High Intensity Focused Ultrasound, from a Patients Point of View.
I chose to have my prostate cancer treated with HIFU, high intensity focused ultrasound. On Sunday, July 23, I had my prostate treated at a clinic in Toronto, Canada. It was necessary to go to Canada, because, although this procedure is used around the world, including Europe, Russia, South Korea , Japan, South Africa and some Latin American nations it has only just been approved by the FDA for clinical trials, which will not start yet for half a year to two years out.
It was an outpatient procedure which took approximately seven hours from the time I arrived at the clinic in the morning until I came out of the anesthesia and was steady and sound enough to walk out of my own accord and across the street to the hotel at which I was staying. That night, although I felt that I had best stay in, I ate a light dinner and stayed up until midnight watching TV and rather antsily pacing the suite.
I had traveled to Toronto four days before the procedure in order to tour a bit, walking this wonderful city of endlessly captivating neighborhoods. For folks in the West, it is done in Puerto Vallerta, in both cases in American owned and run clinics. The afternoon before the procedure I met with the medical staff, which through a stroke of luck and friendship, included a urologist from Milwaukee who had become interested in the procedure and wished to view it.
(Ultimately, he was so impressed that he is thinking of coming out of retirement and working with HIFU himself. Neither is this urologist just anyone; under
Clinton he came close to being Surgeon General, except that he himself had health problems at the time of his consideration.) The doctors and the nurse answered any questions those of us to be treated the next day still had; another patient for the next day, a dentist pressed them hard because his friends were questioning why he was pursuing an “experimental” intervention, not yet approved by the FDA – I will address the lack of HIFU in the United States below.
I felt they answered all questions so my satisfaction, and it seemed to his as well. I ate a light dinner that evening and turned in relatively early in order
to get a good night ‘s rest before hand. I awoke at 5:00 a.m. Sunday and administered two successive fleet enemas in order to clean out my rectum to enable the visualization of the prostate by the doctor. I arrived at the clinic at 7:00 a.m., filled out some additional paperwork largely in the nature of a history for the anesthesiologist and conventional releases.
By 7:30 a.m., I was being anesthesized with an epidural to my lower spine to prevent pain and movement. From what I know from having read and been told about the procedure, a transrectal ultrasound device was then inserted through the rectum and next to the prostate. As one ultrasound beam visualized the prostate, two other beams of ultrasound in a process called ablation were successively pinpointed at numerous points throughout the prostate and, where they met, they heated the tissue to the point it was effectively destroyed. At the commencement of the procedure a suprapubic catheter was inserted through my lower abdomen and into the bladder.
This catheter, which I will utilize for urination for the next two to three weeks, is considerably less onerous than the usual urethral catheter, the big nuisance being the bags into which it drains and the constant sense of a need to urinate which comes from the bladder wall reacting to the water balloon which anchors the tube in. The sensation, however, gradually diminished over the course of the next week, and I have been given medications to hasten the process. The whole procedure took three and a half hours for me, because my prostate was unusually large; ordinarily it takes 2 and a half to three hours. I was then in the recovery room approximately another three and a half hours, regaining consciousness and my land legs.
The following day, I was up at a normal hour and again went out touring Toronto, the only real obstacle being the awkwardness of the tube and bag taped along my belly and to my thigh and the nuisance of having to empty it with considerable regularity. Although I got fatigued late in the afternoon and had to return to the room for a nap, I otherwise was able to function relatively normally and flew home a day later and returned to work Thursday. I have to follow a course of an antibiotic and anti-inflammatory for a month and after the catheter is removed I will be given cialis to take every other day for a month, apparently to enhance the blood flow, because it is not necessary for potency which returned within the week.
I was in a ready to have the catheter removed from my belly and bladder after two weeks, but I had trouble getting an appointment so that it stretched out to
three weeks to my chagrin. Removal is limited only by the time it takes me to regain the ability to void my bladder normally through my urethra, which I started
working on the weekend after the procedure. One problem I encountered, however, was that my usual urologist was unwilling to remove a catheter he did
not put in. Fortunately my friend arranged with a former partner to do it, so apparently one should line this up in advance of the procedure if one is still
having it done out of the country.
In three months, I will go to have a PSA and continue to have one every three months thereafter to check for the success of the intervention. According
to the medical staff and in particular my professionally unbiased friend, I should have a very good chance of being cancer-free, the last five years that having been the case in close to 98% of the cases reco HIFU cases since the equipment was improved and reprogrammed in 2001. Only 5% suffer impotence of any duration and only .03% experience incontinence – I was experiencing tumescence during my sleep already within a matter of days after the procedure and now
three weeks afterward get aroused normally.
So far I would wholeheartedly endorse HIFU, although, because it is not covered by insurance, it was very costly out of pocket. Either of the two firms doing
it in Canada charge $20,000 -23,000. I have, however, also been given the names of two firms which specialize in recovering the costs of out of the U.S. medical treatments uncovered by insurance for a 15% commission upon and only upon recovery. To my mind, nevertheless, having read the literature and the
anecdotes on the other treatment modalities, it was money well-spent if it has beaten the cancer as it so often does.
In fact, that it is just now approved for clinical trials in the US strikes me as scandalous. I myself suspect that it was blocked by the self-serving surgeons and the radiotherapists, especially since the recent approval of testing curiously coincides with GE’s decision to develop an ultrasound division. My sister has spoken to a non-urological surgeon who even is angrier than I, claiming that there are fully eleven cancer treatments used in Europe but effectively blocked in the US by the surgical lobby. I hope to God he is wrong, but looking at the stem cell and Vioxx politics, nothing of that sort would surprise me.
Good luck to you all whatever treatment you choose.