New here, glad to see you!

I expect experience strength and hope, advice, suggestions and to be heard here. Here's the data.

I am now 61.
No GU symptoms. No ED, really. Since being a long-distance bicyclist and dealing with ED, switched to recumbent bike, had no ED since. Generally healthy, plan to be around for another 10-20 years.

October 2008, PSA 2.6
October 2009, PSA 2.6
December 2016, PSA 11.4
Feb 2017, PSA 11.0
March 2017, PSA 11.48
June 2017, PSA 11.83

3T MRI = 13May2017 "IMPRESSION: Mid gland lesion at midline of the anterior transition zone extending to the left and abutting the anterior fibromuscular stroma is at very high suspicion for malignancy with an overall PI-RADS score of 5. No gross extraprostatic spread is present." Prostate volume 25 cc. (yes, 25 cc!)

Fusion biopsy 22June2017
Systemic and focused cores taken.
3 positive cores = 1 described from suspicious lesion + 2 described from elsewhere in the left (1 left apex lateral + 1 left mid lateral)
Histopathology:
Left apex lateral: Adenocarcinoma, Gleason score 7 (3+4), prognostic grade group 2, involving 1 of 1 core, comprising approximately 60% of total core tissue, 6 mm in length,
Left mid lateral: Adenocarcinoma, Gleason score 7 (3+4), prognostic grade group 2, involving 1 of 1 core, comprising approximately 5% of total core tissue, <1 mm in length,
Suspicious lesion one: Adenocarcinoma, Gleason score 7 (3+4), prognostic grade group 2,
involving 3 of 5 cores, comprising approximately 50% of total core tissue, 27 mm
in length.

I have been pursuing treatment for localized disease, and have zeroed in on High Intensity Focused Ultrasound (HIFU). I want to keep as much of my 'happy zone' as possible (i.e. minimal side effects).

I met with Dr. Light in Houston 3 July 2017. His opinion is that I am a great candidate for HIFU. He works through HIFU Prostate Services (HPS).

My local urologist had arranged for a bonescan after the histopathology came back.
July 12, 2017 Bonescan: IMPRESSION: No evidence of osseous metastases.

I have been doing research for HIFU treatment and getting quotes:

HPS quotes $25K with a suprapubic catheter.
Asklepios Klinik Hamburg, Dr. Gross has made a quote for HIFU with 1 week inpatient, fees etc. ~$14K not including flight tickets for two. Awaiting a phone or skype call to ask about catheter afterwards.

Warsaw Poland doctor's opinion was that with my age, Gleason score & PIRADS, he recommended RP.
Bangkok Thailand doctor does not do HIFU.

I am awaiting opinion from European Health Center Otwock in Poland.

I am sorry this isn't nice and chatty, but full of data. I am really glad you're here, but my search of HIFU in this forum showed no posts that I knew how to find more recent than 2011.

Anyone else have HIFU for localized disease?

Anyone else go out of the country for HIFU? Any advice?

Any and all input is welcome.

Justin

Justin,

You might want to read this first:

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html

Of all the focal therapies available internationally, I don't know why you chose HIFU. But you seem to have made up your mind for that one for some reason that you didn't explain. You don't seem to have the typical "index lesion" single tumor they look for - you have one in the TZ and another in the left apex. Prostate cancer is usually multifocal, so if there are two places, there are probably a lot more than two places.

I've been on a couple of radio talk shows about it with Mark Emberton of the Ahmed/Emberton group in the UK and with Stephen Scionti in Florida. The Ahmed/Emberton group probably has more experience with it than anyone.

Hey thank you for the welcome and thoughts, all!!

I will try to get back here to you all with my experiences. I also did some better searching in our forum and found many many HIFU discussions.

Justin

Justin,

HIFU is still considered experimental and 'not proven' in the US. If you're determined to go down that path, we wish you the best of luck. In more conventional treatments, you've got a great location in St. Louis at BJC/Siteman. They know what they're doing there. I've also heard good things about Mercy.

All of us here are pretty much just another guy. I like your forum name.

This is a spectrum of disease, with a spectrum of treatment options. It is not unreasonable to feel an early preference, particularly if guided by someone you trust. You may or may not find comfort in investigating a variety of options beyond the initial suggestion. Particularly since your situation sounds like one that could be effectively treated in several different ways.

The side effects of the treatments are what you'll live with for an unpredictable time, up to and including the rest of your life. You may find that some treatments have a more acceptable constellation of side effects than others. Some you may find that you could live with, and others might be unacceptable. Only you can really make that tradeoff.

Good luck in your efforts!

There are (many) other articles like this that bode well for HIFU:

http://www.jurology.com/article/S0022-5347(16)03006-8/fulltext[url]

Thank you for your insights and support, all!
I hope to keep you posted.
Justin

Well after all the discouragement here, I haven't been here since before my procedure in August 2017.

I had HIFU ablation of my left hemiprostate and some in to the right at European Health Center Otwock in Otwock Poland with Dr. Stanislaw Szemplinski. Inpatient the night before, the day of, and discharged day 3. IV acetaminophen for pain. Suprapubic cath for 6 days. I felt like I had a water-balloon in my *ss for several weeks. Came home 1 week after the procedure.
Ever since, my PSA has been 0.7, done every 3 months.
I had a repeat MRI @ 6 months (PIRADS not done), and a repeat biopsy at 1 year. It showed a small amount of Gleason 3+4 disease that the surgeon in Poland and my surgeon in Saint Louis dismissed. The STL surgeon also said that he'd be happy to remove the rest of my prostate, but that he did not see a need to. They both recommended active surveillance.
So, regardless of the general opinion here, I wanted to provide my feedback about my HIFU and my (3+4) disease. So far so good.
Justin

Justin,
Good to hear you had a outcome that you expected and that all is going well. Keep us updated with your follow ups!

Larry