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User
Posted 23 Feb 2023 at 11:06

Hi all,


I have been working my way through the conversation topics having recently been diagnosed with PCa (Gleason 3+4, 1/12 cores 25% 4, 4mm tumour).  Im investigating Hifu and surgery, and a little puzzled by the options as whilst HIFU seems to have good results it seems many in my position opt for surgery (Im 49 yo).  I was initially swayed by surgery but having further investigated the side effect profile I am looking again at hifu, understanding that it may not be a permanent solution.  It seems my age is a key input into the decision making process.  Has anyone been in this or similar position- I would appreciate any similar experience?


Thanks 

User
Posted 23 Feb 2023 at 18:06

Have a look at my profile. Think I was 56 when I was diagnosed. Went on active surveillance for a couple of years but eventually opted for surgery. Went for a surgeon with a very good reputation but was still concerned about side effects. 3 years on no regrets. For me side effects have been very minimal. Good luck.

User
Posted 24 Feb 2023 at 17:36

The good news is that your PCa has been caught early so it is very treatable. Also good that you are being offered HIFU as it's not available everywhere. Don't go with the flow, decide what you feel is best for you. Read up as much as you can on both treatments and prepare a list of questions to ask your urologist. With the HT/RT route it generally precludes prostatectomy at a later date. I'm not sure if that is the case with HIFU but unlike RT you can repeat the HIFU. I had prostatectomy so I can't really advise first hand on HIFU.

User
Posted 24 Feb 2023 at 18:46
Surgery has been the most usual route for 'young' men for many years. If they are able to remove all cancer with the Prostate, unlike with RT or Focal therapy, there is not the risk of cancer developing at some point in the Prostate over many remaining years. There may be other reasons why one of the forms of RT may be unsuitable in an individual case but it is a treatment with a long history. Long term outcomes of HIFU have yet to be established and a higher proportion of men treated with HIFU need it to be repeated or to be followed in some cases by RP or RT as salvage treatment. However, HIFU, (one form of Focal Treatment), has fewer and milder side effects than with RP or RT. So as a Primary Treatment HIFU has generally been given to older men or those that are prepared to accept the greater and unknown risk of subsequent treatment over many years for less severe side effects.
Barry
User
Posted 25 Feb 2023 at 08:58

As Barry has just explained so well I was one of those younger men and I was pretty much told the same by the consultant and oncology nurse.

User
Posted 03 Mar 2023 at 14:53

I have cancer Gleason 3+4 not visible on 2 excellent quality MRI scans. I've opted for surgery straight away accepting the risk but knowing the  tumour will be removed first time with the gland . That gives me a chance. 

User
Posted 10 Mar 2023 at 06:18

The NHS has a tool called Predict Prostate, which helps men with non-metastatic prostate cancer decide between radical and conservative treatment. You enter in your details then get back statistics for the effectiveness or otherwise of each treatment. 


In my view it sounds like surgery would be a sledgehammer to crack a nut in your case and at this point, but have a look at the tool and decide for yourself. Ideally with someone from the team advising you on treatment, who has all the information on your diagnosis and knows what it means. The 'side-effects' of surgery are significant.

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User
Posted 23 Feb 2023 at 18:06

Have a look at my profile. Think I was 56 when I was diagnosed. Went on active surveillance for a couple of years but eventually opted for surgery. Went for a surgeon with a very good reputation but was still concerned about side effects. 3 years on no regrets. For me side effects have been very minimal. Good luck.

User
Posted 23 Feb 2023 at 20:43

thank you!

User
Posted 23 Feb 2023 at 21:06

Further information on your diagnosis eg staging might help others to provide comment. It is firstly depends on what treatment paths are suitable for your particular diagnosis (and what is available locally). Usually this starts with conversations with your Urologist/Oncologist. In my case the MDT recommended surgery but also offered HT/RT as an alternative. It is a difficult decision to make as they all have different pros and cons. There are plenty on this forum who have had surgery and a few that have had HIFU but it is fair to that individuals' outcomes can be very different. Without a crystal ball it is always a difficult decision.

User
Posted 23 Feb 2023 at 21:28

Hi Chris


Thanks yes it's T2, so visible on the MRI, and it was diagnosed  month ago after elevated PSAs last year (4-5), two MRIs and then a positive biopsy.  I've been advised surgery and HIFU are both suitable, but less emphasis on RT.


 

User
Posted 24 Feb 2023 at 17:36

The good news is that your PCa has been caught early so it is very treatable. Also good that you are being offered HIFU as it's not available everywhere. Don't go with the flow, decide what you feel is best for you. Read up as much as you can on both treatments and prepare a list of questions to ask your urologist. With the HT/RT route it generally precludes prostatectomy at a later date. I'm not sure if that is the case with HIFU but unlike RT you can repeat the HIFU. I had prostatectomy so I can't really advise first hand on HIFU.

User
Posted 24 Feb 2023 at 18:46
Surgery has been the most usual route for 'young' men for many years. If they are able to remove all cancer with the Prostate, unlike with RT or Focal therapy, there is not the risk of cancer developing at some point in the Prostate over many remaining years. There may be other reasons why one of the forms of RT may be unsuitable in an individual case but it is a treatment with a long history. Long term outcomes of HIFU have yet to be established and a higher proportion of men treated with HIFU need it to be repeated or to be followed in some cases by RP or RT as salvage treatment. However, HIFU, (one form of Focal Treatment), has fewer and milder side effects than with RP or RT. So as a Primary Treatment HIFU has generally been given to older men or those that are prepared to accept the greater and unknown risk of subsequent treatment over many years for less severe side effects.
Barry
User
Posted 25 Feb 2023 at 08:58

As Barry has just explained so well I was one of those younger men and I was pretty much told the same by the consultant and oncology nurse.

User
Posted 03 Mar 2023 at 14:53

I have cancer Gleason 3+4 not visible on 2 excellent quality MRI scans. I've opted for surgery straight away accepting the risk but knowing the  tumour will be removed first time with the gland . That gives me a chance. 

User
Posted 03 Mar 2023 at 16:03

Thanks for your feedback; Im still a little on the fence, but may opt for the same...

User
Posted 10 Mar 2023 at 06:18

The NHS has a tool called Predict Prostate, which helps men with non-metastatic prostate cancer decide between radical and conservative treatment. You enter in your details then get back statistics for the effectiveness or otherwise of each treatment. 


In my view it sounds like surgery would be a sledgehammer to crack a nut in your case and at this point, but have a look at the tool and decide for yourself. Ideally with someone from the team advising you on treatment, who has all the information on your diagnosis and knows what it means. The 'side-effects' of surgery are significant.

User
Posted 27 Mar 2023 at 20:26

Hi there. I’m in exactly the same position, although I’m 53. New to this and to forum and I very much empathise. It’s all come pretty fast (last couple of weeks) so bit of a shock. Surgery sounds pretty radical (not least the side effects) so from a preliminary reading HIFU seems best of a bad bunch. Meeting with Oncologist next week so hoping that shines more light on it all. I know one thing, that biopsy was zero fun! 


 

 
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