Transurethral hyperthermia; my experience

Klinik St Georges, Bad Aibling

I’ve been meaning to write this blog for a while as it is 18 months since I had this treatment. I’ve been cautious writing as wanted to see what impact this treatment may have had on my cancer. There are suggestions online about an 85% to 100% cure rate of prostate cancer if the cancer is still in the capsule and you’ve not had a biopsy. There are also suggestions of a 75% cure rate for those having had biopsies - the reason being is that some consider biopsies can spread cancer - see more below and my blog on this issue here. It is worth noting that it is a wee bit difficult to not have a biopsy, as that is what confirms you have cancer. Anyhow in short it is hard to find any hard peer reviewed research around success rates of transuretheral hyperthermia so I suggest treating those figures with caution.

So let me take you back in this blog to September 2017 when I was first diagnosed with T3 prostate cancer. The treatment offered was surgery or radiation with about two years of hormone treatment. At the time I had many discussions with various people including doctors about those options and other treatments that might be available. My blogs on radiotherapy and prostatectomies will give some of the reasons why I was looking for a less invasive treatment. 

Anyhow after much consideration I chose to try and get a place on a High-intensity focused ultrasound (HIFU) trial with Professor Emberton. HIFU is widely used in Europe and other places but only in the UK in specialist centres or a clinical trial. This seemed to me another example of the extreme caution or conservative approach of the NHS. Anyhow it uses high-frequency ultrasound energy to heat and destroy cancer cells in the prostate. The side-effects can be pretty tough but overall it looked better than radiotherapy. You can read more on Prostate Cancer UK’s website here.

To cut a long story short the HIFU trial team took many weeks to come back to me about whether I might be eligible and the financial implications; indeed I only got a letter inviting me to be considered after I came back from the transurethral hyperthermia treatment in Germany. 

Bad Aibling

So how did I choose transurethral hyperthermia?

Well I have long trusted saunas and fevers in terms of their benefits for detoxing and healing. They both have a long history with evidence of their use in Egyptian and Greek times. I had also read about the value of hyperthermia and treating cancer, particularly in conjunction with other treatments like radiotherapy but also as a treatment on its own.

While waiting to hear about HIFU I heard about someone who had transuretheral hyperthermia. This guy's experience was very positive although he only had a Gleason 6 cancer which of course now I know can be treated with Active Surveillance. Chris Woollams from CancerActive also noted it was a possible way forward. I hugely welcomed that the approach had virtually no side-effects and appeared to have such good results. There was also a fair number of clinics, particularly in Germany using this approach - and they have experience of treating many thousands of men. My oncologist in the UK had told me how urgent it was to be treated, so as the weeks passed by, I started to get concerned that HIFU might not be possible. I started to enquire about which clinics might be best; Klinik St Georges was mentioned in several places including the person I spoke to.

Thermae

What next?

The Klinic needed to see my NHS papers and have copies of my MRI. These took a couple of weeks to get and then it took a further week to get agreement that it was ‘likely' they could treat me plus a booking at the Klinik. We also had to arrange payment which in total was close to £6,000 for the five days of treatment. I was then on a plane at the end of November to Munich with my partner and a three hour train journey to Bad Aibling. 

Park, Bad Aibling

Wow what a special town - a spa town....'The Thermae’ which was opened in 2007 was particularly amazing. We managed a half day visit (around £20 each) before the treatment and at the end of the week. There are a collection of thermal spring pools, inside and out (we swam one time in the snow), some with lights and relaxing music, others with water jets and different temperatures. There was also over ten different saunas, some with aromatic smells, some crackling of firewood, one had a thick steam spray fog, while another had a view over the river. Remember the Germans are naked in the saunas and there is a whole etiquette about washing before, sitting on your towel and more. In addition to all that I did also try the traditional peat pulp bath with mineral water; literally covered from head to tow in peat for 15 mins. Anyhow all that and the great little restaurants, Christmas markets, a lovely park to walk in and views of snow-covered mountains made it feel almost like a holiday!

Local hyperthermia treatment rooms

We found an AirB&B before we had arrived and they were fully geared up to folk coming for treatment at the Klinic. We were also able to get organic vegetables in several shops locally including an organic supermarket that owned towards the end of our stay.

How does Transurethral Prostate Hyperthermia work?

Here’s what the Klinik St Georges writes: "Prostate hyperthermia is a very gentle form of local hyperthermia applied under local anesthesia. The machine which directs heat to the prostate works with radiofrequency and is used only for this purpose.

"A heat probe or electrode is placed in a normal bladder catheter and then inserted into the urethra where it is positioned in the center of the prostate. The probe emits radiofrequency waves which are collected either by the hypertrophic tissue of BPH (Benign Prostate Hyperplasia) or the cancerous tissue of a prostate cancer. The heat development inside the prostate is controlled by computer. This elevated temperature causes thermic damage to the malignant tissue, which is destroyed effectively and replaced by healthy tissue. To be precise, with this method we not only destroy the malignant tumor cells in the prostate, but we also trigger an active specific immune response. Due to the temporary hormone therapy, we achieve a hormone growth inhibition of cancer cells outside of the prostate. Patients treated with this method experience a significant improvement in their urination and together with a specific hormone modulation and biological support program can have a very effective treatment with excellent long term results”.

