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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2005

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HIFU vs HDRB

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Clarence Crow - 31 Jul 2005 03:05 GMT
Hello again as I sit here in my 3rd week of catheterisation after
HDRB. This is due to my having an enlarged prostate and BPH for over
18 yrs, when I had a TURP done by a general surgeon.
I'm hoping to have this out tomorrow, Monday, 01 Aug., after a voiding
trial and bladder scan.

I saw some recent posts re HIFU, a new "high intensity focused
ultrasound treatment" presently only offered in Canada.
I researched this as much as possible on the web and have formed the
following opinions.

HIFU relies on vector focusing 2 ultrasound beams, from a trans-rectal
probe to various mapped points of collision to cause heat and thereby
destroy the tumour at those points. I cannot see how the whole of the
prostate could be image-mapped from the rectum to target the tumour
area and miss the surrounding vulnerable areas such as the urethra
etc. (they do not elaborate on how the prostate is image-mapped.)
There is only 1 session of approx. 3 hrs.
I noticed on one website they offered a "complementary TUIP", which
seems to admit they have a high occurrence of causing urinary
blockage.

Even though the 3 sessions of HDRB seemed a bit more rigorous, I
believe there was overall more control over the image-mapping and the
dosage planning and positioning. (I had my catheter needles checked
and moved in at each session to assure the Iridium 192 source was
traveling and dwelling in the same path in each of the 17 needles.)

The other comparisons between the 2 modes of treatment are largely
similar, viz:
1.     Full bowel evacuation
2.    Anaesthesia by Epidural plus possible General.
3.    Similar side effects.

In essence, I wouldn't fly to Canada if I was just starting out on
Options.

 
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c palmer - 02 Aug 2005 08:26 GMT
hi clarence - i waited a few days to see if anyone would post their
opinions on the two forms of treatment.

these two forms  -  HIFU and HDRB are as different as night and day, but
still are suppose to yield the same effect as the end result.

the theory of HIFU was one of the areas of my expertise.  basically what
they are doing in simple terms is adding and subtracting algebraically -
energy.  

picture two sine waves displaced by 90 degrees apart.  at the point of
intersection is where the two beams will interact with each other.  if
they are out of phase by 180 degrees, they will cancel each other and if
they are in phase at 0 degrees, they will add to the other's energy.
where this all comes into play is that you can pass 1/2 the damaging
energy needed into the body, it will not hurt the body's tissues because
the effects will be minimum.  but where the two sound waves collide will
cause a heat build up and hopefully, that is where the cancer cells are.
the kill the pca by physical temp and not by gamma radiation.

by the way, the 1/2 energy strobes is how the computer initializes a
memory cell and  leaves all other memory cells alone.  it's only at the
one crossing point that the information of that memory location is
accessed.   so, if you know how HIFU works, you've got a basic idea
about computer memory.

points of concern as it applies to the prostate.....

they are playing with a real 3-D model inside the human body.   they
have to be concerned with the X, Y and Z axis.

just as the computer has ONLY one memory location.  look at ALL the
locations this HIFU has to access. that is why the long period of time
involved.  this will explain how they are able to miss the urethra as
you had mentioned.

the skill level even goes further..... because you are playing with such
a high frequency called lambda which is the length of the frequency.  go
if i could  show physically, a frequency called X, this is what it looks
like.

I.............................................................I
I<phys. distance in a given time frame   >I


and if i could graph the point of the HIFU unit in human body to the
point of impact......

I.............................................................I
I<distance from HIFU unit to pca cell.....>I

but what happens when the next shot of HIFU is on the other lobe and
only at a  shorter distance.....

I........................................I

which means that the frequency of the HIFU has to be increased to
shorten the lambda distance to match the same physical distance AND it
has to be done on two units to make sure that the two wavelengths are in
phase exactly at the same time.

i think one can see how HIFU would be a difficult process in order to
treat pca.  although  it was developed in 1999, i don't want to sound
like i'm against the treatment.  all i'm explaining is how it works.

the HDRB uses a very high concentration of radiation that is introduced
into the prostate gland by tubes and the radiation is pulled through the
prostate gland at a prescribed rate as dictated by that individual's pca
positioning.  once the radiation is removed from the body - it's gone,
but the effects will still continue much like when one gets a sunburn.  

the advantage of HDRB is that radiation doesn't stay in the body like
seeds and HDRB can be used again, if needed.

i hope i explained what you were asking clarence and also hope i didn't
get too technical.   i was trying to keep it simple.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc
Clarence Crow - 03 Aug 2005 02:30 GMT
>hi clarence - i waited a few days to see if anyone would post their
>opinions on the two forms of treatment.
>
>these two forms  -  HIFU and HDRB are as different as night and day, but
>still are suppose to yield the same effect as the end result.
<snip>
curtis

I appreciate the detail you explained about HIFU, but still cannot
come to terms with the precision available to map from the rectum to
the prostate with ultrasound images, given that the prostate can move
approx +- 7mm, dependent on the bladder and other organs.
Additionally, all the ultrasound images I've seen are not very
distinct (to me, a layperson.)

I've already acknowledged the convergence /\ of the vectored
ultrasound beams in HIFU produce heat which destroys the tissue,
albeit malignant or not.

