall. The water is cooled to keep the transducer and rectal wall cool. This avoids any heat damage that may occur  to the rectal wall.      The Sonoblate machine has its transducer ( the sound emitting device) in a cylinder attached to the end of the probe. The transducer consists of two transducers one for deeper treatment and one for shallower treatment. The transducer moves within a cylinder at the end of the probe so the probe does not move once it is positioned. Both probes can be used to for treatment or imaging. The Sonablate machine takes images after each treatment shot so the doctor has a continuous upto date image of the prostate and any changes that occur during treatment. The prostate will swell with the first shot to increase in size about 10% at least that is what happened with my prostate. As pointed out the Sonablate has a doppler imaging system to give good color and identification of the nerve and vascular (blood vessel) bundles.        The Albatherm has one transducer at the end of the probe and it is fixed. The whole probe moves back and forth in the rectum during the treatment phase. The Albatherm can take only one picture at the beginning of the procedure as it requires a different transducer to take the image. That transduce must slide out into position while to treatment transducer is retracted. The imaging system can identify the nerve and vascular bundles.        The Sonablate procedure has the man lying on his back with his legs up in stirups. You are under a spinal but can also be under a sedation to make you sleep. However, in the Sonablate procedure a patient can in fact not take the sedation and so be awake through the whole process. I was awake during my procedure.      The Albatherm procedure has the man lying on his right side on the Albatherm table and he has both the spinal and the sedation for the procedure. No option to be awake.      Both have good result with incontinuence and erectile dysfunction. The Sonablate procedure has stats of 0.6% incontinuence. The Albatherm stats shows a 5 to 6% with most of that type I or II incontinuence which means the man will get a drop or two when he exerts himself in activities like lift a weight or swinging a golf club. Their stats show that a very small number may show a more serious type of incontinuence but this is very rare. Remember that Albatherm has better stats data that Sonablate as the Albatherm has been monitoring for a long time and Sonablate systems have not. Erectile dysfunction is stated at 20% but I think this is too high as the updated technology has improved the systems and the use of Cialis after the catheter is out will help regain the erectile function. I know that Sonablate treatment includes Cialis but the Albatherm as far as I have seen does not.   The Albatherm frequently will have the patient undergo a TURP (transurethral resection of the Prostate) in order to reduce the size of the prostate and apparently this also eliminates the pain after the treatment. The Sonablate system does not use the TURP. The TURP can cause its own problems and there is a risk of damaging the sphincters that control urine flow even though this maybe a low risk      The Sonablate machine takes a treatment strip that is 1 to 2 mm by 10 to 15 mm long while the Albatherm machine takes a strip that is 1 to 2 mm by 18 to 24mm long. The Sonablate system divides the prostate into 3 zones with each zone consisting of two blocks. The Albatherm does not appear to have zones but only blocks across the entire prostate. The Sonablate with its smaller strip length can get into tighter corners of the prostate.  This my story from this website under HIFU side effectsI was diagnosed with prostate cancer just by accident. I was in my family physician’s office for shoulder problem and I happen to notice in her office a plastic mount of the longitudinal section of a human male pelvis. I have a Ph.D in Zoology so I was interested in what the write up was about. So, I began to read about enlarged prostates and symptoms. I quickly began to realize that I had a prostate problem with intermittent urine flow and weak stream. I discussed these issues with her and she booked a blood test in Feb 2007. I discovered that the prostate was quite large but the PSA (prostate specific antigen) was only 3.3, not a problem. I was referred to an orthopedic surgeon and discovered that I need to have my right shoulder’s rotary cuff repair. After the surgery the enlarged prostate began to swell probably due to the drugs I had to take for the post operative care. The prostate closed off the urethra and within two days I was in the emergency room having a catheter inserted which I had to keep in place for five days. My family physician referred me to an urologist. The urologist routinely had a blood test done to check the PSA and had scheduled a scoping of the prostate through the urethra within a week or two. The blood test for the PSA was done in July, 2007 Several weeks later I had the scoping done but in the interim  my family physician received the report on the PSA reading from the urologist’s office and contacted me saying “Your PSA is high and the urologist will likely want to have a biopsy done.” After the procedure I asked the urologist about the PSA reading but he did not know anything about it. He checked with his office about my results from the PSA testing that he had ordered and his office contacted me to let me know that they had booked a biopsy for me to be done in about two months.            