
Ultrasound destroys 80 percent of prostate cancers in one-year study - howard941
https://newatlas.com/medical/ultrasound-destroys-prostate-cancers-one-year-study/
======
mooreed
As someone whose family member recently just received a test showing elevated
PSA levels (Prostate Cancer indicator); this article is a very real blessing.

# Baseline issues with prostate cancer that suck.

1\. Don't treat a benign version and possibly live with trouble urinating and
follow on problems from that.

2\. Don't treat a malignant version and die

3\. Treat it and potentially be impotent

4\. Treat it and end up with bowel dysfunction

5\. Treat it and rehab through surgical scars looking like an upside down T
from following from belly-button to waistline or a U shape around the rectum.

6\. Of course there is some tail risk of much much worse situations; and while
it's worth remembering, it's not worth enumerating.

# TULSA method

So while this method is not different - it includes things that suck... if you
read further upstream of the newatlas article to RSNA primary source [1] you
will find that not only do they insert a spinning ultrasound device up the
urethra - but it also includes a simultaneous insertion of an endorectal
cooling device(ECD)[2]. Given all that: the parts that suck about this method
pale in comparison to the traditional list of 6 above.

# Conclusion

There is much to be squeamish about with this method, as with any prostate
remediation methodology; but if applied under careful care of patient and
doctor - this looks like a very promising prostate treatment. And as a family
friend once put it to me: "Welcome to the world of cancers; where pretty much
everything sucks."

[1]:
[https://press.rsna.org/timssnet/media/pressreleases/14_pr_ta...](https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?id=2129)

[2]:
[https://press.rsna.org/pressrelease/2019_resources/2129/fig_...](https://press.rsna.org/pressrelease/2019_resources/2129/fig_1.jpg)

(edited for formatting)

~~~
hristov
By the way, your family member is probably aware of this but there is another
ultrasound treatment option for prostate cancer that is completely non-
invasive. It is called hifu.

[https://www.hifu-prostate.com/](https://www.hifu-prostate.com/)

Hifu sends ultrasound from a curved emitter from outside the body in such a
manner that the ultrasound ray will be focused on the treatment area. Thus,
while you have ultrasound going through your body, only in the treatment area
does it become high intensity enough to actually destroy tissue. This way they
can burn off cancerous parts without damaging other parts of the prostate and
the rest of the sensitive parts around there.

I am not sure why the new atlas did not mention HIFU, it also uses MRI.

HIFU is already cleared by the FDA, and it will become approved by medicare
very soon (this coming January, I believe), so it will be paid by medicare and
probably most insurance plans (as they tend to follow medicare).

~~~
chollida1
Can confirm and sing the praises of HiFu.

Went to China so my spouse could have a procedure done in 2014. HiFu took 1-2
hours and my wife walked away from the procedure. She was hiking the next day.

Tumor was shrinking almost immediately.

The alternatives we had were surgery that would have removed part of her abs
or weekly treatments of
[https://en.wikipedia.org/wiki/Tamoxifen](https://en.wikipedia.org/wiki/Tamoxifen)

Neither of which was great.

Now we had to pay for the HiFu but it was soooo worth it. I think it was about
$25,000 USD so very reasonable and affordable for us.

~~~
dorfsmay
For which cancers does this procedure work (assuming your wife didn't have
prostate cancer)?

I understand 25 k USD feels reasonable if it saves your life without surgery
and it's complications, but it steep for "just ultrasound". Do you know why it
was that expensive?

~~~
killjoywashere
MRI is probably the major technical cost. It's fairly high touch and the
magnets wear out, so the capital cost of each test is fairly real. That and
the professional component. Interventional radiologists are very much in the
consultant/handyman/engineer business of "Treatment: $1; knowing where to put
it: $9999"

~~~
comfrey11
In Japan an you can get an MRI for $160 US I hear

~~~
killjoywashere
Do you get the radiologist's read for $160? Do they put an ablative ultrasound
probe in you and hold it for an hour for $160?

~~~
comfrey11
Honestly I’m not sure with the 160 covers. It’s just another one of those
things in our medical system that is priced a bit too high to make sense for a
good number of folks. I would like to see healthcare be more accessible.

------
HorizonXP
I did my Masters' thesis with the group that invented and developed this in
Toronto. I know some of the co-authors on the paper personally since we worked
together.

AMA.

