I have read mixed reviews. One in particular was quite critical. Essentially it emphasised the focal aspect could be a disadvantage and miss other instances that would be dealt with in whole gland treatment as in RT for example.
There is a newer version of HIFU called TULSA Pro which looks interesting, but it does not appear to be available in the UK.
I think you can have a spinal block and sedation with HIFU.
I think one of the main reasons I am attracted to HIFU is no HT required. The other is no more radiation. I have had about 12 - 14 chest/abdomen/pelvic ct scans, which is quite high radiation exposure.
Steve, you said RT was a walk in the park. What type of RT was it? Did you have any initial or subsequent urinary retention, bowel issues, or irritations?
If RT was 'a walk in the park' and without HT, I would be reasonably confident to opt for that. I have read that HT improves the chance of recurrence by 10%.
I have had abdominal RT and other than the very minor matter of loss of body hair, it was without incident.
There is also the benefit of whole prostate treatment.
I mentioned it to my Urologist and he didn't seem at all keen on it. He said that he knew of a few cases where there were detrimental outcomes. I didn't ask him to expand any further at the time.
Re HIFU. There are a range of treatments available for PCa. (most of us have limited choices) Unfortunately, they all involve a degree of harm. some more than others. We all have to look at the risks and benefits appropriate to our diagnosis. Individually, some are prepared to accept more risks than others for what is a perceived better quality of life. I think this is the case with some of the newer treatments like HIFU. It is the QOL factor versus the risks.
I have no doubt that RT combined with HT is superior to HIFU in terms of potential cure because it treats the whole prostate and there is an element of systemic treatment. However, there is still no absolute guarantee.
Then there is the age component to the equation. The accepted worldwide protocol is to avoid psa testing in the over 70s, certainly in the over 75s. The same goes for prostatectomy. Older patients may not need cure, they just need to 'die with it and not of it' and in the process have a decent QOL. Hence Watchful Waiting or Active Surveillance for suitable older patients.
You seem to have had the 'gold' standard of targeted RT.
How did you manage the constipation when you have to ensure the rectum is empty for RT? There is also the requirement for a full bladder, which would possibly have been difficult with urinary problems.
I don't yet know if my stats are good enough for HIFU as I am awaiting biopsy, but I like to have a plan A and B etc. HIFU is just a consideration, even if the stats were good I don't know if I would opt for that. I have indicated some of my thinking in my reply to NN101.
One thing I feel really strongly about (at the moment) is I don't want HT. As I said to NN101 it is a question of balancing risks and benefits against QOL. My current thinking is that I would risk the 10% gain from HT.
‘Older patients may not need cure, they just need to 'die with it and not of it' and in the process have a decent QOL.’
I think this needs thinking through a bit more! I certainly would not say that dying with untreated or under-treated prostate cancer provides quality of life in the trajectory towards death if, treated properly with the possibility of cure is offered in the first place!
everybody approaches this differently, of course, and everyone has the absolute right to make their own informed decisions. It’s easier for me to say, of course, because prostate cancer is something I will only ever be affected by in seeing my husband going through the processes.
But…. I want him at my side for as long as possible!