A week after the biopsy, I received a phone call from the urologist’s office informing me that I had prostate cancer and that I had an appointment the following Monday with the doctor to discuss my options. His office stated that this type of cancer was completely treatable but nothing else. When I got to the doctor’s office, the urologist came into the room and asked me what treatment I wanted. I asked for information on the possible treatments and their advantages and disadvantages only to get a reply that I was informed by his office so that I could look on the internet and research what my option were. The best that I could get from him was that there are two basic types of treatments –surgical removal and radiation treatment. He would not give me any information as to which was better or what are the side effects of each type of treatment. Due to my zoological background I was quite familiar with the anatomy of the male reproductive system, the accompanying structures, their positions in the body and the possible damage that could occur from any invasive procedure. I point blank asked about the differences between the two procedures with regard to problem of incontinence and erectile function but he stated that they are just the same and indicated that it was my decision. No further information would he offer me. I later found out from another urologist that radiation therapy is not recommended for a man of my age, 60 years old. Instead it is used for much older men (in their eighties) as the peripheral damage to tissue would not be a problem; assuming that these men would have died before the problems from that type of procedure would become an issue—not a pleasant prespective.             This had all taken place in September, 2007. I decided to look on the internet since that was the only thing this urologist offered and I stumbled upon the HIFU, specifically the Ablatherm. After reading the information on this procedure I decided to go with this method as it offered the least peripheral damage from the procedure. Incontinence was considered to be 5% of only type 1 and 2 incontinence which means that one would dribble a little urine when one would put a strain on the abdomen like golfing or lifting heavy weights. Erectile dysfunction was down to 20% or less when the nerve bundle sparing procedure was implemented. This procedure is always done unless there is an issue with the nerve bundles being to close too the prostate then it may not be possible. As far as I could ascertain, it seems as if all the Ablatherm procedures incorporate the nerve bundle sparing technique.            I contacted the Toronto Albatherm and after some discussion my prostate which measured 72cc had to be reduced to 40cc. This was to be accomplished by the use of hormone therapy. Dr. O prescribed Zoladex implant and Casodex pills for ten weeks but I had to get my urologist where I lived to prescribe this treatment. I was surprised and happy that my urologist agreed to do it even though he did not want anything to do with the post operative care or anything at all to do with HIFU. At the end of 9 weeks I needed to have the prostate measured. So I arranged to get it measured and on December 20th, 2007 the procedure was performed. My prostate size was reduced to 45.5cc good but not low enough yet. So, after a brief discussion with Dr. O I was to continue the Casodex treatment for one more month and get measured again. Unfortunately, the prostate did not reduce very much at all, only one cc less. Dr. O changed the prescription to Avadart and I was on the combination of Avadart and Zoladex for 6 weeks. At the end of the 6 weeks the prostate was measured and again only dropped one cc and now measured 43.5cc. In all cases three sets of measurements were taken and three volumes of the prostate were calculated. The numbers I have given are the average of those three volumes. The prostate measurement was still too high but when I contacted Toronto Dr. O mentioned that they were getting a new probe which would allow them to do larger prostates. The smallest dimension of my prostate was 38mm which was the upper dimension limit of the new probe. I decided not to go with the Ablatherm as I did not want to take the chance of having to undergo the procedure a second time. Dr. O’s stats showed that he had only needed to redo the treatment in two cases in over 300 so his results were excellent but again with my prostate size at the upper limit I felt that would increase my chances significantly of needing a retreatment.            