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