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."
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.
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).
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.
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?
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"
It’s not paid by the government, it’s paid by the health insurance system that everyone must enroll in and had to pay for every trimester. Granted, it’s not too expensive.
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.
Some trans women have prostates? TIL. I honestly didn't know.
But you're right that I completely forgot about the intersex group.
In fact, I initially wondered if homosexual couples (of either sex) could refer to their SO as "wife", but then the comments also use "she", so I kinda dismissed the possibility of a biologically male "wife".
I assume the sound waves overlap and increase in amplitude, destroying the tumor cells.
But I'm wondering why a shrinking tumor is enough - usually we cut the whole thing out so that it doesn't metastasise or regrow from small leftover parts. If the beam kills most of it, is that enough? Does it trigger a mass die-off or stimulate our immune system to do the rest of the job? Just wondering what the explanation here is.
HIFU is "competing" with transurethral focused ultrasound (TUS). HIFU works, but has its limitations. Given that it's transrectal, it will not be able to deposit ultrasound energy only into the prostate; the rectum gets hit too. Furthermore, there's no temperature feedback during the procedure; the doctor will send ultrasound energy to the target area and use ultrasound imaging to gauge the efficacy.
It's a decent alternative, but it will never be as good as TUS at targeting just due to their inherent differences. But HIFU is available today, while TUS is not, and HIFU might be "good enough" for most people that it is more commercially successful.
You can get temperature readings from a higher-frequency transducer. My old lab worked with HIFU and the transducer I used was a combination 1MHz and 20MHz conical transducer, where the inner high-frequency one was used for non-invasive temperature measurement. You get comparable results to implantable thermocouples.
The damage to the rectum isn't much as it's outside the focal point of the ultrasound. The main ablation happens at the point where the ultrasound is focused.
@hristov I am incredibly moved by your wonderfully thoughtful reply; we are just getting up to speed so had not heard about this at all. From the bottom of my heart, thanks for sending this.
If elevated PSA is the only real sign of cancer, then, depending on his age, it's entirely possible your family member could die _with_ prostate cancer rather than _of_ prostate cancer. According to https://www.webmd.com/prostate-cancer/prostate-cancer-surviv..., 2/3 of "very elderly" men who died of things other than prostate cancer had undiagnosed prostate cancer on autopsy. And, if the cancer is localized, the 5 year survival rate is nearly 100% (same link).
My dad got a regular PSA test from his old doctor. But that doctor retired, he got a new doctor, moved, got a new doctor again, and the guidance changed, recommending against annual PSA tests. Then my dad developed some back pain. Took it easy, went to the doc, did physical therapy, etc., but it just got worse. Turns out, he had (has) stage IV prostate cancer, with several tumors along his spine and was on the precipice of MSSC before he received a correct diagnosis at age 66. His PSA was north of 80.
The good news is that treatment has shrunk the tumors dramatically and he's mostly back to normal. The bad news is that he still has stage IV prostate cancer. It'd have been great to have had it caught earlier.
I skimmed all the comments, and am surprised that nobody mentioned the recent advances in radiation treatments. The cancer is modeled with MRI images, dots are tattooed on the patient's body and used to line up the patient with projected laser dots to ensure that body is in exactly the right position, and three trackers are placed into the prostate (Calypso) which allow real time tracking of prostate position. Radiation beams are targeted directly at the cancer, causing minimum damage to the surrounding tissue. The treatment takes about 15 minutes once a day for 30 days. The doctors say it has few side effects and is vastly preferable to surgery. The nurse said this procedure has been available for about 5 years.
My step dad designed the hardware that does the tracking. Had to do some pretty cool stuff to treat the microprocessors because of all the radiation ...
My very naive understanding of ultrasound techniques is that they can work very well, but in cases where they don't work they end up creating a mess of things (scar tissue, etc) that make subsequent removal pretty much impossible as the surgeon can no longer see clear boundaries. That info is several years out of date and second-hand, so perhaps by guiding the process a little better as TFA suggests they can avoid making any subsequent surgery impossible.
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.
The first thing I always think about with ultrasound is how it's used to break up kidney stones. Is there a danger here of breaking up the tumour and thereby allowing cancer cells to spread through the body more easily?
Yes, I realize that's the intention. My concern is whether ultrasound might unintentionally break up the tumour and release cancerous cells to spread throughout the body.