Me having local hyperthermia

Some more background regarding transuretheral hyperthermia including clips of Dr Douwes who runs Klinik St Georges and was very present in the Klinik stopping to talk to many of us:
https://www.youtube.com/watch?v=pfecKEX2iRM

See my video with Prof Alexander who used to work at Klinic St Georges and takes a slightly different approach now:
https://myunexpectedguide.blogspot.com/2018/10/return-to-editingprof-dr-alexander.html

See more generally about hyperthermia here: 
https://www.canceractive.com/article/whole-body-hyperthermia-helps-kill-cancer-cells

Klinik St Georges

What was it like?

Treatment is tailored to your particular prostate cancer. On arrival, which was a short walk from the AirB&B, I was given various medical tests including an ultrasound and blood tests. Staff were friendly and mostly spoke English to a standard well enough to communicate - great as my German is almost non-existent. During the week there was a treatment every day including:

- two sessions of the transurethral hyperthermia which lasted over three hours. Temperatures in the probe reach 48 to 52 degrees centigrade and are controlled by a computer. It was certainly very uncomfortable sitting up and having the probe and catheter inserted for that time; the constant feeling of peeing/burning made it hard to even read a book the first time. However the second time there was less discomfort. 

- five local hyperthermia treatments; these were lying down for about an hour with a hot plate put over the prostate area

- various intravenous infusions; Vitamin C, Selenium and a chelate to help remove heavy metals.

Treatment room for IV

You can read about one guy’s experience on the CancerActive website - not at all dissimilar from my own: 

https://www.canceractive.com/article/german-cancer-kliniks

I was also given six months of three hormones. Time was so short before leaving and communicating with Germany wasn't easy, so I didn't get a chance to find out more about the hormones - I found out later that I could have got these on the NHS on my return. Anyhow I got a prescription from the German doctors and bought them at some considerable expense from the pharmacy opposite the Klinik; Finasterid 5mg, Bicalutamid 50mg and two Trenatone injections that each last three months. 

As noted the doctors considered that the biopsy I had, could have encouraged the cancer to spread so hormones are not always part of the treatment. They write in their information pack: “We combine the, already very effective, transuretheral heat therapy, with a temporary hormone therapy. Why? Because it has been shown that in most patients already had a transrectal multi-biopsy during which, not only, the malignant cells were washed into the system where they lodged in the lymph nodes or bone marrow, but the biopsy insult also induced the local prostate inflammation following a healing process during which many mediators are released such as growth hormones (for example EGF, VEGF, COX2, etc). The biopsy injury to the prostate must heal and for this are inflammatory mediators and growth hormones are needed. But precisely these mediators produce in a less vicious tumour a faster and aggressive growth of the tumor and those feed a general activation."

The reason for this is that they consider the hormone therapy prevents the body’s remaining cancer cells from growing. Hence you see PSA levels drop while taking the hormones and for six months after as the hormones take time to leave the body. The other reason they give for taking hormones, is that there is sufficient time for the hyperthermia induced immunological effects to become active. In short they aim to destroy the malignant tumor cells in the prostate but also trigger an 'active specific immune response’.

Map with pins showing international patients

Side effects? 

Well apart from some minor fatigue due to the concerns/stress and worries about what to expect, I only had a slight burning sensation when passing urine for a couple of days. There were no other side-effects although I understand some people can have some but generally these are very minor compared with other treatments. However the hormones were a different matter - you can read more of my thoughts re hormones and my experience in a previous blog here.


Results

Urination is meant to improve however I didn’t see such changes which have only got slightly poorer over the last two years ie I am still being being woken two times in a night, occasionally three. I use the International Prostate Symptom Score (IPSS) to try and keep track. It has gone from 15 to 18 in two years. See more about IPSS here.

Klinik St Georges

My MRI 18 months on from the first MRI and just over a year on from the treatment, showed “no change”. However as I note in an earlier blog, the MRI could be read as showing a 20% drop in size of the tumor. See previous discussion here.

Now clearly shrinkage is good but also disappointing that results were not more significant. The rise in PSA is also very disappointing. So did the transuretheral hyperthermia only knock the tumor growth back for a while or has it had a more significant impact? 

I have since met a guy in Stroud who has had the same treatment and his PSA is climbing after two years. I understand most people only have one treatment but that a number of people have had two or three treatments to keep their cancer at bay.

I did contact the Klinik again, they give 4 months follow up free but after that the advice is around £80. They recommended a PET scan (more on scans in another blog) and concluded that my "tumor cells are still active. The PSA is a tumor marker and indicates, if there is a problem. This might also be an infection. Therefore, the request for an imaging report. Yes, we assume that another hyperthermia in combination with hormone blockade will have a shrinking effect.” 

It's worth mentioning that while this treatment is widely used in Germany it was seen by my NHS oncologist as being 'alternative'. It is interesting to see the different approaches between countries; Mistletoe is another treatment widely used in Germany but seen as very fringe here by most of the medical profession. I can feel a blog coming up on this issue sometime!

So when I get my PSA result a further hyperthermia might be an option? However at a cost of £6,000 plus possibly a scan this will need serious consideration. Could that huge amount of money be spent better?