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Subject:   Re: Re: hifu mindwarp trivia from planet earth Name:   TV from Canada Date Posted:   May 4, 08 - 8:20 AM Email:   tv168@yourlink.ca Message:   Hi Ted Some of the information that I have read indicates the the HIFU treatment had some problems with damaging the rectal walls. This was eliminated when they started to pump cooling water into the condom. The cool water at 17 to 18 degrees C protected the rectal wall and also cooled the probe. Both systems have in place sensors that the least little movement will shut down the machine to prevent any damage to non-targeted tissue. The Albathem people at Maple Leaf in Toronto told me that moving your toes would shut the machine down so that is why they require the patient to also have a sedative to put him to sleep during the process. The Sonablate system also has movement sensor as I was told not to move my hand when I wanted to reposition my arm after couple hours in the OR. Both have sensors that monitor the rectal wall tempature to prevent heat damage to the rectal wall. Turps have been recommended for Albatherm patients to reduce prostate size and it eliminates any pain after the procedure which has been atested to by patients. You should not have any blockage because your urethral opening has been enlarged from the TURP. As to sloughing and passing necrotic tissue, don't worry about it. The three pieces that I passed into my leg bags very small and not a problem to pass. Some patients have indicated that there is some discomfort when one passes larger pieces but not a big problem. I have not passed anything of any size as yet. The suprapubic catheter is only 3 to 4mm in diameter so that gives you some idea of how small the pieces were. This catheter does not have any pain associated with it--nothing basically--it is just there. The only thing that does happen is that you will be passing a few drops of blood through the penis on a regular basis for the first few weeks, at least I did, but you may not with so little prostate tissue left. Blockage with that small amount of prostate tissue is not likely. My blockage problem was according to Jenna in Toronto Sonablate CANAM was due to my large prostate--43.5cc,as well as the pain in urination. This was controlled by pain killers and anti-sposmatics. I can't see that you would have strictures because most of your prostate is gone. Any radiation treatment immediately increases your chances of incontinuence and erectile dysfunction as the radiation will have damaged surrounding structures and that is its the main problem. Radiation damages the DNA of cells as it passes through those cells. More damage is done the greater the concentration of rays. Radiation operates under the concept that you destroy the prostate tissue by damaging the DNA of the cells to a point that the DNA cannot repair itself and therefore the cell dies. The radiation is focused on the prostate but the rays coming through other structures to its focal point-- the prostate, can potentially damage the tissues in those structures. Eric's problem with strictures seems to be related to the growing cancer within the prostate. From reading on early HIFU procedures it seems that the doctors only treated part of the prostate; that part containing the cancer. Now, and I am not sure when this started, the doctors destroy the entire gland and no longer only treat the cancer areas because biopsies don't find all of the cancer. Whether Eric had that type of procedure or not I don't know. Some of the other stories indicated that patients have had strictures but managed to get them corrected with a lot less problem than Eric. As you can see I am bias towards HIFU because it may create problems after the procedure but so do the other types of procedures. Read the surgery stories. One can generally deal with HIFU problems and they are not long lasting. Some procedures may not show the problems initially as radiation but they can show up 6 or 8 months down the road and these problems are permanent. No matter how one looks at the problem of prostate cancer, it is more difficult to handle than the common types of surgery such as rotary cuff repair, repair of knee cartilage, hernia surgery etc. The prostate is involved with urinary and reproductive functions and as such is in continually use. Any disruptions to the prostate cannot have the gland left in a non-functional position like a broken arm in a sling to rest while it is repairing.

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