gary.miller12@comcast.net wrote...snip...

Hi Gary...Which is better?  If only such simple, straightforward
questions could be easily answered.  How do you weight the importance
of preventing biochemical recurrence vs. quality of life (QOL).  The
answer to your question will also depend upon what kind of PCa is being
treated, low-risk or advanced.

Generally speaking, HIFU is much less invasive than surgery, so
recovery is much quicker.  Still HIFU can have high levels of
significant side effects such as impotence.  HIFU is also relatively
new, so long-term studies only extend out to about 5 years (so the
median time post treatment is even shorter) at this time.  A recent
review article summarized the situation with HIFU as follows: "Only
case series have been published; there are no randomized studies. The
quality of evidence is poor, with no reports having longer follow-up
than a mean of 2 years, with median follow-ups substantially shorter.
Efficacy outcomes are thus premature and preclude assessment. Toxicity
varies substantially with impotence rates 44%-61%, grade 2-3
incontinence 0%-14%, and rectal fistulae 0.7%-3.2%" (Can J Urol. 2005
Apr;12(2):2593-7; Technology review: high-intensity focused ultrasound
for prostate cancer)".  Still, for people who can't tolerate surgery or
radiation, for people seeking salvage therapy after failed radiation
therapy, or for people with advanced PCa who seek to debulk the tumor,
HIFU might be a reasonable choice.  Also, as time goes on HIFU may
improve further.  I'd ask the doc who treats with HIFU what his stats
are.

The robotic RP procedure is also a relatively new procedure and
long-term studies comparing its efficacy against that of the
traditional open surgical procedure do not yet exist.  Although most
expect the robotic procedure to produce similar long-term outcomes,
this has not yet been demonstrated.  For comparison, long-term
recurrence rates from the open procedure (M. Han, A. W. Partin, M.
Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169,
517-523, 2003) can be viewed at

http://www.prostate-help.org/download/jhnomo.pdf

I've added a few HIFU abstracts below, Uchida and Gelet are two
pioneers in this area, so their results should be among the best.
Finally, there is a lot more traffic at alt.support.cancer.prostate so
you may want to try posting there...Best wishes and good health, ron

Hinyokika Kiyo. 2005 Oct;51(10):651-8
Transrectal high-intensity focused ultrasound in the treatment of
localized prostate cancer: a multicenter study.
Uchida T, Baba S, Irie A, Soh S, Masumori N, Tsukamoto T, Nakatsu H,
Fujimoto H, Kakizoe T, Ueda T, Ichikawa T, Ohta N, Kitamura T, Sumitomo
M, Hayakawa M, Aoyagi T, Tachibana M, Ikeda R, Suzuki K, Tsuru N,
Suzuki K, Ozono S, Fujimoto K, Hirao Y, Monden K, Nasu Y, Kumon H,
Nishi K, Ueda S, Koga H, Naitoh S.
The Department of Urology, Tokai University Hachioji Hospital.

We report a multicenter trial with transrectal high-intensity focused
ultrasound (HIFU) in the treatment of localized prostate cancer. A
total of 72 consecutive patients with stage T1c-2NOM0 prostate cancer
were treated using the Sonablate 500TM HIFU device (Focus Surgery,
Indianapolis, USA). Biochemical recurrence was defined according to the
criteria recommended by the American Society for Therapeutic Radiology
and Oncology Consensus Panel. The median age and prostate specific
antigen (PSA) level were 72 years and 8.10 ng/ml, respectively. The
median follow-up period for all patients was 14.0 months. Biochemical
disease-free survival rates in all patients at 1 and 2 years were 78%
and 76%, respectively. Biochemical disease-free survival rates in
patients with stage T1c, T2a and T2b groups at 2 years were 89, 67% and
40% (p = 0.0817). Biochemical disease-free survival rates in patients
with Gleason scores of 2-4, 5-7 and 8-10 at 2 years were 88, 72% and
80% (p = 0.6539). Biochemical disease-free survival rates in patients
with serum PSA of less than 10 ng/ml and 10-20 ng/ml were 75% and 78%
(p = 0.6152). No viable tumor cells were noted in 68% of patients by
postoperative prostate needle biopsy. Prostatic volume was decreased
from 24.2 ml to 14.0 ml at 6 months after HIFU (p < 0.01). No
statistically significant differences were noted in International
Prostate Symptom Score, maximum urinary flow rate and quality of life
analysis with Functional Assessment of Cancer Therapy. HIFU therapy
appears to be minimally invasive, efficacious and safe for patients
with localized prostate cancer with pretreatment PSA levels less than
20 ng/ml.
PMID: 16285617

Nippon Rinsho. 2005 Feb;63(2):345-9
High-intensity focused ultrasound for localized prostate cancer
[Article in Japanese]
Uchida T.
Department of Urology, Tokai University Hachioji Hospital.

