HIFU

Hello the group: I'm new here and new to PCa. I believe I'm a candidate for HIFU therapy and have heard and read many pros and cons. I'm interested in hearing from any members who have been through this procedure.

Many Thanks!
Guy2019

Welcome to HW.

as JNF said HIFU isn't for primary treatment.

Welcome. As JNF said, please provide us the details of your diagnosis--such as your PSA history, biopsy results, what your doctors have said about your DRE, etc. HIFU is not approved for use in the USA for prostate cancer--for good reason, it's not been shown to be effective for cancer treatment.

Where are you located?

Also, if you hang around with us, you'll find that we believe in research, proven methods, and data. HIFU has none of those backing it up.

Welcome and sorry you had to join this merry group of survivors. Hang in there we only want to share our experience. Sometime it may come across as harsh but believe me when I say we care. Your job is to learn as much as you can and our collective experience is a great resource, so keep asking questions. Denis

There is a good reason why it has been discontinued in Europe and Japan. It is also the only treatment option in which risk of reoccurrence increases with time.

It hasn't been approved for PCa treatment. It was approved for prostate tissue ablation in June 2018. Some trials for it's use for PCa continue. You certainly could have the treatment off label for PCa , but Medicare nor commercial insurance would reimburse the cost. If you are ablating prostate tissue say for for BPH, then it would be on label and potentially reimbursed.

The FDA approval for prostate tissue ablation came in October, 2015.

https://www.medscape.com/viewarticle/853120

It sounds like it could be an attractive treatment if they manage to refine it because of low side effects, particularly ED. The results of the clinical trials won't be available until 2029 though.

Even with 3 cores, assuming they are all G6, AS is still a good choice. With previous radiation, you would be dosage limited, I think--depending on the previous dosages and areas treated. If you had previous pelvic radiation, the surgery could be a problem--previously cooked tissue is tough to deal with.

Where are you located? Especially with previous cancer treatment, you need to be at a really good facility for complex situations.

2019Guy, it would seem prudent for you to get another reading on your biopsy slides, probably from Dr. Epstein at JHU. Please see the sticky thread at the top of our forum for details on how to do that. Reading prostate pathology is a real art so you want it done right and by an expert since you are making potentially life changing decisions here.

BTW, one of our members once compared undergoing surgery for a G6 cancer as using a sledge hammer on a thumb tack. In my opinion there is some wisdom in that comparison.

Jim

Boy, you guys are great. Thanks a million for all the wise words. They're very important to me, especially from people who've been through it.

My radiation in early 2009 was in the neck area and as I recall was around 5300 cGy (they usually do 6-7K but I'd had surgery first so the higher dose wasn't necessary; I'm coming up on 10 yrs out with NED).

I'm being treated at Kaiser in Los Angeles. They have a good general reputation as a hospital but that's all I know about them specifically. I fully intend to explore other opinions, including the excellent radiation oncologist who treated me in 09. I realize that I'm not in emergency mode and fully intend to educate myself over the next months - I've got Dr. Walsh's book in the latest edition as a start, and then there are all of you!

My biopsy slides were reviewed by 2 pathologists at Kaiser. My uro is also reaching out to another rad onc he trusts for his opinion, this to come back this week. I'd read of Dr. Epstein in the Walsh book and he certainly seems to the main man when it comes to this stuff. So I'll consider that as well.

I seem to be something of an odd case in that my prostate volume isn't very large (try telling that to my nighttime self getting up again and again when I should be sleeping!) and my PSA reading in August was a staggeringly-high 1.2 (actually down from 1.4 in 2015), with free PSA of .38.

That's where we stand at the moment. Once again, I deeply appreciate everyone's concern and knowledge.

(Disclaimer: I've discussed all this on another forum (not playing favorites... I just found that one first). Figure there's no point in limiting myself when it comes to learning!)

2019Guy, a couple of more thoughts:

1. I agree with JNF that the prior radiation is not likely to preclude prostate radiation now. But neither of us have our MD so his other advice about consulting an RO is certainly right...just make sure he/she has significant experience in treating prostate cancer not simply an "RO".

2. Many of us had normal prostate sizes. What that does is allow for all types of radiation.

3. No problem consulting other sites. Heck, get as much info as you can.

4. I'm sure the pathologists at Kaiser are just fine but...Dr. Epstein is the standard. Get it done right.

5. As long as you are reading, get some balance to Walsh's (generally pro-surgery) book. Try Dr. Scholz", "Invasion of the Prostate Snatchers" or his newer book, "The Key to Prostate Cancer".

6. You might want to consider making a "signature" which you can do in your profile. That will allow us to see your vital stats w/o jumping back to earlier posts.

Jim

Guy, it sounds like you're doing good research--if you can get in to see Dr. Sholz that would be a good thing. A sense of humor is vital--by the time you're done, you'll have been violated repeatedly by the best. My humorous take on this: I learned to look at the glove rack in the exam room, and note which box was most used. If it was the small or medium box, no worries, but if it was the extra large----ACK!

With your G6 and low PSA==AS really does sound like a good choice. Now, there is a version of PC that is really ugly that puts out very low PSA--I think there are a couple of guys here who came in with metastatic G9's with PSA's of under 10. But that is really rare--and I don't think it's you.

There are lots of great and near-great PC docs on the West Coast--get with them and learn. Make the decision that is right for you and your wife. That's the bottom line.