HIFU Focal Therapy

HI 123, I also have 3+4, similar history to you , in that the first mri was inconclusive and then a subsequent MRI  came back with a hot spot at a later date which led to biopsy and 3+4 score.  They did 12 cores, one positive which was 1mm 4 and 3mm 3.  As such I think I am a good candidate for HIFU and have explored it a lot.  However, I have received a lot of very (!) negative pushback from surgeons who say my age (49) predetermines my cancer prognosis and HIFU is "kicking the can down the road".  Did you receive any such guidance and did you et any assurance on how likely PCa is to recur?  Thanks for any advice, I am really in a quandry.

Hi PGS, what is your age, if I may ask?  I have been heavily steered away from HIfu as I am 49.  I can find no reliable data on recurrence, I assume because many men at <55 have a prostatectomy which somewhat begs the question....

Hi GTfox73, I am 62 with confirmed PC in one part. The most difficult part with PC is actually deciding on the treatment. I had my consultation last week and the consultant strongly recommended HIFU and was very confident of the procedure. I am going to get a second opinion tomorrow from a different consultant and then decide the way forward. Yes there isn’t enough data and that really worries me but UCLH have lot of experience with HIFU but I view every recommendation with a slight suspicion as not sure whether sometimes it is done for their benefit / stats etc. You are much younger so perhaps different considerations apply. Which part of U.K. you are in and probably best to get a second opinion. 

Hi gtfox73,

One NHS Oncologist asked why would I have a treatment that had a data sample size of 10 in France (I think HiFU started in France many years ago), so yes I definitely had negative pushback.  

I get the feeling that different NHS trusts have different experiences and different results in treatments and are more likely to push those treatments depending on their expertise.

It is a difficult decision.

For the private focal treatment, I had a mpMRI and a targeted biopsy under sedation. They are treating what they are seeing in the mpMRI, I felt more comfortable with this.  It also helped that it was the least invasive treatment.

I always wondered how accurate my NHS biopsy under local anesthetic was, pretty sure I was moving in those stirrups.  It felt a bit like a scattergun approach.

I did have a BRCA gene test which came back negative, if it was positive I think the HiFU consultant would have said go and get a prostatectomy.

Who knows if I made the right decision, at the moment it feels the correct decision but time will tell.

Have you managed to talk to a focal treatment consultant?  I would advise doing that.

Good luck,

123