While this was going on I continued to search the internet about treatment options and symptoms to see if something could have alerted me to the problem earlier; pain during ejaculation was one thing I had but did not realize it was an issue. In my search I came across the Sonablate system and was amazed that it had so many locations in the US and Mexico and even one in Toronto as well. I contacted the US HIFU and discovered that they were opening three more treatment centers in Canada: Winnipeg, Niagara and I think Montreal. The Winnipeg center was within a 7-hour drive for me and so no plane flight needed. I was apprehensive about this technique as I got the impression that the doctor was moving the probe manually within the rectum for each treatment. After talking to the nurse at US HIFU she made me aware that the probe in only adjusted by the doctor in order to get a complete image of the prostate. After that the probe moved mechanically within a cylinder within the condom filled with cooling water. Unlike the Ablatherm which moved back and forth in the rectum for each plane of treatment the Sonablate probe did not move again only the transducer moved in its cylinder. Also the Sonablate system has continuous monitoring of the prostate image during the procedure so that changes can be made due to the swelling of the prostate once the burning process has started.            The nurse took my phone number and passed it to Dr. D in Winnipeg saying he would contact me later that day. That evening I received his phone call. He spent over half an hour talking to me and my wife answering questions and giving information about the procedure. I decided to go with this procedure feeling that it was even better than the Ablatherm. After reading Internet testimonials on the HIFU message site about sedation options I realized that I could get a spinal and avoid the sedation since any sedative or anesthetic tends to knock me out for a very long time. I contact the Maples Surgical unit, where the HIFU treatment was to take place and arranged to have the anesthesiologist contact me. That same day I received his phone call and we talked about my sensitivity to anesthetics and I was able to arrange to have no sedation administered.             Before I left for Winnipeg I needed to get my prescriptions for use after the procedure as well as a pair of anti-embolism stocking—thigh high. I went to a drug store with the idea of just picking up a pair off the counter. To my surprise there were several tensions of stocking and I had to get measured in order to get the right size. I checked back with US HIFU for specifics on tension of stocking. I was to get the lowest tension—16 to 20mm of Hg (mercury). I went back to the drug store to be measured. The drug store did not have the correct one in stock but the store would order them for me and they would arrive within a week. I still had plenty of time to wait for the order which arrived in 8 days. Now, I had everything I needed for the procedure—the four prescriptions and the anti-embolism stockings.            I arrived in Winnipeg by myself due to some mix up. My wife was initially going to accompany me but the person who was going to look after our place could not do it at the last minute so I contacted the US HIFU to see if it would be okay for me to come alone since I was not going to have any sedation which seemed to be alright. Unfortunately, upon my arrival I discovered that legal issues make it essential that all patients must be accompanied by an adult. Everything is set for the procedure with a number of HIFU personnel having been flown in to assist the doctor. The administrator of Maples Surgical Center did some scrambling and was able to arrange through some business to have someone stay with me for the next 16 hours after my procedure. So, my treatment day remain as scheduled.            Just before the procedure I met with the doctor and the anesthesiologist and the nurses. The doctors informed me that I must be perfectly still during the procedure as the machine takes very minute strips of prostate tissue and burns it with the ultrasound. The Sonablate machine is very sensitive to any movement as it could change the position of the probe and not hit the target prostate tissue. The anesthesiologist stated that he would not give me sedation but because the procedure can take several hours I might have some discomfort lying in one place for so long, so all I would need to do would be to ask and he would give me a very small amount of the sedation just enough to eliminate the discomfort but should not put me to sleep. As it turned out I was on the table for 5 hours and did not need any sedation. I must admit that keeping still was not as difficult as I thought that it might be. I was not supposed to move even my arms. The first step of Dr. D was to measure my prostate, and low and behold the prostate measured 34.5cc. I was not taking any treatment other than I still had the Zoladex implant. This measurement left me with a very unusual feeling in that God wanted me to have the Sonablate HIFU system because if my prostate measured 34.5 cc I would have gone to Toronto. The Winnipeg center did not open until February, 2008 and I had started the process of getting prepared for the procedure in October, 2007. The Sonablate HIFU divides the prostate into six blocks in three tiers so that the treatment strips are short and much easier to get into the smaller areas of the prostate.   