Treatment - HIFU or other?

Hi Ptr,

I was not in the same position as yourself, being now 70 years of age and taking heart medication which was already affecting my potency. Nevertheless, I was still able to get an erection which I could maintain with a ring. My surgeon warned me however, that if I proceeded to surgery I would be incontinent initially, but dry by 12 months. On the other hand, in view of my age and the medication I am taking, I would probably not regain my potency. This of course should not apply to you as a younger man but I have read that it can take up to two years to recover full potency after radical prostatectomy.

I had da Vinci surgery in September 2014, had catheter removed after 2 weeks and almost dry by 6 months when I stopped using pads. I only leak a little now when I sneeze or have a coughing fit (or a little too much to drink). On the Erectile dysfunction front, Viagra does not work, so I am considering insertable pellets (Muse). I have to make do with a pump meanwhile, which amuses my wife, but whilst I can enjoy dry orgasms, I have yet to achieve penetration. I therefore quite understand why you may wish to avoid surgery at this stage.

My choice between Radiotherapy, surgery or HIFU was for me quite straightforward. I wanted cure and in view of my age, felt that active surveillance was not a long term option, especially as my Gleason score of 6 (3+3) was found after template biopsy to be Gleason 7 (3+4) and my PSA increased from 7 at diagnosis to 9 and then shortly before the operation 11. The stage also was revised from T2b to T2c. So, everything was going in the wrong direction. I had discussions with the specialists about the 3 main options, and chose surgery as it was described as " the Gold standard" for cure albeit with the side effects. I was not interested in Radiotherapy as this would have involved months of treatment and it would be many months thereafter before the PSA levels would be potentially reduce to a level that would be regarded as a cure. Also, there is a risk of impotence later on. Further, I have a heart pacemaker and cannot undergo a MRI scan so the opportunity to monitor my prostate more closely was not open to me. I liked the sound of HIFU, which targets the tumours in the prostate, but again, MRI scanning is necessary to confirm the treatment has been successful.

As it happens, after the operation, which was straightforward and I was allowed home the following day, the tumour was found on biopsy to have been far more widespread than had been supposed and I was told that I was only a few months away from the tumour having spread beyond the prostate, so I count myself very fortunate. Interestingly, HIFU would not in fact have been appropriate given the extent of tumour. My PSA at three and 6 months post operation was undetectable.

I can of course only speak as to my own experiences, but one thing I did find valuable was to ensure that all available investigations had been carried out so that my decision was made with all the facts to hand.

If you have not had an MRI scan, I would suggest that this should be the next step.

I do hope that you find this helpful and wish you good luck for the future.

Hi Peter,

I am 44 year old British male, about to undergo HIFU in a couple of weeks.  I have very similar prostate cancer to yours,  predominantly 3+3 in three areas with a tiny amount of 3+4. PSA has been between 3.2 and 4.2 over past year.  I'm generally fit, healthy and normal weight.

I've been undergoing active surveillance for the last year but with the 3+4 emerging during last biopsy in May 2015 I have decided to go for HIFU.  Mainly because I'm a suitable candidate and it has fewer risks of adverse side effects. Also the recory times and success rates are good.  My consultant who has been very good recommended it for me.

I can update you on my progress in a few weeks' time.  Personally for me it was the only treatment I wanted, as all the others looked too severe.  My op is on 29th June 2015, so will post a week or so after that. Although I've not had it yet I'd suggest you explore it furrther and push for it if that's the kind of reatment you'd like.

Good luck!

Hi Peter,

Although men may have similar stats, in reality they can benefit to a greater or lesser degree as individuals from various treatments. You want the best treatment for you having considered your options and potential side effects. Not all hospitals can offer all the options so you might have to look elsewhere. HIFU is an example. It is not widely done in the UK either and where it has been undertaken it is usually as a salvage treatment where another treatment has failed. I had HIFU on 28th July 2015 to treat some further cancer after radiation treatment I had in 2008 failed. It was preceded by a template perineal biopsy under anesthetic and it went well for me. My PSA fell from 1.99 pre HIFU to 0.42 by 27th August 2015. HIFU only treats the cancer in the prostate or very very close to it. Unusually and because it was in a study, I had it even though I have a suspicious iliac node which may still be affecting the PSA level and may require further treatment. HIFU has a number of advantages, one being that it can be repeated in need.

If you decide to consider HIFU further and it is not readily and reasonably priced in Belgium, you could try facilities in France and Germany

Edited by member 03 Nov 2015 at 22:48  | Reason: Not specified

Hi Steve

Where did you get HIFU done?

Thanks

David