Quoted from the International Journal of Radiation Oncology, 60-70% of men with low stage, low grade prostate cancers, with PSA less than 10 (frequently managed with Active Surveillance), will be found at Radical Prostatectomy to instead have bilateral and higher grade disease. This implies a risk for local or distant recurrences due untreated active disease.

And, from Prostate Cancer and Prostate Diseases: Men with Gleason 3+3 cancer and PSA’s in 2-3.9 range have 32.6% chance of having Gleason 7 or higher at Radical Prostatectomy when the whole gland can be examined. If the PSA is 4-10 in these men, 44% have higher grade cancer when the gland is examined after Radical Prostatectomy.

There’s more: From Northwestern University, investigators found that men with low risk prostate cancer who waited more than 6 months for surgery had double the risk of being found to have high grade cancer, and double the risk of biochemical (PSA) recurrence than those treated before 6 months after diagnosis. They conclude men with low grade cancer should be counseled on the increased risks of worse outcomes if they wait longer than 6 months for treatment.

May make us think twice on the safety of the Active Surveillance approach.

Only the Sonablate unit allows us to constantly adjust the settings to tailor the treatment to the individual’s responses. See the posting regarding Tissue Change Monitoring for additional advantages of the Sonablate unit over other HIFU technologies.

Actual post-treatment followup statistics will have to bear it out over the next few years, but I suspect the occasional need for re-treatment currently seen will be seen less often with this new feature. Very exciting!

Dr. Thomas Walsh working with Dr. Paul Turek and others at UCSF note very preliminary data showing a 1.8 fold risk of Prostate Cancer in men with infertility, and a 1.5 fold risk of developing other cancers.

Univ. Calif. Davis researchers report patients treated with radiation for initial therapy for prostate cancer, and men treated with radiation for positive margins at radical prostatectomy have a 2-fold risk for developing subsequent bladder or colorectal cancers due to the radiation exposure.

Caution was urged as there are trends towards treating the positive margins before any rise in PSA confirms residual cancer.

Additionally, at the 2009 American Urology Assn meeting, stats were quoted describing a risk of 1% per year of developing a secondary cancer in the bladder or rectum due to radiation exposure.

The Univ. Calif. San Francisco criteria for active surveillance are:

PSA less than 10
Gleason Sum 6 or less
No grade 4 or 5 tumor on biopsies
Less than 33% cores positive, and no core with over 50% involvement with cancer
Stage T1 or T2

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Treatment is recommended for “Progression” defined as:

Rise in PSA of more than 0.75 ng/dl per year
Lowering of PSA doubling time
Rise in Gleason score on followup biopsies
Increase in tumor size on ultrasound

The following is a list of publications and presentations that highlight clinical results and research activity of High Intensity Focused Ultrasound - HIFU.

Visually directed high-intensity focused ultrasound for organ-confined prostate cancer: a proposed standard for the conduct of therapy. Rowland O. Illing*†, Tom A. Leslie‡, James E. Kennedy‡, John G. Calleary*, Christopher W. Ogden§ and Mark Emberton*† *The Institute of Urology and Nephrology, University College London, London, †The Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, ‡Department of Urology, The Churchill Hospital, Oxford, and §Department of Urology, Chelsea and Westminster Hospital, London, UK Accepted for publication in British Journal of Urology 27 July 2006.

Five Year Experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized Prostate cancer. Toyoaki Uchida, Hiroshi ohkusa, Hideyuki Yamashita, Sunao Shojl, Yochihiro Nagata, Toru Hyodo and Takefumi Satoh. International Journal of Urology, Vol. 13, 228-233. 2006.

Outcome Analysis of High Intensity Focused Ultrasound for clinically localized prostate cancer in Japan- Seven-Year Follow-Up. Makoto Suzuki, M.D., Toyoaki Uchida, M.D., Toshiro Terachi, M.D..: Tokyo, Japan. (Presentation made by Dr. Suzuki at Western Sectional AUA Meeting in Maui, June 2006) Visually Directed HIFU for Prostate Cancer –a new standard. Rowland O. Illing**, Sam Dawkins*, Chris W. Ogden* and Mark Emberton**. *Institute of Urology and Nephrology, University College Hospital, London, UK ** The Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK

Treatment of localized prostate cancer using high-intensity focused ultrasound. Toyoaki Uchida. Dept. of Urology University of Tokai Hachioji Hospital. British Journal of Urology International 2006.

Prostate Cancer Therapy with High-Intensity Focused Ultrasound -Comprehensive Review Thomas A. Gardner and Michael A Koch, Indiana University Medical Center, Indianapolis. Clinical Genitourinary Cancer Vol 4. No.3, 2005.