My cancer was centered in the apex of the prostate where the capsule is thinnest and folds so some cancer cells could escape. Dr. D completed the treatment but wanted to make sure that no cells were missed in the small neck of the apex. He stated that the hormone treatment should have destroyed any cancer cells that might have escaped as those cells require testosterone to live but the stem cancer cells within the prostate would not die with a lack of testosterone, so, he created a seventh block (which is possible since the treatment strips are much smaller then the Ablatherm) in the very apex to clean out anything that was there.            After the procedure I was able to get dressed and sit in a recliner chair until my escort arrived. I did run into some problems with pain later in the day but Dr D and the administrator of Maples Surgical unit were keeping in contact with me. Dr. D tried to phone me the next day but I was not in the original motel room that I had stated. However, I had Dr. D’s cell phone and was able to contact him and he quickly replied to make changes and prescribe pain killers for me. Even after I got home I was able to contact Dr. D and he continued with a follow up. He also made arrangements to have another urologist available in my city that I could contact if problems arose. The pain killers eliminated my pain problems within a day or two and after a week I no longer require them. You can also go to www.yananow.net and look under HIFU  and TV for the discription of my procedure. I hope some of this will help you with your decision. I consider HIFU the best way to go for treatment of Postate cancer. One may have some problems afterwards but they are minor and do disappear whereas some of the other treatments could have problem side effects that stay with you.   DocTV Fri, 11 Jul 2008 00:00:00 GMT  On 7/11/2008 ukguyinlv wrote:Hi,I am a 53 year old white male and have just been diagnosed with prostate cancer. Right now off the top of my head I can't remember my PSA result, but can tell you that my Gleason score is 3+3=6. My urologist advised me of basically two options, either the complete removal of my prostate gland or radiation treatment / seeding. He did mention the new "HIFU" laser ultrasound treatment but said it was only available to me if I was to travel to either Mexico or the Bahamas and at a cost of $25,000. After some internet searching I am leaning to travelling to Japan as it is considerably less inexpensive..$8,000. The treatment would be with a hospital stay of three days. All of this is of course alittle new and overwhelming to me right now. If there is anyone who has had the HIFU treatment performed and can offer me any advice or insight I would be very greatfull. I may not be able to reply back right away as in the next week or so I will be in the process of changing my computer. Thanks in advance for any imput. Hi I had HIFU treatment for my diagnosed prostate cancer in January of 2007 when I was 67. This treatment is delivered by High Intensity Focussed Ultrasound, not laser.The high energy ultrasound beam is transmitted from a device inserted into the rectum while the patient is under general ansthetic – the direction, focus point and intensity of the beam is contolled by the surgeon from a constant computer scan of the prostate to be treated. The energy destroys the appropriate part of the gland, and because it is so precisely contolled there is likely to be less concomitant damage to the genito-unrinary nerve bundles which pass through the prostate (which normally is about wallnut sized). The process takes about three hours – the general anaesthetic is necessary because the subject must not move during treatment.There was another minor procedure carried out which aided the urethra to cope with passing the necrotic material (destroyed prostate material) with the urine.I was in hospital for two days only initially and was sent home with a catheter tube to the bladder through the penis.  I returned to hospital a week later for one day for tests and removal of the catheter, (Ow!) the only painful bit of the process.There was a certain amount of discomfort for a few weeks (it was major procedure after all) but gradually all returned to normal, and the greatest pleasure following recovery was being able to pass water at full flow once more!For over a year there has been a certain degree of erectile disfunction, but happily this is gradually 'rectifying' itself and without any medication aids. The procedure does destroy the means of producing seminal fluid so that any future orgasms are 'dry', but none the less pleasurable.I had a small problem some 18 months after the procedure when I had a little difficulty in passing some late released necrotic material, but that is all.My PSA count has been constantly less than zero since the procedure – previously it had been betwen 16 and 18. I was very lucky in that my procedure was done as part of a trial at a hospital in Stockport (near Manchester), and therefore part of our 'free' National Health Service.Hopefully the procedure will