I am not a doctor nor an expert in this area, but I would presume that would be a valid risk if the frequency were not tuned specifically to resonate the tumor prior to increasing the amplitude. And then there is the matter of focus / accuracy. Perhaps nih.gov has a study with numbers to show the attainable accuracy and what statistics are given back to the equipment and the doctor to compensate and tune the signal. My understanding is that the inverse is generally true, in that, there is too much heat and the surrounding area is scarred.
@HorizonXP first thank you for your willingness to answer questions.
1) Any idea on where to look to find out when this might become available? Looks like it was just cleared by FDA with 510(k) clearance.
2) My guess is that if you want this done - you would have to travel to UCLA? and Dr. Raman (or colleague) would perform the operation?
3) Is there anywhere to find a real discussion of down side risks with actual rates and figures?
For example, the RSNA article has a statement:
>"There were low rates of severe toxicity and no bowel complications."
4a) What does `severe toxicity` entail? 4b) Is that a operational complication that is remedied at the hospital and overcome in the short-term? or is that a long term quality of life issue?
5a) Furthermore what is this actual "low" rate? is it 2/115 or is more like 10/115? It looks like the base rate for these is perhaps around 3%-7% is how would I compare this study of 115 to something published like: [1]
Similarly RSNA states:
> "We saw very good results in the patients, with a dramatic reduction of over 90 percent in prostate volume and low rates of impotence with almost no incontinence" --Dr. Raman said.
5b) Where could I look to find the actual rates of each of these negative side effects? 5c) Or would you guess they are not published?
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.
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.
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.
What benefits does using sound have over using targeted electromagnetic radiation to induce localised heating? Since I assume that is possible too, perhaps I'm wrong there.
My understanding is prostate cancer has a particular need for this sort of less invasive approach, as surgical procedures there tend to damage the sensitive equipment nearby - incontinence and impotence are common side effects of it, and often not worth it when prostate cancer tends not to be deadly.
Things like liver cancer you're probably better off just doing a surgery for, as you'll have more chance of getting it all, spotting metastasized offshoots, etc., and it's fairly accessible.
It seems that 29 centers in the US do this type of FUS treatment commercially as listed on the FUSF website.
Any focused ultrasound tech has potential to gain wide acceptance but it is mostly the imaging component (MRI guided in most cases) that hold it back due to costs and availability.
There is work being done in the area but the interesting part is that the MRI isn't only used for its direct imaging but also the ability to use it as a very expensive thermometer[1].
Not every procedure lends well to alternative imaging modality (Brain surgery is one) but ultrasound guided FUS is really where there is potential to increase adoption.
Good paper, but it focuses on cancer applications but it would be a disservice to not point out the strides that HIFU is making in drug delivery[1], neurosurgery, and neuromodulation[3].
The (un)fortunate point of MRI thermometry is that is not only very effective at reading temperatures, but it can also produce thermal dosage maps that help in characterizing tissue leisioning (the exact response of HIFU ablated tissue is still be debated). On top of that you also get traditional MRI imaging essentially for free.
I'm always wary of reading too much into articles about promising medical developments, because it seems like often the headlines look great but they are actually referring to some relatively early stage of trials, so results of later trials might not be so good or even if they are it might still be a long time before the treatment is used routinely.
However, in this case, the article reads as if this is literally a cure for (one sort of) cancer, with an 80% success rate, which can be done as an outpatient procedure with a relatively low risk of complications. That seems like about 80% of the holy grail, at least in terms of treating prostate cancer specifically.
Can you give an expert perspective on how excited we should or shouldn't be about this result?
I just read the abstract, and I'd say we should be very excited about this result.
When I left my Masters in 2012, the clinical trials being done still resulted in a prostatetectomy. Meaning, these generous men donated their time to allow us to use them as guinea pigs, yet received no benefit since their prostates were removed anyway. That did allow us to perform in-depth pathology reports about the efficacy of the treatment.
This paper has 115 men that were treated and allowed to not have the surgery done, so this is the first time that we were able to see what the outcomes of the treatment truly are. Based on the results in the abstract, it looks like the hypothesis that men would be "cured" and have a better quality of life (i.e. no incontinence or sexual dysfunction) seems to be well-supported.