~~~
radicalbyte
Is there any chance that these techniques could be equally effective for other
cancers? For example Liver, Kidney, Lung cancers?

~~~
HorizonXP
Yes, very much so. Ultrasound in medicine is very cool technology. Obviously
many of us have experience with ultrasound imaging, which has revolutionized
medicine in a number of ways. But we also learned that if you crank up the
amplitude and frequency, you can heat the tissue. Our research group was one
of several that figured out that you can use MRI-based thermometry to measure
that heating, and use it as the input to your control loop. Then, it's a
matter of adjusting the frequency, amplitude, and positioning (i.e. in this
case, rotation) to "paint" your heat pattern.

Thus, at least at our site, it was used to develop treatments for uterine
fibroids, some types of breast cancer, and some types of brain cancer (using
transcranial ultrasound, which is much harder to do because you have to go
through bone and adjust for that medium). Generally, areas that you can reach
from the skin and/or with a special probe, are potential treatment targets.

Lung cancers are hard to treat with ultrasound, for a few reasons. The biggest
is that it moves, which makes it hell for the MRI and system as a whole to
keep up without hitting unwanted areas. The other is that ultrasound doesn't
travel well through air. For ultrasound ablation to work, you need a good
conduction interface. That's why ultrasound technicians slather that clear gel
on you when they're imaging you. It's possible to do in the lungs, just
exceedingly difficult. It's unlikely that someone will commercialize something
there.

The liver and kidneys won't be targeted either because the only way to reach
them is by performing an incision. You might as well use other techniques like
laparoscopy.

~~~
_Microft
Would transcranial ultrasound have the problem of unwanted hotspots because of
reflections and a focusing effect of the curvature of the skull? I would
assume that this could only be done by scanning the head with a MRI, modelling
the tissues in detail, simulating the process and then constructing a wave
front from many emitters that does what one wants. Ideally all of that in real
time as I guess the heating process will change the properties of the treated
tissue in a way that would require it.

~~~
HorizonXP
Precisely. See Ultrasound attenuation coefficient
([https://en.wikipedia.org/wiki/Attenuation#Attenuation_coeffi...](https://en.wikipedia.org/wiki/Attenuation#Attenuation_coefficient))

You'll note that it's measured in dB/(MHz-cm), and that soft tissue is 0.5,
while bone is 6.9. Just like light, anytime ultrasound hits an interface,
there are reflections and refractions. Furthermore, since bone attenuates
ultrasound so much, you have to increase your amplitude greatly (and even more
so with higher frequencies) in order to get enough thermal energy to be
deposited at your target. If you don't do it right, you can create dangerous
hotspots at the bone-tissue interface, and you can also deposit energy where
you didn't intend to. Given that ultrasound therapy intends to be more precise
than other techniques, you're kind of defeating the purpose!

Edit: in response to your edit, yes that's exactly what they do. They create
an array of transmitters to be able to precisely target various locations
within the skull. It wasn't my area of research, but I'm pretty sure they used
them to create interference patterns as well, so many emitters were activated
to work in concert to target one area.

See this image:
[https://sunnybrook.ca/uploads/1/_research/about/fus/3-ultras...](https://sunnybrook.ca/uploads/1/_research/about/fus/3-ultrasoundbraindevice.jpg)

------
hsnewman
My father and brother both got prostate cancer, the effects of surgery are
life changing. I've been monitoring my PSA and it's still low (at 60). This is
so much less intrusive and gives me hope that if I do get prostate cancer, I
might be able to lead a normal life if I'm lucky enough to get this treatment.
This is no joke of a disease.

------
Dolores12
This is good video[0] explaining how it works. Chosen resonating waves may
destroy bridges, not to mention some cell membrane. The problem is there is no
money in that for big pharma & co.

[0]
[https://www.youtube.com/watch?v=1w0_kazbb_U](https://www.youtube.com/watch?v=1w0_kazbb_U)

~~~
mrtksn
I always approach these statements with skepticism.

Okay, let’s say that there’s no money for the big pharma, what about
governments with socialized health care? What about rich people and their
loved ones who suffer from cancer?

The “not much money in this” aspect seems believable only when the condition
is a rare one but cancer is a huge unsolved issue for everyone, including rich
people and politicians. How can they not pursue cancer treatment option that’s
not profitable enough for commercial players?

~~~
adventured
Further to that point, there is radically more money in big healthcare than
there is in big pharma. In the US big healthcare is 8x-10x larger than big
pharma.

There is a lot of money to be made by big healthcare in any procedure in the
US, including one as described by the article. Hospitals, admin, doctors,
nurses, techs, medtech, they'll all be thrilled to ring the cash register
instead of big pharma.