High-intensity focused ultrasound (HIFU) is a noninvasive treatment
that induces complete coagulative necrosis of a tumor at depth through
the intact skin. We evaluated a biochemical disease-free rate, safety
and morbidity for localized prostate cancer treated with HIFU. A total
of 132 consecutive patients with stage T1c-2N0M0 localized prostate
cancer underwent HIFU using Sonablate-500 (Focus Surgery, Indianapolis,
USA). The 5-year biochemical disease-free rate in all patients was 67%.
The 5-year biochemical disease-free rates for patients with a
pretreatment PSA less than 10 ng/ml, 10.01 to 20.0 ng/ml, 20.01-30.0
ng/ml and more than 30.01 ng/ml were 88%, 67%, 34% and 13% (log rank
test, p < 0.0001), respectively. HIFU therapy appears to be a safe,
efficacious and minimally invasive therapy for patients with localized
prostate cancer.
PMID: 15714990

Urology. 2004 Feb;63(2):297-300
High-intensity focused ultrasound for the treatment of localized
prostate cancer: 5-year experience.
Blana A, Walter B, Rogenhofer S, Wieland WF.
Department of Urology, University of Regensburg, St. Josef Hospital,
Regensburg, Germany.
OBJECTIVES: To report on our 5-year results with transrectal
high-intensity focused ultrasound (HIFU) in the treatment of localized
prostate cancer. HIFU delivers high energy, causing rapid coagulation
necrosis of tissue within the target area without damaging the
surrounding tissue.
METHODS: A total of 146 patients with biopsy-proven Stage T1-T2N0M0
prostate cancer have been treated using the Ablatherm device. All
patients had a prostate-specific antigen (PSA) level of 15 ng/mL or
less and a Gleason score of 7 or less (inclusion criteria). The mean
follow-up was 22.5 months (range 4 to 62) and included PSA measurement
and control sextant biopsies.
RESULTS: The median PSA nadir 3 months after treatment was 0.07 ng/mL
(range 0 to 5.67). The median PSA level after a follow-up of 22 months
was 0.15 ng/mL (range 0 to 12.11), and 87% of the patients had a
constant PSA level of less than 1 ng/mL; 93.4% of all patients had
negative control biopsies. One rectourethral fistula was noted after a
second HIFU treatment in a patient with a history of hemicolectomy and
repetitive anal fistulas. Of all the patients, 12% underwent
transurethral resection after HIFU because of obstruction, but no
severe stress incontinence (grade 2 to 3) was observed. Erectile
function was preserved in 47.3% of patients, and the International
Prostate Symptom Score and Quality of Life Index did not change from
before to after treatment.
CONCLUSIONS: Our results demonstrated the efficacy and low-associated
morbidity of HIFU. HIFU does not exclude other treatment options and is
repeatable. HIFU seems to be a valid alternative treatment for patients
who are not suitable for radical surgery.
PMID: 14972475

American Urological Association Annual Meeting
May 8-13, 2004
San Francisco, California, USA
Program#/Poster#: 830
Presentation Title: PROSTATE CANCER CONTROL WITH TRANSRECTAL HIFU IN
242 CONSECUTIVE PATIENTS: 5-YEAR RESULTS
Presentation Time: 5/10/2004 8:00:00 AM
Author Block: Albert Gelet, Jean Yves Chapelon, Laura Poissonnier,
Raymonde Bouvier, Olivier Rouviere, Ibrahim Bah-Clozel, Denis Lyonnet,
Jean Michel Dubernard. Edouard Herriot Hospital, Lyon, France, INSERM
Unit 556, Lyon, France, Edouard Herriot Hospital, Lyon, France

Introduction and Objective: To evaluate the 5-year results after HIFU
treatment for localized prostate cancer according to the
disease-related prognostic factors. Methods: All our patients treated
with HIFU as primary care for localized prostate cancer, with a
baseline PSA level = 30 ng/ml, and with at least 1 year of follow-up
were included in this analysis. They were treated using the Ablatherm®
HIFU device (EDAP S.A., France). Patients follow-up included sextant
biopsies and PSA level measurements. Any positive biopsy or 3
consecutive increases in the PSA level was considered as a failure for
the disease free rates (DFR) calculation.
Results: 242 patients fulfilled these criteria and were all considered
for analysis. The mean patients follow-up was 28 ± 21 months (range:
12 to 108 months). The population description before HIFU was: mean age
71 ± 5.4 years, mean prostate volume 32.4 ± 16.6 cc, mean PSA level
9.2 ± 5.8 ng/ml, and all had positive biopsies. The clinical stage was
T1 for 118 patients, T2 for 115 patients and T3 for 9 patients.
Neoadjuvant hormones were administered to 33 patients. The DFR were
calculated using the Kaplan-Meier method.
For the overall population, the mean nadir PSA was 0.63 ± 1.30 ng/ml,
and further follow-up evidenced a 81% negative biopsy rate, and a 63%
actuarial DFR at 60 months. These results were stratified according to
the disease-related risk, the initial PSA level and the baseline
Gleason score:

Prognostic Factors     n             DFR          p
Low-risk                    62            78%
Intermediate-risk      108            61%    p<0.01
High-risk                   72            47%

PSA (ng/ml)
0-7                           97       78%
7-15                        106       61%           p<0.0001
15-30                        39       44%

Gleason score
2-6                            144     70%
7                                67      60%           p=0.005
8-10                           31       37%
Adjuvant treatments were administered to 40 patients (17%) presenting
with rising PSA level with or without residual positive biopsies. For
17 patients with positive biopsies (10.2%), watchful waiting is still
justified due to the low (mean: 1.02 ng/ml) and slowly rising PSA level
(mean velocity: 0.31ng/ml/year). Conclusions: Transrectal HIFU is a
minimally invasive therapy with 5-year results similar to those
observed for the other non surgical options. The DFR is influenced by
the usual disease-related prognostic factors.