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HIFU , Solution or Enigma

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User
Posted 06 Mar 2023 at 19:12

 

Had an appointment privately to discuss HIFU last week after research about this been the niche treatment for low level cancers grade 3 + 3 Gleason.

I was informed that the probe does not remove all the cancer and leaves some behind which I find disappointing which then further treatment may be required in another 5 years + time. This is not the niche treatment in terms of a cure; hence I presume why it is not widely available on the NHS due to minimising the cancer rather than curing? The only benefit it seems is that it is less invasive and has a better outcome preserving sexual function and continence, but it is just delaying the inevitable second treatment option.

One question I did not ask was ‘why all the cancer is not targeted by the probe,’ has anyone got any answers to this please. Is it because the probe cannot reach all the areas? and the more areas targeted may cause more side effects? The next step is to have an advanced MPI MRI to be carried out in London to pinpoint a target area , it seems the basic MRI done in the NHS does not give a true picture if the cancer is low grade as the private specialist said  the volume of cancer, although slow growing, is greater than what I was told in the NHS.

Other peoples experience and views about these points will be appreciated.

It is likely the RP is the favourable route now to eradicate the localised cancer. Staying on Active Surveillance is obviously a benefit in the short term eventually treatment will have to happen.

 

User
Posted 07 Mar 2023 at 16:20

Barry's comment is spot-on.

A focal therapy is for treating just parts of the prostate, and thus only suitable for focal disease. HIFU and cryotherapy and Irreversible Electroporation (Nanoknife) all destroy tissue, basically leaving it necrotic and your body needs to repair that area, cleaning up the dead cells. There were some attempts to treat most of the prostate with a focal therapy that that mostly doesn't work well because you've lost the blood supply in too large a volume for the body to recover the necrotic tissue, and you've lost the blood supply for the urethra. Radiotherapy on the other hand which treats the whole prostate doesn't destroy all the tissue, only the cancer cells (plus a small percentage of healthy cells), but there's enough blood supply left for the tissue to repair and maintain itself healthy afterwards.

It's important that patients having focal therapy understand if they will be moving back to Active Surveillance afterwards as is often the case. It might not suit all of them to still have cancer present and to be on Active Surveillance, which is not completely risk free itself.

User
Posted 01 Jul 2023 at 23:11
I don't think it exists. The companies that sell focal treatments will naturally want to put them in the best possible light and the BAUS and international equivalents have no motivation to do the research as they are focused on the radical treatments.

The only reputable research I know of was into the effectiveness of proton beam therapy. The results were not as good for PCa as for some other, more difficult cancers so the NHS decided to approve proton beam therapy only for brain tumours, some head and neck tumours and small children.

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

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User
Posted 07 Mar 2023 at 07:43

Hi,
You have been correctly informed that the HIFU probe cannot focus on every area within the Prostate so if you have cancer in that particular area and you need treatment you would most likely either be asked if you would accept cryotherapy or opt for RP or RT, assuming you are suitable for one or both of these more radical procedures. Another reason why a man may not be suitable for HIFU is if there is heavy calcification in the area of focus. It is also the case that sometimes there it is too big an ask for HIFU to deal with the cancer and the more radical RP or RT is called for. The objective with HIFU is to treat only significant tumours within the Prostate, thereby minimising side effects and preserving function. It does sometimes but not always mean that a repeat procedure is necessary. I needed this by December 2021 after previous HIFU in 2015 which was given as salvage treatment for failed RT. RP also has its failures. A good quality MRI is certainly required with HIFU. Another Focal option might be be Irreversible Electroporation, more popularly known as Nanoknife but this not widely available in the UK. Suggest you use this link to gets opinions of top Focal Specialist in UK https://www.youtube.com/watch?v=aWb6HqOkqew

 

Edited by member 07 Mar 2023 at 14:25  | Reason: tautology

Barry
User
Posted 07 Mar 2023 at 16:20

Barry's comment is spot-on.

A focal therapy is for treating just parts of the prostate, and thus only suitable for focal disease. HIFU and cryotherapy and Irreversible Electroporation (Nanoknife) all destroy tissue, basically leaving it necrotic and your body needs to repair that area, cleaning up the dead cells. There were some attempts to treat most of the prostate with a focal therapy that that mostly doesn't work well because you've lost the blood supply in too large a volume for the body to recover the necrotic tissue, and you've lost the blood supply for the urethra. Radiotherapy on the other hand which treats the whole prostate doesn't destroy all the tissue, only the cancer cells (plus a small percentage of healthy cells), but there's enough blood supply left for the tissue to repair and maintain itself healthy afterwards.

It's important that patients having focal therapy understand if they will be moving back to Active Surveillance afterwards as is often the case. It might not suit all of them to still have cancer present and to be on Active Surveillance, which is not completely risk free itself.

User
Posted 07 Mar 2023 at 17:09

In a previous post Malton says 7 out of 7 cores were positive on the left hand side. I guess that means the cancer is too widespread for HIFU ?

Dave

User
Posted 07 Mar 2023 at 19:37
As Professor M E says in the lecture I linked to, it is most important that men are properly assessed for suitability with HIFU, which would include volume and location among other factors and that high quality MRI tests and good biopsy are essential. There must come a point where it is decided that for a particular individual Focal Treatment will not do the job. Of course this tipping point also applies but in a slightly different way with RP as when originally diagnosed the surgeon told me he would give me an RP if I strongly wanted it but he was doubtful if he could remove all the cancer so recommended RT instead. I am pretty sure that some surgeons mindful of their success stats would not have offered the RP in such a situation. One would think that there would be borderline cases with HIFU too.
Barry
User
Posted 07 Mar 2023 at 20:50
I think that the above posts have it in a nutshell - focal treatment is so called because it concentrates treatment on one or two (or a limited number of) cancerous areas while radical treatment (RP / EBRT / brachy) is called radical because it treats the whole gland. Despite being available to PCa patients since the 1990s, HIFU seems still to be best suited to a) those men who would otherwise be considering AS or b) those looking for a salvage treatment. HIFU / green laser / FLA / cryotherapy / nanoknife do not appear to be realistic alternatives for those who need radical treatment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 01 Jul 2023 at 21:57

Has anyone on this forum found reliable data on recurrence of PCa for those who don't chose radical treatment?  I have looked long and hard and struggle to find it, this is surprising to me

User
Posted 01 Jul 2023 at 23:11
I don't think it exists. The companies that sell focal treatments will naturally want to put them in the best possible light and the BAUS and international equivalents have no motivation to do the research as they are focused on the radical treatments.

The only reputable research I know of was into the effectiveness of proton beam therapy. The results were not as good for PCa as for some other, more difficult cancers so the NHS decided to approve proton beam therapy only for brain tumours, some head and neck tumours and small children.

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

 
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