Agonising over treatment options especially focal therapy

Good plan to visit consultants specialising in all 3 disciplines Tony. You can then ask more detailed questions. A case can be made for and against all forms of treatment. Surgery and Radiation (of which there are several types and combinations) set out to kil lall cancer cells by removing the entire Prostate or causing all cancer cells in the Prostate to be irradiated thereby causing death to them over time by damaging their DNA so they can't effectively divide. On the other hand Focal Treament treats only cancer lesions that are considered significant and may require two applications to complete the job. Also, while a man still has Prostate there is a possibility that in time a further lesion may develop. The advantage of Focal treatment is the it helps preserve function, generally has fewer and milder side effects and is quickly done, you generally have a cup of tea and go home the same day or the next one. In need you can have follow up Prostatectomy or Radiation although this is made somewhat more difficult any treatment to the Prostate.

I had two applications of HIFU, although if not where the probe can reach it would be Cryotherapy or Irreversible Electroporation in the UK. You do of course have to be a suitable patient which is more critical with Focal Treatment. I found the catheter when in place for a week made me a little sore but apart from that it was a doddle! I had HIFU as salvage treatment for failed Radiotherapy and for 4 years now my PSA has not exceeded 0.05, 3 follow up MRI scans have been clear and I have been told I am in remission. Focal Treatment can be also be given as a primary treatment for suitable men. This is a very good recently posted video about the 3 main types of treatment. Forum rules don't allow me to be specific but the hospital in this video is the leading one in the UK for Focal Therapy and I am very grateful for the HIFU I had there. https://youtu.be/zYTU94-8pTc?si=bo5KTm0p2Jzczlqf

Edited by member 04 Jul 2025 at 00:19  | Reason: to highlight link

Such a tough decision, Im 56 and was diagnosed 3+4=7 in March , since then have been back and forth with which treatment to have , at first I was also interested in HIFU and it’s strange as my NHS Urologists wouldn’t give it the time of day , they said it wasn’t approved and had no long term track records , strange then how other NHS hospitals do offer it and a top London surgeon who I am seeing privately also rates it for low volume cancer

i did decide against it in the end mainly because I would have struggled to get it on the NHS so would have had to pay privately, i then personally wouldn’t have been able to relax knowing it could spring up in another part of the prostate and from what a surgeon told me although it doesn’t cause the issues for future potential surgery that RT does it can make it more problematic , in his words an untouched prostate is always best for surgery 

I have booked full surgery as he says he can do full nerve sparing , he is also confident on continence but makes no promises on ED , if you do consider this route it is worth asking the surgeon about your continence as I think they can work out the odds of recovery on that better than ED 

all the best with it mate 

Nick

Wish you well with it Tony, it really is a minefield navigating treatment options, got to say when I was diagnosed I didn’t think I would have all these options thrown at me with not much guidance from the NHS , on the flip side of that at least we are lucky enough to have options 👍