eventually become one of the standard procedures provided by the National Health Service, which I earnestly hope it might. There is no 'knife' surgery involved, no chemicals, no radiation, and no hormones – just very 'loud' sound, and because of its nature destroys only that tissue on which it is focussed – nothing before and nothing beyond.I find it almost criminal that men with prostate cancer are expected to pay so much for this treatment if their only option is have to purchase it as a private patient. I feel very privileged and lucky to have had the opportunity for having been given the choice of this prostate cancer procedure. Hope this is of help. L  ldugarde Fri, 11 Jul 2008 00:00:00 GMT Hello again to all,I'd really like to thank everyone for there imput regarding their advice / experiences with the HIFU ( High Intensity Frequency Ultrasound ) . Discussing things with my wife, we both were / are alittle concerned about volunteering for the HIFU here in the U.S. due to the surgeons not being fully experienced ...what do others think?  Also this question may seem rather a stupid one, but due to me being a new member of the prostate cancer club feel it's o.k. to make a fool of myself !  After being informed of my condition by my urologist he said that right now it is very microscopic, and probably my health would be fine for maybe the next 1 to 3 years, but still he insisted on me scheduling to see him on the 30th of this month (July) to give him my decision..it seems to me that he may be pressuring me into a fast answer to have my prostate removed for his own financial gain ! Which leads me to my possible "stupid" question..If i were to get a second opinion would it involve a completely new set of tests and yet more biopsies taken, and more importantly if so by taking more biopsies from my prostate could it cause my cancerous cells to spread ??  Maybe a strange question to ask but does anyone out there have any answers or suggestions..Thanks again for all of the past and hopefully future imput.   Alan.   ukguyinlv Sat, 12 Jul 2008 00:00:00 GMT UKguy here once again with yet another question..!  To all that have travelled either beyond the U.S. or a great distance to participate in the HIFU studies / proceedures, how do you manage regarding follow-up visits..do you return to whereever it was performed or do your local urologists support you even if they are not well versed with the proceedure ?? ukguyinlv Sat, 12 Jul 2008 00:00:00 GMT Hi Alan, no I can't reccomend one procedure over the other; both sides claim the same arguments as to why theirs is better. When I said last June, I meant June 07. I had the external bag for 12 days. If you do this I can give some sage advice as to how to be more comfortable; hot tips so to speak.  max Vtmax Sat, 12 Jul 2008 00:00:00 GMT From what I have read there is a chance that biopsies can spread the cancer outside the capsule when it is confined to the prostate. One person on www.yananow.net site feels that is how his cancer spread. According to several members in the www.yananow.net site you can request that you biopsies be sent to any other doctor and clinic for a second opinion. In fact they all state that you should do this as there can be errors in reading the resuls. In the above site there is one gentleman who was diagnosed with prostate cancer and then he sent the slides to the John Hopkins cancer clinic to a prostate cancer specialist--I think his name was Bahn, who after reading the result stated that he did not have prostate cancer. From the people on the yananow site there is apparently quite a wide range in diagnostic results from biopsies. Oh an by the way your questions are not stupid questions but quite intelligence questions but most people are reluctant to see another doctor because they think that it would offend the first doctor. When it comes to your life and health, a good doctor would say seek a second or third opinion whereas a bad doctor would not want that because he does not want you to have a sound background on the topic so that you cannot question any of his decisions--be they good or bad.One of the biggest problems with the HIFU is getting support. In both systems they have a 1-800 number that is manned all day where you can asked questions and get help from nurses that are involved with the HIFU treatments. This nurses can be quite knowledgeable but you can also get a nurse that is new to the HIFU system and may not be able to give you much if any help. I know that the Ablatherm HIFU in Toronto has excellent nurses for their type of treatment. Also the Sonablate in Toronto also has a superb nurse that help me with all the issues that I was experiencing. Unfortunately, if you can get a urologist at your home city to do the follow up, it would be so much easier and less stressful. I was not so lucky to have an urologist but only my family physician who did an excellent job but had limited knowledge as she was not an urologist. I was lucky to get referred to a Sonablate nurse in Toronto when my assigned nurse was not helping me at all. This nurse in Toronto has 30 years experience and could answer all my questions and give suggestions on what to do to correct all the issues that I was experiencing. As it turned out they problems were not major problems but minor problems that just needed adjustment in medicine dosages. DocTV Sat, 12 Jul 2008 00:00:00 GMT Several others have referred to Canada (where I live). Clinics are now open in Winnipeg, Toronto, Niagara Falls and Montreal.http://www.internationalhifu.com/hifu-centers-to-help-treat-  Here are the benchmarks:Success determined as PSA < 0.5 ng/ml at 3 months    Low risk patients defined as having all of the following characteristics: Stage T1 & T2 prostate cancer Gleason 6 or 7 (3+4) PSA < 10 Volume less than 40 cc.