FOCAL THERAPY HIFU

Hi Bop,

You seem to have two similar posts. Might I suggest that you consolidate them into one single post, and keep the thread running as your situation changes?

My surgeon had to do a prostatectomy on a failed HIFU case last week, and I asked him what he thought of HIFU.

’Not much,’ he answered ‘but then as a surgeon, I am biased.’

Best of luck.

Cheers, John.

Edited by member 01 May 2020 at 07:24  | Reason: Not specified

Clinicians naturally have faith in and favour their specialties and to get a better idea you need to look at statistics.  Even here results can be skewed because of patient suitability.  One eminent surgeon said where an individual qualified, he thought only surgery was the best answer but Athalays (former prominent member of this forum) highly regarded oncologist said he could achieve with RT anything that could be done by surgery as regards PCa treatment.  Proton Beam which is very expensive and has largely been done in the USA has it's failures but also it's advocates both clinicians and patients.  One of the difficulties in making comparisons of treatments between success and reducing side effects is that these have been considerably improved and refined over recent years including techniques, equipment and appropriate patient selection. Newer treatments such as focal have also improved but it is only by looking back after various numbers of years that a better comparison can be made but by this time further improvements are likely to have taken place.  Then there is the possibility that one form of treatment may be combined with another.  Also, some men may be happy to trade off slightly inferior results for milder side effects, an individual choice.  All current treatments have pros and cons and all those for which a patient is suitable may be considered.  Timing, cost, stage, past results, age, general aversion to a particular treatment, availability, accessibility, any contradictions and being prepared to look for options are some of the aspects that may influence a treatment decision.  

OK, I asked because some read about it and don't realize prerequisites to qualify. There is one other hurdle which you may be aware of so I will mention in case not. I think you might find it difficult to get your CCG to fund HIFU within the NHS as primary treatment for PCa. It is not a widely available treatment and where done within the NHS is usual as a salvage treatment within a trial, as it was in my case. So chances are you will have to pay for it. The procedure is done under general anesthesia so a prior assessment of heart, lungs etc is done. The procedure starts with an enema. It is all over very quickly and were it not for the fact that I had a drive home which you are told not to do within 24 hours, I would have driven home the same day.

I will link here to my experience which I hope you will find helpful https://community.prostatecanceruk.org/posts/t10960-HIFU--my-experience#post133611

With HIFU a Fistula sometimes formed but this is far less common now. This is a very easy treatment with little short term side effects and no long term ones in my case (although it was previous RT that caused ED in my case so I can't comment on that relative to HIFU). There are  other things I will add shortly if I can find them.

Edited by member 01 May 2020 at 23:16  | Reason: Not specified

Some links I had bookmarked have been taken down but here is one from this charity https://prostatecanceruk.org/about-us/news-and-views/2018/7/hifu

and another from the UK's top Focal Urologist/

https://www.canceractive.com/article/professor-mark-emberton-on-high-intensity-focussed-ultrasound-or-hifu

Edited by member 01 May 2020 at 23:07  | Reason: to highlight link

If I were G 3+3=6, I would be seriously investigating Active Surveillance, rather than radical procedures at this stage. Did you know, there is a school of thought that G 3+3=6 should not even be classified as ‘cancer’ at all?

And if you had critical illness insurance with the likes of Aviva (née Norwich Union), they would not pay out on the policy as G 3+3=6 is not classed as ‘life threatening’!

Professor E also does NanoKnife, a less invasive surgery. It was trialled by him on the NHS and the success result was inconclusive, but he still offers it privately for around sixteen grand, as does a famous klinik in Heidelberg.

Best of luck.

Cheers, John.

No, but I wouldn't mind changing places with him though!  (cropped pic of display for tourists a few years ago now. I liked NZ)

Have you looked at Andy’(PCUK: andyprostate) page? He’s been through an extensive HIFU journey at UCLH. Worth a chat I’d say.

I looked at all the options before seeing the Prof Whocannotbenamedonhere. Some key points as I was classified as stage 1 Gleason 6 localised cancer. Reading many research papers, although it’s early stage, it became very clear that’s it’s still a cancer even though tends not to break out of the cellular matrix....although there are early studies showing this is possible. Also post RP in 40% of cases after Histology there tends to be an upgrade post biopsy as targeting can miss smaller amounts of higher grade tumour. In my case post op was upgraded to T2c Gleason 7 (3+4). And the 3T mpMRI showed the amount of tumour was small but distributed through all four quadrants plus very close to compromising the prostatic capsule. 

A major concern of any surgery was continence. I can kinda accepted ED might be something I have to live with. On November 27th 2019 I had Retzius Sparing (less disturbing on bladder control nerves) Robotic Assisted Radical Prostectomy with NeuroSafe. 2 nights at London bridge(Guys) under the care of the Prof and his sidekick Da Vinci Xi. Full continence reached week 5 (had minor leaks and dribbles after catheter removed). Life sprang back into the old fella fairly quickly even though one side of nerves removed. Erections good and pretty much same as pre-op. No problems at all with penetrative intercourse so that exceeds expectations. First set of PSA bloods undetectable <0.01...next bloods due by end of month...fingers crossed 🤞🏻 

Good luck with the journey and hope you have a good outcome.

Edited by member 04 May 2020 at 15:46  | Reason: Not specified

Hi Barry, and any one interested in hifu

The links you were looking for. 

https://community.prostatecanceruk.org/default.aspx?g=profile&u=43080

http://andrewhamm.co.uk/prostate/blogdetails.htm

Dave

If you search for ‘Santis Prostate’ you will find him.

And I also had an NHS consultation with the top prostate oncologist at the Royal Marsden.

These guys, together with Prof. E are world renowned specialists, so you will be in good hands whatever path you choose.

Best of luck.

Cheers, John.

Hi, chaps.

My prostate blog latest URL: http://andrewhamm.co.uk/prostate

My husband has had two focal treatments . A focal FLA in the USA in 2017 and a focal HIFU in Jan 2020

He recovered very quickly from the focal HIFU and has no ED, incontinence and no impact at all on his ability to work and live his life ( Lockdown meant he has not skied this season but his PCa has not caused QOL issues.

No regrets therefore for not going radical as the potential impacts for him could have lead to mental health issues as it does for many men.

The downside is we are completely aware he may still need a removal and have possibly just ‘kicked the can down the road’

PSA test on Monday ( at local GP in Midlands not the normal London option due to WFH) 

if the focal HIFU has failed then the ‘kicking the can down the road’ has given time to mentally adjust that removal may well be needed as opposed to rushing into it when the diagnosis was G6 and low risk ( though high volume originally)

A very eminent surgeon was consulted before the focal HIFU and assured he can still remove it even after 2 focal treatments ( the FLA was apparently very neat!)

so if the PSA has not dropped now he has had time to fully recover I guess it will be back for another scam and back to the drawing board!

He is lucky enough to be BUPA covered under their cancer guarantee although the FLA was out of pocket. 

Lockdown means the NHS are funding Monday’s PSA test though! 

Good Luck with your decision

Clare