Archive for the ‘Ultrasound’ Category

RENAL & UROLOGY NEWS: High-intensity focused ultrasound shows promise as a treatment for early-stage prostate cancer, according to interim study results presented at the seventh meeting of the European Association of Urology’s Section of Oncological Urology. READ MORE>

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JULY 6: NURSING TIMES.NET: UK research that found reasonably favourable results from high-intensity focused ultrasound (HIFU) treatment in 172 men with localised prostate cancer (cancer that had not spread) looks promising, but long-term studies are needed. READ MORE>

Current UK National Institute for Health and Clinical Excellence guidance advises that the evidence supports the safety and efficacy of HIFU for prostate cancer, provided that monitoring, audit and clinical governance of any procedures are carried out.

It advises that longer-term effects on survival and quality of life are unknown, and that doctors should therefore ensure that patients understand these uncertainties and the alternative treatment options.

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JULY 5: NEW PROSTATE CANCER INFOLINK: Now he’s had a chance to read the full report from a group of UK doctors detailing their experience with high-intensity-focused ultrasound treatment, NPCI administrator Mike Scott has changed his views of the outcome.

” The following commentary reports with greater accuracy and in more detail on the same article, dealing with the same series of 172 HIFU patients, as was previously discussed on this web site on July 2 this year, ” he writes. READ MORE>

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JUNE 6: URO TODAY: Three dimensional color Doppler imaging transrectal ultrasound (TRUS) may be used for prostate cancer screening while reducing unnecessary biopsies in men with elevated PSA levels. READ MORE>

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MAY 27:  NEW PROSTATE CANCER INFO-LINK:  New reports on HIFU (high-intensity focused ultrasound) treatment highlight the dangers of patients accepting new methods whose long-term effectiveness has yet to be proved. Mike Scott: “We expect many men to continue to elect HIFU as a treatment for prostate cancer. We expect many of these men to do well. We also expect a significant number to have significant problems and complications. As usual, caveat emptor!” READ MORE>

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MAY 25: STATESMAN.COM:  US researchers say they haven’t learned enough about HIFU (high-intensity focused ultrasound), which heats the prostate to destroy cancerous tissue yet to make judgments about it. And some have questioned the ethics of doctors being paid directly by a company for a procedure that must be performed in another country (ie, Mexico). READ MORE>

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MAY 22: PROSTABLOG NZ:  How many questions did you ask your doctor when you got the news you have prostate cancer? A dozen? More?

I can’t remember now, even though it was less than six months ago, but I’m guessing it would barely have broken double figures, even by the time I was on my third visit to the urologist.

Did you know there are at least 28 queries you should probably make, and another 22 if you’re looking at brachytherapy?

I know this from an excellent new book on prostate cancer just published by the Michael Dattoli and his colleagues in Florida – The Dattoli Blue Ribbon Prostate Cancer Solution:  How to survive and thrive without surgery (February, 2009).

DattoliBk 1It’s a 260-page manual on the latest techniques for treating prostate cancer, most of it written by Dattoli, whose pen portrait in the back says he is “a board-certified oncologist with more than 20 years of brachytherapy experience and has performed thousands of prostate implant procedures…a noted author and speaker in this complex field of medicine.”

Aha, perhaps I hear you say:  he’s biased towards radiotherapy and hence the tilt at surgery in the book title.

Maybe. I’m hardly in a position to judge, being merely a humble prostate patient, although one who has done a fair bit of journalistic investigation into the topic during recent recovery “downtime”.

This book seems to me to be very thorough in its examination of prostate treatments, research, survival and success rates, issues and dilemmas, and refers to every branch of the burgeoning field of treatment I’ve so far come across.

The case he puts for radiotherapy/brachytherapy and combined drug treatments (if needed), in the second half of the book, seems convincing to me.

Essentially, he’s saying that advances in radiotherapy equipment and techniques make its use so accurate and effective that people with aggressive tumours and/or cancer that’s got out of the prostate box are better served by his approaches than surgery or some of the many experimental but unproven (long-term) therapies now on offer (in the US, anyway).

The book reinforces for me how crucial it is to discover prostate cancer at the earliest possible time, since it is one version of cancer that can conceivably be “cured” when discovered at its least developed and aggressive stage.

At that point, it seems surgery is still as good an option as Dattoli’s approach, although he attacks the notion that getting it cut out is an end to the matter. It may not be, even with contained, low-aggression varieties like mine.

The book explores, and partially dismisses, many of the newer approaches, such as cryotherapy (freezing the tumour), hyperthermia (heating it), HIFU (high intensity focused ultrasound), many new drugs (because there is no long-term research done yet) and most versions of surgery.

He strongly advocates the latest approach to radiotherapy – four dimensional (the fourth is motion) intensity modulated (rather than short, high dose) radiation therapy (4D IG IMRT) – which he uses at his clinic, the Dattoli Cancer Center and Brachytherapy Institute of Sarasota, Florida.

With this complex treatment mode, he says the centre can achieve a very precise radiation attack on the tumour(s) with little collateral damage and few long-term after effects (depending, of course, on the patient).

It sounds very expensive. Pictures in the book show space-age technology, which obviously doesn’t come cheaply.

In a couple of discussions in the book, Dattoli borders on the disingenuous when he says centres using other kinds of expensive gear push its efficacy partly because they have big investments to recover.

That said, his record seems impressive, and 14 years of results are highly praised in an “independent” review by Charles E. Myers Jr MD, founder and director of a body called the American Institute of Diseases of the Prostate:

“Many men with intermediate to high-risk cancer treated [by Dattoli] with radiation to the prostate gland and pelvic lymph nodes with external beam radiation and seeds remain free of disease out to 14 years…Radiation therapy is consistently more effective when combined with androgen withdrawal. Faced with these facts, I can only conclude that radiation therapy can kill prostate cancer stem cells or in some way arrest their ability to go on to establish metastatic disease.”

Even ignoring the book’s main thesis (the superiority of 4D IG IMRT), it contains usefully detailed outlines of all aspects of prostate cancer, written in superbly accessible language. Everything is explained and translated for the layperson.

That alone makes it worth the read, although it’s not a quick read, given the fact-heavy nature of the explanations.

It contains other helpful material, including a guide to the foods we should eat (out goes my four-red-meat-meals-a-week diet) and a rundown on the latest drugs being trialled and/or used.

As a footnote, I should add that nothing I read in this up-to-date resource on prostate cancer makes me think I made the wrong decision electing radical prostatectomy. For me, it still feels 100% the right way to go. I believe I was well advised.

Further footnote: I’m interested to know how many of the treatment techniques canvassed by Dattoli are available in NZ. I suspect we trail by a long way, but perhaps there’s some advantage to that: we can observe how various developments pan out in what is undoubtedly the prostate capital (well, country) of the world.

And those 28 questions? I’ve reproduced them here, for those many men in the future who are going to get the bad news:

 Dattoli 1

Dattoli 3Copies of the book can be obtained from:

Dattoli Cancer Foundation, 2803 Fruitville Road, Sarasota, Fl 34237, US.

They cost about $US23 with postage included.

Read a 15-page extract from the book where Dattoli discusses hormone therapy: HERE>

Go to the Dattoli website HERE>

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NEW PROSTATE CANCER INFO-LINK: Prostate cancer control following targeted focal therapy (TFT) using cryotherapy or high intensity focused ultrasound (HIFU) should now be considered promising, according to a new study. The authors say TFT provides an alternative to active surveillance and more aggressive treatments for patients with low-risk tumors. READ MORE>

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