Focal Therapy experience please

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User

Posted 09 Mar 2022 at 16:28

Hi all,

Firstly, I wanted to thank this community. I have been reading these conversations since my father has been diagnosed with prostate cancer and it has been really informative as well as a comfort for me, especially as I feel overwhelmed with everything with the diagnosis, and choosing treatment options etc.

I have come across focal therapy and my father is interested in it especially with the side effect profile. I know there isn't long term survival data, but it looks promising from what I have read. I wanted to know people's experience with focal therapy (both HIFU and cryotherapy), and wanted to know where is the best centre for this treatment.

Thank you in advanced! Much appreciated.

User

Posted 09 Mar 2022 at 17:55

It depends on his diagnosis. If he has a T1 gleason 3+3 or 3+4 and doesn't suffer too much with anxiety, focal therapy might be a good option. But the recurrence rate is high so if he is expecting a cure or would be devastated when it fails, rule it out. Focal therapy is good a) for men who would otherwise be suitable for active surveillance or b) as a salvage treatment or c) for men who are really okay with the possibility of repeating the treatment if unsuccessful first time. It is not really suitable for men who need radical treatment and are hoping to avoid side effects.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 09 Mar 2022 at 19:59

Thanks LynEyre, I definitely need to read more on this as I was under the impression it was radical treatment. But by the sounds of it my dad may not be suitable for it. He is query T2 Gleason 4+3...

User

Posted 10 Mar 2022 at 00:37

With a 4 + 3 Gleason and staging of T2, (assuming MO and NO), Dad may well be suitable for HIFU, Cryotherapy or Nanoknife (Irreversible Electroporation), depending on where in the Prostate the tumour is located. I am not sure about the other two but certainly HIFU only treats what is thought to be significant tumour(s), leaving insignificant ones and thereby the chance of better preserving function. It is possible that in due course what was believed to be an 'insignificant' one may become 'significant', which could to some extent be why more follow up treatments are necessary. There is also the possibility that the HIFU tumour may be just too great for the HIFU to treat or as can also happen with RT, a new tumour develop.

UCLH offer the 3 mentioned focal treatments, and if interested I would get a referral to them to discuss. They also do RT and more Prostatectomies than anybody else in UK, so will not pressurize a man to have focal treatment. Having said that, they are extremely busy and their clerical side is pretty poor in my experience.

I had HIFU twice for failed RT, so be aware that these treatments as well as Prostatectomy sometimes fail.

Edited by member 10 Mar 2022 at 00:38 | Reason: Not specified

Barry

User

Posted 13 Mar 2022 at 17:24

Thanks Barry for your insights and experience, much appreciated. My father is being treated in London at Charing Cross Hospital and I have requested to speak to someone regarding focal therapy as an option.

Can I also check if you need anti-androgen before having LHRH? My dad didn't tolerate Bicalutamide, so was stopped after 2 doses and no other alternative was given when I requested for one. Is this normal practice to have no cover for the testosterone flare?

Many thanks

User

Posted 13 Mar 2022 at 20:33

Men aren't usually given HT unless they are going to be having radiotherapy or brachytherapy - for the rest, it was introduced as a temporary covid thing while waiting lists for surgery were bad. There is no testosterone flare if he isn't going to be having injectable HT and he certainly won't need HT if he goes for focal therapy - it would negate the benefit of opting for a less intrusive treatment option.

If he does choose RT or brachy and the onco thinks he needs HT, they will prescribe a hormone that doesn't need bicalutimide first.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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