(Note as far as I know these are very very similar to brachtherapy)   Sonbolbast is one of the companies and I'm sorry but I can't remember the name of the other company (Ablatherm?) Ramney Sat, 12 Jul 2008 00:00:00 GMT Ramney,Thanks for your response and once again a big thankyou to everyone for your continuing support / advice. To the volunteers who have been accepted so far for the HIFU proceedure in the U.S. or elsewhere for that matter, is there any financial outlay and if so how much compared to say travelling to Canada ?? ukguyinlv Sun, 13 Jul 2008 00:00:00 GMT The cost for the Ablatherm in Toronto was $21,930 Canadian. The cost for the Sonablate in Winnipeg was $22,000 Canadian. If you get into a trial in the US, I don't know if you would have to pay for it or not. Some patients have gone to Germany and other countries and paid a lot less for the procedure but I don't know what the cost of travelling and staying in a hotel would add to the basic cost. DocTV Sun, 13 Jul 2008 00:00:00 GMT TVDoc,  Thanks alot for your answers and advice. I notice that you are a faithful follower / blogger (?) along with quite afew others and I cannot express my gratitude to yourself and everyone for their imput. All replies are really appreciated. Up 'til now I am thinking of the watchful waiting  stage until I can get a second opinion. I will be searching for upcoming chances to volunteer although as stated earlier am alitle wary of the person performing the HIFU lacking in experience. Failing that I will probably head for Japan as they have been using the HIFU proceedure since 2004, and it is considerably less inexpensive ( around $8000 U.S. ) also it will help that my wife is Japanese.Thanks again to you and everyone.    Alan. ukguyinlv Mon, 14 Jul 2008 00:00:00 GMT Hi UK chap If you would like to discuss HIFU in the UK in some detail, please ring 01761 415570.  We have lots of experience of HIFU treatments and shoud be able to offer you good free advice.  Nick Thu, 24 Jul 2008 00:00:00 GMT Hi there Nick,Where are you located exactly and when would be the best time to give you a call..?? ukguyinlv Sat, 26 Jul 2008 00:00:00 GMT We are based in Bristol but organise HIFU treatments all over the UK.  We have a network of 26 surgoens who perform the HIFU treatment, with some as "free" NHS treatments and others just in the private sector.Please call during 9.00am to 5.00pm Monday to Friday on 01761  415570Look forward to hearing from you. Nick Nick Sat, 26 Jul 2008 00:00:00 GMT Hi Alan,My husband was diagnosed here in Tennessee with cancer on June 4, his psa was 4, his gleason was 6, and he is titled as low grade, low volume. We too were offered the HIFU option in the same cities as you. His urologist performs in both countries and were very excited, until we spoke with Vanderbilt, which is doing a clinical as well. My husband is young like you, 50 yrs old. Great physical condition, but to our dismay is not a good candidate for HIFU. Here are the reasons: Europe started this procedure first and are beginning to get some results back and the findings are that the patients are seeing a re-occurence in the cancer between 7-10 years post treatment. There fore the age range that is best for this treatment is over 65. Surgeons refuse to do surgery (radical-retro-pubic prostatectomy) after HIFU, because the HIFU can actually push the cancer cells outside the prostate capsule( which is where most of the low grade cancers are confined to) Once the cancer cells have been compromised, the only other alternative would be radiation. With this in mind, we have decided to go with the radical (nerve sparring technique). I wish you the very most of luck with your treatment options. Please feel free to write back if you have any questions.Michelle      Loved one has IT! Mon, 28 Jul 2008 00:00:00 GMT  On 7/28/2008 Loved one has IT! wrote:Hi Alan,My husband was diagnosed here in Tennessee with cancer on June 4, his psa was 4, his gleason was 6, and he is titled as low grade, low volume. We too were offered the HIFU option in the same cities as you. His urologist performs in both countries and were very excited, until we spoke with Vanderbilt, which is doing a clinical as well. My husband is young like you, 50 yrs old. Great physical condition, but to our dismay is not a good candidate for HIFU. Here are the reasons: Europe started this procedure first and are beginning to get some results back and the findings are that the patients are seeing a re-occurence in the cancer between 