HIFU anyone ?

Fred, if you check my bio (click on the icon) you will see my diagnosis was not that different to yours, and I had to eventually decide between HIFU and robotic surgery. 

Some people say that surgeons tend to advise surgery, and radiologists tend to advise radiotherapy, which I suppose is human nature, because each is more comfortable with their own specialist area of medicine.

Happy to expand on my experience if it helps

Rob 

Edited by member 01 Jan 2019 at 11:00  | Reason: for clarity

My misgivings for HIFU is that Prostate cancer is more often than not a multifocal disease in that there will be more than one or two areas of cancer within the prostate. The biopsy will probably miss tiny areas and the MRI however good cannot possibly show microscopic areas that have not progressed to visible tumour yet. 

As focal therapy in prostate cancer is monotherapy where the aim is to destroy the visible tumour there is always the risk of microscopic tumours being left behind to continue growing.

My husband's mp MRI showed 2 lesions in his Prostate but when he had it removed the histopathology showed there was moderate patchy involvement. Had they just treated the 2 areas of concern he would still have a cancerous prostate.

Everyone has to make their own decision though and hope for the best.

Best Wishes

Ann

P.S  

We found a great book to read which covers everything Prostate Cancer related especially when having to make treatment decisions is Dr Patrick Walsh's " Guide to surviving Prostate Cancer". ( 4th edition) He is a world renowned American urologist who first developed nerve sparing prostatectomies.

Edited by member 01 Jan 2019 at 11:14  | Reason: Not specified

That is a fair point Ann but in need HIFU can be repeated or followed by Prostatectomy, or RT whereas with Radiotherapy tumours can regrow but treating them with further RT is problematical. Also, some tumours that remain after HIFU or RT may never cause a problem. This is known because it has been found that many men die with tumours, rather than because of them, some men not even knowing they had them. It has been established that many men are over treated by having indolent tumours treated with RT or Prostatectomy, and some leading urologists specializing in Focal therapies consider less damaging HIFU (there are also other Focal Therapies) to be a good option for some men rather than Prostatectomy or Radiation.

There is a very interesting discussion with the leading expert on Focal therapy in this radio programme.  The introductions are unnecessarily long but Prof M E's views are worth listening to. https://www.curetalks.com/event/rsvp/HIFU-Focal-Therapy-for-Prostate-Cancer/134/

Edited by member 01 Jan 2019 at 12:29  | Reason: Not specified

Had the MDT not seriously advised that in my case they believed it would not be possible to remove all my cancer by Prostatectomy, I would have opted for surgery, (It was beyond Focal treatment too). This left Radiotherapy which can cover a more extensive area and 10+ years after RT, a 68 Gallium PSMA scan and an MRI showed no cancer outside my Prostate, so the RT did a good job in this respect. Unfortunately, as can happen with a Prostate, even a quite extensively radiated one, tumours can regrow. Some of these may need treatment whilst others are not significant and can be left. My first HIFU treatment dealt with the first regrown tumour but a very small tumour has since regrown in another part of my Prostate and consideration is being given to treating this. There could be other as yet small tumours (multifocal) that have not yet been identified. (I urge members to listen to Professor M E who covers this aspect in the link I gave). I could have stopped any further cancer developing within my Prostate by having a late Prostatectomy as there are a few surgeons who will do this tricky op post RT but I was told there would be 100% likelyhood of permanent incontinence apart from other adverse side effects. So I preferred to have HIFU and again in need. HIFU like other treatments should only be given to suitable patients. I could have just relied on HT until I become refractory and suffered the effects of this and possibly other further down the road systemic treatments but much better in my opinion to have repeat HIFU.  How do you think I could have done better Ann?

Should it be decided that the small regrown tumour I now have would benefit from treatment, my first choice would be Focal Laser Ablation (FLA) as it is very precise with less collateral damage than HIFU. This also means it can treat nearer to critical organs. This is what Clare's husband had but unfortunately it is only available abroad and at considerable cost. Even with FLA it is still possible that further tumours may develop over time and there may be a need for further FLA or more aggressive treatment in due course.

Of course, everybody diagnosed with PCa hopes that one primary treatment will be all they will ever require and for some this proves to be the case but for many men regardless of what primary treatment they have, it will need to be backed up by at least one other form of treatment to help them fight this disease.

Incidentally, the same argument against HIFU not treating insignificant tumours can be made for RT where greater precision means only part of the Prostate is radiated. HIFU is claimed to preserve more of the function of the Prostate than surgery or radiation.

Edited by member 01 Jan 2019 at 22:18  | Reason: Not specified