~~~
dmix
And “big pharma” or “big health” isn’t a homogenous unit protecting their own
interests (well not entirely).

There’s no way one firm won’t pass up on a hundred million to save 50 firms
from losing a billion.

The only time that happens is when BigCo gets the government to ban things,
regulate the small firms out before they can even start selling stuff, or when
the FDA drags its feet for a decade.

The fact the latter happens so often is one of the best reasons for public
health insurance (IMO) because the US health industry is in many ways very far
from a market where competition can efficiently account for stuff like this.
But it’s not as bad to completely squeeze out whole new classes of treatments
(new patented drugs is another story) which would be worse case scenario.
Instead it tends to work through a million small rules but that only let the
big guys exploit new stuff while potentially dragging their feet or charging
10x the cost, rather than completely excluding the market from it.

------
tonyedgecombe
>The minimally invasive technology involves a rod that enters the prostate
gland via the urethra

Ouch.

~~~
post_break
The alternative is death right? So give me some pills, knock me out, and go to
town.

~~~
BurningFrog
Prostate cancer is rarely lethal since it develops so slowly, and is often
left untreated.

That said, many cases _are_ life threatening.

~~~
fortran77
My father died from metastasized prostate cancer.

While statistically your statement may be true (in that a large number of
people die of something else before the prostate cancer kills them) it's still
a lethal cancer that kills more men each year than breast cancer kills women.

~~~
BurningFrog
This is 100% true, and I could have made that clearer.

Another reason it's left untreated is that the surgery side effects are fairly
serious.

~~~
1_over_n
This is a great point. There is a good book which i think features a
statistical perspective on screening in relation to dying _with_ prostate
cancer vs dying _from_ prostate cancer. This book is a great read and i would
advise anyone who is interested in health issues to get an intuition of
"risk".

[https://www.amazon.co.uk/Risk-Savvy-Make-Good-
Decisions/dp/0...](https://www.amazon.co.uk/Risk-Savvy-Make-Good-
Decisions/dp/0241954614/ref=sr_1_1?keywords=risk+savvy&qid=1576087187&sr=8-1)

------
orthopodvt
The headlines don't reflect the results reported in the abstract. In
particular, a erectile dysfunction rate of 25% at one year is very high.
Furthermore, the criteria for cancer oblation seems to be PSA decrease of 75%,
which was achieved in 96% of patients. However, one would generally expect a
much larger reduction in PSA if the cancer were truly oblated.

~~~
dmix
The levels of prostate cancer are very much titled toward older males past
their sexual prime:
[https://www.verywellhealth.com/thmb/Imcc48tegbPKpY2cL18sXOIB...](https://www.verywellhealth.com/thmb/Imcc48tegbPKpY2cL18sXOIBFAY=/1501x1001/filters:no_upscale\(\):max_bytes\(150000\):strip_icc\(\)/prostate-
cancer-gender-chart-5b44d65e46e0fb00373a82a3.jpg)

ED may be less of a concern with this group compared to other cancers or
diseases. Not to mention the high rates of heart disease at that age in
America already causing it.

Plus the rates must be compared to other modern prostate treatment options.

------
Ductapemaster
My father and my uncle both had this surgery (therapy?) to treat prostate
cancer, and not only has it been effective (low to no PSA after over a year),
their recoveries and post-surgery experiences are significantly better than
any of the individual's they talked to who had a traditional prostatectomy.
Not to say they are _unaffected_, but their experiences have not been life
changing as the experiences of others they know (eg. incontinence).

I'm so happy to see innovative and less invasive treatments for common
diseases being approved.

------
DarrenDev
This from the guy who invented the PSA test, well worth reading,
[https://www.nytimes.com/2010/03/10/opinion/10Ablin.html](https://www.nytimes.com/2010/03/10/opinion/10Ablin.html)

~~~
stewbrew
How is this related to this procedure? Both are about prostate cancer, but
that's about it.

------
chrisweekly
I lost my father and my uncle to rare forms of prostate cancer. Here's to more
research funding and accelerated progress on every front.

------
WalterBright
It's great to see this.

I've often wondered why electromagnetic waves could not be focused on a tumor
to destroy just it.

------
carbocation
What is this number like in a comparator group (i.e., placebo or state-of-the-
art therapy)?