7-10 years post treatment. There fore the age range that is best for this treatment is over 65. Surgeons refuse to do surgery (radical-retro-pubic prostatectomy) after HIFU, because the HIFU can actually push the cancer cells outside the prostate capsule( which is where most of the low grade cancers are confined to) Once the cancer cells have been compromised, the only other alternative would be radiation. With this in mind, we have decided to go with the radical (nerve sparring technique). I wish you the very most of luck with your treatment options. Please feel free to write back if you have any questions.Michelle     Hi there Michelle,Thankyou SO much for your response. I DO have another question for you...how did you find out that your husband was not a candidate for the HIFU..??  How could I find out also..would it mean leaving the country first to speak face to face as it were with a HIFU specialist? Do you have any names of HIFU specialists that I could possibly call to discuss my candidacy(?) All the best to yourself and your husband and thanks once again..   Alan.  ukguyinlv Wed, 30 Jul 2008 00:00:00 GMT  On 7/30/2008 ukguyinlv wrote: On 7/28/2008 Loved one has IT! wrote:Hi Alan,My husband was diagnosed here in Tennessee with cancer on June 4, his psa was 4, his gleason was 6, and he is titled as low grade, low volume. We too were offered the HIFU option in the same cities as you. His urologist performs in both countries and were very excited, until we spoke with Vanderbilt, which is doing a clinical as well. My husband is young like you, 50 yrs old. Great physical condition, but to our dismay is not a good candidate for HIFU. Here are the reasons: Europe started this procedure first and are beginning to get some results back and the findings are that the patients are seeing a re-occurence in the cancer between 7-10 years post treatment. There fore the age range that is best for this treatment is over 65. Surgeons refuse to do surgery (radical-retro-pubic prostatectomy) after HIFU, because the HIFU can actually push the cancer cells outside the prostate capsule( which is where most of the low grade cancers are confined to) Once the cancer cells have been compromised, the only other alternative would be radiation. With this in mind, we have decided to go with the radical (nerve sparring technique). I wish you the very most of luck with your treatment options. Please feel free to write back if you have any questions.Michelle     Hi there Michelle,Thankyou SO much for your response. I DO have another question for you...how did you find out that your husband was not a candidate for the HIFU..??  How could I find out also..would it mean leaving the country first to speak face to face as it were with a HIFU specialist? Do you have any names of HIFU specialists that I could possibly call to discuss my candidacy(?) All the best to yourself and your husband and thanks once again..   Alan. Hi Alan,Since I don't know where you live, I'm going to go with this assumption that it's in the USA :). You can google Clinical trials performed in usa, and it will give you a listing of the on-going trials. Vanderbilt in Nashville is only about 3 hours from us and I called their Clinical trials department and spoke to a Pam Steele. She is the director of the trials being performed there. I think there is also one being conducted at Duke in North Carolina and I believe her name is Jill. They will talk with you and take your history, and explain most all about the procedure. He first of all was too young. He is 50 and I think you have to be at least 60 before they will even consider you. A lot of that infomation is also on the website on the Clinical trial page. My husbands doctor actually does the HIFU, so he put us in contact with the North Carolina division of HIFU that uses the sonoblate and that is where we found out the locations of the surgery sites which were Cancun, Puerta Viarta and Nassau. Their phone number is 704-332-4308. A nurse from that facility as well as a HIFU engineer, a DR. George Suarez(inventor of the sonoblate) and my husbands personal physician all fly down with you. They have certain wkds of the month that they travel to these countries, you just pick the place and they schedule you. they even help with the hotel and the airfare. A really class A production. They will still do Ted's HIFU, we were just trying to find a clinical so we didnt have to pay the 25K fee associated with this surgery. After we found out that the doctors as Vandy were concerned with the cancer returning after the procedure has been done on such young men in Europe, we are still leaning more toward the radical.  Please let me know if  this helps you out.  Best of LuckMichelle      Loved one has IT! Wed, 30 Jul 2008 00:00:00 GMT Alan. It's Michelle again, Here is a link to the site I told you about that 8 you wHere Clinical trials are being performed at in each state.    