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HIFU v Radiotherapy v Prostatectomy

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User
Posted 11 May 2022 at 22:55

Hi all, I'm new to this community. I was diagnosed in 2018. Had a PSA then of 5.2. MRI revealed small focal lesion in left base of prostate. Had a template biopsy done, 1 afffected sample out of 18 taken. Gleason 3+3, T2, N0, M0.


AS was recommended due to small localised PCa & I've been on AS since then. PSA has fluctuated a bit, but rising slowly from over 7 to over 8. Second MRI in August 2020 showed no apparent change in PCa size.


PSA then jumped to 10 in Feb 2022, so had another MRI in March which showed a marginal increase. Had another template biopsy end of March - 4 samples out of 31 taken had cancer and Gleason now 3+4.


I've been advised that AS is still one option, but have also been offered RP, RT (external beam) or HIFU.


I don't like the sound of RT, both from the point of view of the number of visits to hospital & the potential side effects. I haven't ruled out RP completely as a radical treatment, but very concerned about the side effects with it too. I've read a lot of posts on here from men who still have problems with incontinence months or years after the surgery, and as a fairly active 60 year old, that doesn't appeal!


So at the moment my inclination is to go for HIFU, which has far less chance of unpleasant side effects. Also the cancer is still small & apparently confined to the one area easily accessible on the left hand side of the prostate, so appears an ideal cadidate for HIFU. My hospital at Basingstoke was, I think, one of the earliest to offer HIFU outside of trials, and they are pretty experienced at the procedure.


The only thing that has me wavering a bit are the very conflicting views about how effective it is, with some published studies suggesting it is very effective, but a number of posts on here about "high recurrence rates" (how high?)


Is there anywhere that I can get reliable stats/comparisons for the various treatments?


 

User
Posted 12 May 2022 at 00:18

If you read this thread


 https://community.prostatecanceruk.org/posts/t28100-Looking-for-Hifu-results#post267709


You will see two videos linked to by Old Barry. They suggest HIFU has moved on and is now better targeted. The advantages of very low side effects are compelling. So if you are deemed a suitable candidate for HIFU it is a good idea.

Dave

User
Posted 12 May 2022 at 08:12
My feeling is that more than with any other treatment, you will only be offered HIFU if it is felt it will do the job because if there are doubts, the more radical options of RP or RT would be offered. Having said that, both RP and RT have their failures and HIFU can sometimes follow failed RT as I can personally attest. HIFU can often be repeated in need or followed by RP or RT. Do you use the pin hammer approach and only the club hammer if required or go straight to the club hammer?
Barry
User
Posted 17 May 2022 at 01:27
You seem like a great candidate for HIFU to me!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 12 May 2022 at 00:18

If you read this thread


 https://community.prostatecanceruk.org/posts/t28100-Looking-for-Hifu-results#post267709


You will see two videos linked to by Old Barry. They suggest HIFU has moved on and is now better targeted. The advantages of very low side effects are compelling. So if you are deemed a suitable candidate for HIFU it is a good idea.

Dave

User
Posted 12 May 2022 at 08:12
My feeling is that more than with any other treatment, you will only be offered HIFU if it is felt it will do the job because if there are doubts, the more radical options of RP or RT would be offered. Having said that, both RP and RT have their failures and HIFU can sometimes follow failed RT as I can personally attest. HIFU can often be repeated in need or followed by RP or RT. Do you use the pin hammer approach and only the club hammer if required or go straight to the club hammer?
Barry
User
Posted 17 May 2022 at 01:27
You seem like a great candidate for HIFU to me!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 17 May 2022 at 12:25

Thanks all, very useful and interesting.


The 2 videos from an expert in the procedure were very enlightening.

User
Posted 18 May 2022 at 19:55

Hello again.


Thought this might be of interest.  The urology specialist nurse at Basingstoke Hospital has sent me a copy of a paper on the HIFU trial that was carried out at Basingstoke Hospital.  Looks like I might not be allowed to post the whole paper here, but a summary is available on the internet at https://www.sciencedirect.com/science/article/abs/pii/S0090429519307307 and here https://www.goldjournal.net/article/S0090-4295(19)30730-7/fulltext


Results look equally encouraging to what was reported by the Professor from University College in the videos.


I know that 3 of the 5 authors of the study are still carrying out HIFU treatments at Basingstoke.


Feeling pretty positive now about HIFU as a treatment option.


 


 


 

User
Posted 18 May 2022 at 20:32
I try to be unbiased and objective but 30 months is not even medium term in this study. Also, you will note that a high percentage of the men involved needed retreating with HIFU to get a good result. However, the procedure is so easy and side effects so minimal in most cases, that it may be acceptable for many suitable men who also have the opportunity of more radical treatment after it if necessary.
Barry
User
Posted 21 May 2022 at 21:34

Maybe that summary didn't do justice to the whole paper! The median follow-up was 30 months, but the range was 12 months to 9 years.


I might find out if I can post the whole thing as I am sure it will interest other people interested in HIFU as a treatment option.

User
Posted 24 May 2022 at 08:17

I live in Bucks, which does not offer HIFU, but I did ask about it and was told I could be referred to another trust but the feeling I got from the healthcare professionals I spoke to did not think HIFU was established enough to know the long term efficacy. The NHS site says HIFU is only available as a clinical trial.


 

User
Posted 24 May 2022 at 13:34

This is an interesting link and details contacts for HIFU on NHS. One of those listed did my first HIFU under as part of a trial but repeated it outside a trial on NHS. https://prostatematters.co.uk/treatments-for-in-capsule-diagnoses-t1-t2/where-to-access-hifu-treatment/


Incidentally, Prostate Cancer UK are funding HIFU research


 


 


 

Edited by member 24 May 2022 at 13:37  | Reason: to highlight link

Barry
User
Posted 01 Jun 2022 at 11:58

Toby


 


As part of your research look at IRE treatment--see my post on this treatment method


Has the lowest side effects treatment of all the ones I looked at. I also looked at HIFU.


 


paul

 
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