Focal Therapy, laser therapy

Hello PJ and welcome. Sorry you need to be here but we will certainly help if we can. You are unlikely to get a lot of first hand knowledge of those two treatment choices because most of our members have chosen more traditional and established treatments. And, it's hard to give you much advice about specific treatment for you until your biopsy and you can report back with Gleason score, number of positive cores, % postive, etc.

Having said that I'll give you some more general comments. HIFU has consistently shown to be an inferior treatment choice. The failure rate is high and most of us have avoided that. Re focal therapy it certainly does have the immediate QOL advantages plus my understanding is that it can be repeated if necessary. On the other hand, prostate cancer is mostly a multi-focal disease hence the higher liklihood of needed repeated treatment. We have one member, Ziggy9, who doesn't post much here anymore - but he had targeted focal therapy and it was very successful. If you search for his name you will find some of his posts and I'm sure he would be ok with you emailing him with specific questions. If you don't find it, email me and I will contact him on your behalf.

Of course QOL is in the eye of the beholder and before you're done we will probably engage in some spirited debate about surgery vs. various radiation treatments. In the meantime please let us know your biopsy results and we will get as specific as we can. You may also want to read the "sticky" thread at the top of our forum that is designed for newly diagnosed men as you will probably find that helpful. And if you really want to start digging into info and options I suggest you read Dr. Walsh's, "Guide to Surviving Prostate Cancer" (more of a surgical perspective) and Dr. Scholz', "Invasion of the Prostate Snatchers" (more of a non-surgical perspective).

Good luck We are here to help you with this.

Jim

It was suggested to my husband to do focal laser therapy. His MRI showed a 12mm pirads 4 lesion. He decided to have a prostatectomy. Post surgery revealed a 38mm lesion. His surgeon commented that the MRI is not always accurate... no kidding. I am glad he decided not to do focal therapy. They would have missed most of the tumor!

While research is good and necessary, your leaning toward treatment options is premature. You don’t know whether you have PCa. If you do, you don’t know the Gleason grades and scores and the extent of involvement by the number of positive cores and percentage of involvement. Right now you are somewhere in the range of no cancer to high grade cancer. You just don’t know. Treatment methods would be markedly different along that range and may. Specifically preclude the two methods you mention.

Regarding HIFU, it is not FDA approved to treat PCa. The reason is that it has not proved to be effective. It is approved for prostate tissue ablation and reimbursement conditions greatly control who the provider can be.

Focal treatments are not mainstream since most PCa is multifocal. Preponderance of treatments treat the entire gland, not parts of it. If you have a non-radiated prostate that receives focal laser to a suspected cancerous spot, the rest of the prostate continues to be ripe for PCa development. If it continues it will require subsequent treatments and further disease risk. You are looking at “one and done” without side effects. Focal treatment is not proven to do that.

As to traditional treatment side effects, yes they are expected. All treatments, including the two you have mentioned, will include side effects. As for me, I had extensive maximum radiation therapy combining HDR brachytherapy and EBRT. Nine years later I have no negative treatment side effects. The radiation impact on my QOL is that it eliminated the PCa. Exactly the treatment side effect I was hopping for.

Continue to research, without preconceived limits, get the biopsy, understand it, and then determine what too do. My advice is to stick with common and proven methods that provide the highest probability of success and effectiveness. The first focus has to be on treatment effectiveness and couple this with expected treatment side effects. I chose the treatment method providing the highest probability of cancer control with the lowest expected negative side effects. For me that was radiation therapy and it has proven to be effective and exceeded my initial expectations.

Best wishes