http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=4 Good Luck  Loved one has IT! Wed, 30 Jul 2008 00:00:00 GMT  On 7/30/2008 Loved one has IT! wrote: On 7/30/2008 ukguyinlv wrote: On 7/28/2008 Loved one has IT! wrote:Hi Alan,My husband was diagnosed here in Tennessee with cancer on June 4, his psa was 4, his gleason was 6, and he is titled as low grade, low volume. We too were offered the HIFU option in the same cities as you. His urologist performs in both countries and were very excited, until we spoke with Vanderbilt, which is doing a clinical as well. My husband is young like you, 50 yrs old. Great physical condition, but to our dismay is not a good candidate for HIFU. Here are the reasons: Europe started this procedure first and are beginning to get some results back and the findings are that the patients are seeing a re-occurence in the cancer between 7-10 years post treatment. There fore the age range that is best for this treatment is over 65. Surgeons refuse to do surgery (radical-retro-pubic prostatectomy) after HIFU, because the HIFU can actually push the cancer cells outside the prostate capsule( which is where most of the low grade cancers are confined to) Once the cancer cells have been compromised, the only other alternative would be radiation. With this in mind, we have decided to go with the radical (nerve sparring technique). I wish you the very most of luck with your treatment options. Please feel free to write back if you have any questions.Michelle     Hi there Michelle,Thankyou SO much for your response. I DO have another question for you...how did you find out that your husband was not a candidate for the HIFU..??  How could I find out also..would it mean leaving the country first to speak face to face as it were with a HIFU specialist? Do you have any names of HIFU specialists that I could possibly call to discuss my candidacy(?) All the best to yourself and your husband and thanks once again..   Alan. Hi Alan,Since I don't know where you live, I'm going to go with this assumption that it's in the USA :). You can google Clinical trials performed in usa, and it will give you a listing of the on-going trials. Vanderbilt in Nashville is only about 3 hours from us and I called their Clinical trials department and spoke to a Pam Steele. She is the director of the trials being performed there. I think there is also one being conducted at Duke in North Carolina and I believe her name is Jill. They will talk with you and take your history, and explain most all about the procedure. He first of all was too young. He is 50 and I think you have to be at least 60 before they will even consider you. A lot of that infomation is also on the website on the Clinical trial page. My husbands doctor actually does the HIFU, so he put us in contact with the North Carolina division of HIFU that uses the sonoblate and that is where we found out the locations of the surgery sites which were Cancun, Puerta Viarta and Nassau. Their phone number is 704-332-4308. A nurse from that facility as well as a HIFU engineer, a DR. George Suarez(inventor of the sonoblate) and my husbands personal physician all fly down with you. They have certain wkds of the month that they travel to these countries, you just pick the place and they schedule you. they even help with the hotel and the airfare. A really class A production. They will still do Ted's HIFU, we were just trying to find a clinical so we didnt have to pay the 25K fee associated with this surgery. After we found out that the doctors as Vandy were concerned with the cancer returning after the procedure has been done on such young men in Europe, we are still leaning more toward the radical.  Please let me know if  this helps you out.  Best of LuckMichelle     Alan,Here is the site where you can find what clinical trials being offered.http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=4   Loved one has IT! Wed, 30 Jul 2008 00:00:00 GMT Hello once again Michelle,Thanks for your prompt response from my last post. I just returned from my visit with my urologist this afternoon, after he insisted that I return to let him know what proceedure I was planning on. However, I came out of his office maybe alittle more relieved but also confused, hence my determination to get a second opinion!  My PSA is 0.6 and my Gleason score is 3+3=6. Also my PCA3 is 38.4.  At first he had told me that although my cancer is microscopic it is aggressive. After todays visit he said that I have plenty of time to decide what to do ..CONFUSING and IRRITATING INDEED !!  When I mentioned the HIFU treatment to him he remarked that although he knew little about it, he DID say that there were alot of complications, again not giving me any examples.. In September he said that he would be travelling to the Bahamas for HIFU training... For now I have decided to go with the " watchful waiting " while I try to locate another urologist for the second opinion. All being well this can be done before I decide on my next visit to Japan at the end of the year. I did notice those trials that were taking place here in the U.S., but like you mentioned, I too believe that I was too young (53)  Thanks for all of your information ( I had heard of Dr Suarez actually ) and I wish your husband all the very best. Please try to update me with his condition should you have the time. Regards,  Alan ukguyinlv Thu, 31 Jul 2008 00:00:00 GMT