More of these trials will need to occur before it becomes approved as a viable alternative to surgery. The big benefit though is that even if the the treatment fails to kill all of the cancer, it probably kills enough of it that you can go back to a watchful waiting approach, keep monitoring PSA levels and symptoms, and if anything was missed, follow up with full surgery. That is, surgery can become the last-ditch approach vs. being the only approach.
I was about to say definitely general anesthetic, but I'm not 100% sure now. The patients for prostate cancer were definitely put under. I don't know about the uterine fibroid patients though. They might have received an epidural?
It's less about the pain of the heat, and more about the discomfort of having probes in your genitals, and the requirement that you stay perfectly still.
Considering they're putting a rod up your urethra which will be burning you from within, and another device up your rectum, while you're in the uncomfortable confines of an MRI scanner, I suspect local might not be something most people would be comfortable with.
Lots wouldn't be comfortable, but there's a few who'd likely be ok with it. Urethral+anal electric stimulation is a relatively known kink. There's no way to keep still in that situation though, so I'd expect anaesthesia would be necessary for that.
I think they're following up with these patients yearly. It's the same post-operative care procedure they do with prostatetectomy patients, except they're probably being more thorough here because they have something to prove.
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.
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.
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?
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.
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.
I went 40 years without getting a flu shot because I was terrified of needles. And I mean I would look away if someone was getting a shot on tv. Absolutely terrified of needles.
A little over a year ago I was diagnosed with cancer. I have had all my teeth removed, had a feeding tube (PEG) installed, chemo, liver biopsy, and more random horrible shit. I went from terrified of needles to getting more of them than I can count.
My mother had thyroid cancer the better part of a decade ago, just the one dose of the radioactive iodine sabotaged her teeth to. Like you she didn't have the best of dental health as it was but she's been losing a few teeth a year since.
My father died of cancer just before I turned 13 and he wasn't sick very long, over the course of a year or so he had a port installed, had a roughly horseshoe shaped and size scar on his scalp, had headgear bolted into his skull in multiple locations and the day we had to take him to the ER he had worked all day and by that night was effectively drowning in is own bodily fluids with his lungs mostly full of fluid at which point he went on a respirator, went unconscious and was taken off life support less than a week later.
Cancer sucks man, I'm sorry you got dealt that hand.
Mouth/neck cancer. 35 treatments of radiation. It has been a year and my gums are still destroyed.
My teeth were not in the best shape going into this. But the risk was high that the radiation would kill my teeth and need to be removed anyway. The problem here is that I was going to be monumentally fucked from the radiation/chemo and they weren't sure my body could handle pulling teeth if they died.
And dead teeth just sitting in there could cause osteonecrosis of the jaw. Essentially a dead jaw. Then they would have to remove my jaw and that would be insane. So I opted to just have all my teeth pulled in one shot and get dentures later. And it wasn't some random dentist looking to profit saying I needed to have them pulled. Two ear, neck and throat doctors, a oral surgeon, two oncologists, and a radiologists all agreed that it was essential.
This is factually true. There is some controversy regarding PSA screening programmes that they do not improve all-cause mortality. Making surgeries less invasive and less liable to complication, as well as improving screening, is likely to improve outcomes.
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.
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".
> Even without treatment, only a small minority of men diagnosed with early-stage prostate cancer die from the disease, Swedish researchers reported Friday. Drawing from a national cancer register, they estimated that after 10 years prostate cancer would have killed less than three percent of these men.
> Prostate cancer often has an indolent natural history, and patients are more likely to die with than to die from the disease. There is reliable evidence that PSA testing results in considerable overdiagnosis and overtreatment of men with prostate cancer, while associated potential harms include pain, fever, bleeding, infection, and transient urinary difficulties resulting from prostate biopsy, as well as erectile dysfunction, urinary incontinence, and bowel dysfunction.
> On May 22, after reviewing the evidence on both benefits and harms of PSA testing, the US Preventive Services Task Force (USPSTF) concluded that the reduction in prostate cancer mortality after PSA testing was very small and that the benefits did not outweigh the harms. Their recommendations are against PSA-based screening for the general US population of men at any age.
If you're electing to have a prostatectomy (i.e. removal of your prostate), then yes, your alternative is likely death.