Transrectal High-Intensity Focused Ultrasound in the treatment of Localized Prostate Cancer: A Multicenter Study. Acta Urol. Jpn. 51 651-658, 2005. Toyoaki Uchida. The Dept. of Urology, Tokai University Hachioji Hospital.

High Intensity Focused Ultrasound for the Treatment of Localized Prostate Cancer. A Multi-Center Experience. George M Suarez*, Miami, FL; Rafael Estrella, Santiago De los Caballeros, Dominican Republic; Carlos Garcia, Puerto Vallarta, Mexico. Abstract from Presentation given at The 15th International Prostate Cancer Conference in Vail, Colorado, February 2005

Transrectal HIFU: The Next Generation? Prostate Cancer Research Institute (PCRI) Insights. Douglas O. Chinn, MD Chinn & Chinn Urology Medical Associates, Arcadia, CA February 2005. Pages 8-15.

Clinical Outcome of HIFU for the Treatment of localized prostate cancer: 5-year Experience. Toyoaki Uchida, Hiroshi Ohkusa, Hideyuki Yamashita, Yoshihiro Nagata Department of Urology, Tokai University Hachioji Hospital. Abstract - ISTU 2004

Clinical Outcome of HIFU for Localized Prostate Cancer: 5 year Observations. Toyoaki Uchida, E. Yamashita, Y. Okusa, T. Nagata, Tokai University, Tokyo, Japan. Podium presentation given at the 2004 Japan Endourology and ESWL Conference, Okayama, Japan November, 2004.

High Intensity Focused Ultrasound for Prostate Cancer: Clinical Results and Technological Evolution John C. Rewcastle, Ph.D. Department of Radiology, University of Calgary Alberta, Canada Quality of Life in Patients with High Intensity Focused Ultrasound (HIFU) for localized Prostate Cancer. Toyoaki Uchida, E. Yamashita, Y. Okusa, T. Nagata, Tokai University, Tokyo, Japan. Podium presentation given at the 2004 Japan Endourology and ESWL Conference, Okayama, Japan November, 2004.

Transrectal High-Intensity Focused Ultrasound for treatment of patients with Stage Tib-2N0M0 localized Prostate Cancer: A Preliminary Report. Presentation of preliminary clinical results of transrectal HIFU in stage T1b-2N0M0 prostate cancer. Dr. T Uchida, M.D.

Localized Prostate Cancer Treatment by High Intensity Focused Ultrasound (HIFU) Toyoaki Uchida M.D., Department of Urology, Kitasato University, Tokyo, Japan. The Journal of Highly Advanced Medical Technology. Highly Advanced Medical Technology Research Center, Volume 15, March 2000 (Translated from Japanese and updated with current information by Focus Surgery, Inc.)

Localized Prostate Cancer Treatment by High Intensity Focused Ultrasound (HIFU): Preliminary Results. Toyoaki Uchida M.D., Department of Urology, Kitasato University, Tokyo, Japan. This summary has been abstracted from previously published work and supplemented by additional new treatment data prepared by Dr. T. Uchida, M.D. by Focus Surgery, Inc.

Noninvasive Surgery of Prostate Tissue by High Intensity Focused Ultrasound: An Updated Report. European Journal of Ultrasound. N. T. Sanghvi 2,*, R. S. Foster1, R. Bihrle1, R. Casey3, T. Uchida4, M. H. Phillips2, J. Syrus2, and A. V. Zaitsev2 , K. W. Marich2 , F. J. Fry

Last year the recommendations were modified to limit Vitamin E to 200 IU per day to prevent increased risks of strokes and heart attacks, and to preferably stop it altogether. Selenium had been recommended to no more than 100 mcg per day (rather than 200) due to the worry that prostate cancers might actually grow faster if present. Same for Zinc above 70 mg per day.

The current multi-institutional study seems to reflect not only a failure of Vitamin E and Selenium to prevent prostate cancer, but a distinctly possible increased risk in men with family histories of prostate cancer. In addition, Selenium may cause diabetes.

Stick with lycopenes (tomato products), anti-inflammatory medicines, pomegranate juice, and soy proteins.

The scheduled treatment weekends in Puerto Vallarta for 2010 are:

Jan 15-17
Feb 26-28
Mar 26-28
Apr 16-18
May 14-16
Jun 18-20
July 16-18
Aug 20-22
Sept 17-19
Oct 15-17
Nov 12-24
Dec 10-12

Future dates will be posted as they are designated.