When I had my last (3/3) session of HDRB, one of the technicians
explained to me about the positioning and dwell times of the Iridium
192 seed as it was advanced along each catheter path. In particular,
he said the dwell was for it to generate a "bubble" on the path until
the entire prostate was filled with "bubbles", similar to blisters,
thereby killing all tissue, including the tumour within the prostate
and missing the urethra and other sensitive tissue. He informed me
that the 17 catheter needles were placed in 2 outer concentric circles
in the prostate. Admittedly, the Urologist begins placing the needles
by reference from a TRUS probe, but also plots from the slices of the
previous CT Scan/s. The urologist also performs a Cystoscopy after
placing the needles and to observe the internal bladder wall for
dimpling to see if any needles need pulling back. When he's satisfied
with that another CT Scan is performed to map and plan the whole HBRB
treatment. This is then X-Rayed as a benchmark, to ensure the Iridium
192 seed is on track and dwell for each needle-catheter.
At every session of HDRB a separate X-Ray is taken and compared to the
original one and the needles are adjusted to comply with the original
X-Ray.
I still seem to be sold on HDRB, but I did find another website on
HIFU which was more detailed and had some testimonials from guys who
had it done in Mexico.

http://www.internationalhifu.com/

(why do you think the FDA won't approve it for the US? Political or
other reasons?)


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c palmer - 03 Aug 2005 12:55 GMT
hi clarence - on HIFU, i think that the testing hasn't been done enough
to give good reliable results to the FDA's satisfaction.

i read what you said about the procedure that you had done, but the
major problem that i see with radiation,  is to kill the prostate and
leave the urethra in tact.

it doesn't make any difference if it is seeds are HDRB,  this same
problem still exist.  why?  because prostate cancer doesn't grow in the
same spot for each person.  for example,  what happens if the pca is up
against the urethra, next to the bladder or near the erectile nerves.
then, they are going to HAVE to place radiation there in order to save
that individual's life.  
as a whole.  there will be some who will fair out of these procedures
and think that they are the greatest, while there will be some that the
results will be less that satisfying and will have troubles.  this is
why it isn't a one shot fits all situation and each person has to feel
comfortable with their choice of treatment.

by the same point of view,  this is why explanations need to be given
for each procedure and both the positive as well as the negative sides
mentioned.  

as you pointed out the prostate can move + or - 7 mm during the
procedure, the skill of the operator is everything for a successful
outcome regardless of the type of radiating treatment - heat or
otherwise.

i do believe that they will end up using viruses to fight diseases.  i
know this works in heart disease and am reading about of the positive
things they can do with this type of technology to grow new arteries and
by pass clogged ones.  

hopefully, the treatment for prostate cancer won't be any surgery,
thermo, freezing or radiation, but merely a shot in the arm and you're
cured.  am i really that far off on my thinking?

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc
Clarence Crow - 04 Aug 2005 00:26 GMT
curtis

I've also discovered some places who are trialling immunotherapy,
where they actually harvest the tumour tissue, modify it with a killer
agent and inject it right back into you to search and destroy all the
cancer cells.

At present, it's under a Clinical Trial in Brisbane Queensland, but
here in the West, it is still at the University level.

http://www.qimr.edu.au/research/labs/chriss/

Our TGA is similar to your FDA in granting approvals.

BTW: does WebTV allow you to visit these urls?



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c palmer - 04 Aug 2005 04:48 GMT
BTW: does WebTV allow you to visit these urls?
========

hi clarence - webtv started out ahead of most technology back in 1994,
but over time, webtv has not kept up.   if webtv can not support it, it
flashes on the screen, "contains too much information to be shown"  or
"is not supported by webtv"

of course, there are a lot of things that are common place that webtv
can't access.

java script, WMV, psf, and a ton of other things.

that is why i'm slowing learning my laptop functions.  so, in time, i'll
be posting with a different addy...

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc
Clarence Crow - 04 Aug 2005 20:45 GMT
>BTW: does WebTV allow you to visit these urls?
>========
[quoted text clipped - 3 lines]
>flashes on the screen, "contains too much information to be shown"  or
>"is not supported by webtv"
<snip>
curtis
Here is an abstract from Baylor Research Institute outlining
Immunotherapy to  the Prostate by usage of "Dendritic Cells."

/begin
Treatment options for inoperable, advanced prostate cancer (PrCa) are
limited and immunotherapy represents an alternative. The discovery of
methods allowing generation of large numbers of dendritic cells (DCs)
prompted numerous clinical trials aimed at eliciting tumor specific
immunity. However, the optimal strategy for tumor antigen delivery to
DCs remains one of the key parameters that need yet to be determined.
Killed tumor cells, as a source of tumor associated antigens (TAA), in
the DC-based immunization offer a novel strategy that allows
presentation of both CTL and T helper epitopes. This may permit
presentation of multiple TAA epitopes and a diverse immune response
with multiple effectors including CD8 and CD4 T cells, NK cells and
macrophages, thus increasing the chances for in vivo tumor rejection.
Based on our in vitro results we propose that Dendritic cells loaded
with prostate cancer bodies can elicit prostate cancer-specific immune
responses in vivo. We propose a clinical trial in 15 HLA-A2.1 patients
with hormone-refractory prostate carcinoma who will be vaccinated with
autologous monocyte-derived DCs loaded with killed PrCa cell lines
(LnCAP and PC3). Aim 1: To determine safety and tolerability of DCs
loaded with killed allogeneic PrCa cell lines. Aim 2: To evaluate the
level of immune and clinical responses in patients vaccinated with DCs
loaded with killed allogeneic PrCa cell lines. This study will permit
us to establish the safety and tolerability of DCs loaded with killed
allogeneic tumor cells as a source of TAA. It will also permit us to
gain insights into the level of prostate cancer immunity induced by
DCs.
/end

All the best with your laptop endeavours :)

my real POP address: Neville Heathwood<nevdevATwestnetDOTcomDOTau>
[replace the uppercase with @,.,.]


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