I haven't read this paper, and it's been years since my Masters when I last kept up with this, but the patients at this stage are usually getting their prostates removed. The aggressiveness of the cancer is enough to threaten their life and well-being, so they elect for this procedure. It's usually followed up with radiation and chemotherapy to kill any residual tumour cells left behind, usually at the periphery, or if metastasis has occurred.
So great, prostate and cancer's gone, everyone's happy right? Well, no. The surgery damages a lot of the surrounding tissues, so these men are left with sexual dysfunction (which sucks but you can somewhat handle since you are living) and incontinence. The urinary and bowel issues affect your quality of life immensely. If you're in your 60s, you might have another 10-20 years to live with this. But if you're in your 40s, which is a lot of the cases for aggressive cancer types, you're stuck this way for many decades.
Hence why this ultrasound technique is so appealing because you can perform a minimally-invasive procedure that destroys only what you target, and spares the urethra and other tissues. Better outcomes, and better quality of life.
Given that the gold standard is surgery, this new technique has to prove itself against that, by showing that it is actually successfully destroying the cancer. That's why these clinical trials are occurring.
As an addendum, one study in Thailand looked at a sample size of dead men, and found that 1 in 7 had prostate cancer, but died of other causes. What that means is that many men get prostate cancer and may be asymptomatic because it is not aggressive. It can manifest as localized tumours/nodules within the prostate that you wouldn't be able to detect without good palpation and/or sensitive imaging. And because you're asymptomatic, you might not even seek diagnosis, and you'll probably die of other causes.
It also means that many men get diagnosed with cancer and may seek premature treatment. Most good doctors will recommend a watchful waiting approach; regular checkups and PSA level checks to ensure that you're still in the asymptomatic area. There's other treatments that can occur before surgery. But if you end up down this path, your cancer could be very localized within the prostate.
However, surgery is an all-or-nothing approach, there's no saving the prostate. Ultrasound ablation could be a good alternative and allow targeting. We're still far off from proving that though, but it's definitely viable. It's also why ultrasound ablation is being used for things like uterine fibroids, and breast cancer. There's even use cases for brain cancers.
It's a very cool technology, and I'm very optimistic for it. But I left my Masters in 2012, and we're still conducting these clinical trials. This is exactly the pace it should be occurring at, since it needs to be ironclad. But I found it too slow for my liking, so I moved on in my career path.
Idk if they would knock you out or just give you anesthetic but keep you semi-aware. "Knocking people out" is generally avoided, but this obviously depends on the specific situation.
Are there any medically experienced people that know if this could be more likely to be a full "knock them out" kind of procedure?
So, I clear international freight through customs for a living. Maybe a decade ago we had this shipment from a now defunct website that was (I think, maybe it had the c) 'fuk.it'. In the package were various 'sexual toys'. Some sort of electronic shock device, some comically large anal 'toy' and a 'deep hole dick spreader' which was a urethral sound being marketed as a sex 'toy'.
We had to go to the website to try and figure out how to classify the stuff with names like the above and 'colon snake' and not only did they sell these torture implements but they sold a variety of -caine local anesthetics.
I had a recurrent kidney infection a few years ago, and they inserted a camera up into my bladder this way to have a look. It really wasn't that bad but I did notice that when the doctor was getting ready, the nurse subtly became very close at my other side in a very casual manner and I suspect she was ready to restrain me. I did wonder how often the doctor got a black eye for his trouble..
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.
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.
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.
Can we not spread these pseudoscience lies on HN? Steve Jobs died in part because he believed he could cure his pancreatic cancer with herbal remedies and diet, which you're espousing.
My condolences. Steve Jobs had a neuroendocrine tumor though, which is much slower growing than the other types of pancreatic cancer and more treatable if caught early (which it was).
> In 1900, the top 3 causes of death were infectious diseases—pneumonia and flu, tuberculosis, and gastrointestinal infections (a fourth infectious disease, diphtheria, was the 10th leading cause of death). Improvements in sanitation, public health (vaccination development and delivery), and medical treatments, such as antibiotics, led to dramatic declines in deaths from infectious diseases during the 20th century.
> Mortality from all causes declined 54% between 1900 and 2010.
In other words, we cured or learned to treat the formerly top killers. Now we've just got the harder to cure and less prevalent stuff left, but continue to make significant headway on those too.
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# 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...
[2]: https://press.rsna.org/pressrelease/2019_resources/2129/fig_...
(edited for formatting)