Treated with Hifu but need more treatment

Hi Margot444.

Good evening it's great to meet you tonight.

I'm very sorry to hear that your husbands PC has increased.

Surgery is very much a personal choice and I can see in your case the thought of taking it out once and for all seems the best way forward.

We have got members who will hopefully be along to give you there help and advice having been through this themselves.

I hope that this is helpful????

Prostate Worrier.

Many thanks for your kind words, yes I am hoping for advice and any thoughts ppl have.

Margo

Hello Margo444 and welcome.

I have the feeling that you are not a resident in the UK because the treatments you are being offered are not that widely available there at the moment and, therefore, there is not much knowledge about the effectiveness of one treatment over another on this forum. I also live outside the UK where things are done slightly differently but this is good as it offers a different perspective.

I have not come across a 'crabby' pattern but think this might be cribriform which may sometimes be associated with a greater likelihood to spread and be related to a prognosis for biochemical recurrence, depending on the type. If this is the case then a wider treatment of the prostate would, in my opinion, be a more sensible option compared to a more focal therapy. The question then would be what kind of therapy would be better. You have been looking at surgical procedures but there has been a lot of work with other techniques which might be an option using radiotherapy, many of which have similar outcomes. The things to weigh up are the possible side effects from each of the techniques and balance them against what is important to your husband.

One suggestion is to have a PSMA PET CT scan which can be more sensitive than an MRI at picking up smaller areas of cancer just to check that the cancer is still confined to the areas that you know about. This would direct the extent of the surgery needed and impact possible side effects.

Your husband's initial PSA is low but with all treatments the aim is to get it a lot lower than the 1.3. If you are going down the surgery route you would expect it to become negligible and any value above 0.2 would be a sign of a recurrence. If you go down the radiotherapy route then the aim is to get it below 0.5 within 6 months of treatment for the best prognostic outcome.

I am sorry if things sound a little vague but I hope it has given you a couple of things to think about.

Please come back with any questions.

Thanks so much for taking the time to reply to my post.  Yes you are right it is cribriform.

Yes we live in Hampshire and have been offered more focal therapy if he wants it or surgery or radiation.

My husband is worried that if he has focal therapy or radiation and if it was still to return then he won’t get the surgery because the prostrate will be so badly scared they won’t take it out.

The MDT are meeting today so we will see what they all say.

once again thanks for your time.

Hello Margot.

By Hampshire I presume you mean USA and not Hampshire UK.

The USA seems to be ahead of the UK in the use of focal therapies so it is useful to know what is available. I can understand your husband's concern that surgery is more difficult after the focal therapies or radiotherapy. Please let us know what the MDT recommend. There are several men on the forum who have either recently had, or about to have surgery and you might find their experiences useful.

Thanks for your time and by the way it is Hampshire UK.

Glad to see that the UK has access to the newer treatments. I am a little out of date with facilities in Hampshire as I moved away from there 27 years ago.

Hi Margo

I am puzzled why they didn't treat both tumours , makes very little sense but perhaps I am reading it wrong.

As far as surgery goes it can be more difficult after Hi Fu but probably not as bad as surgery after Radiotherapy.

I would def check it out though.

The other point is perhaps getting a second opinion because of the way that this has unravelled. I assume it is a NHS centre although I am not asking u to name them

Regards

Steve

Hi Margot, and a warm welcome to the forum,  I also have cribriform pattern with my prostate cancer. Which does increase the likelihood of metasteses, but  it's  not a given, especially as yours has been caught quite early. I  would think it is quite likely though that the detection of cribriform variant, being a red flag, which usually  means an aggressive treatment, if you do go down the surgery route a course of radiotherapy afterwards is likely,  but not certain . best wishes to you both, take care. 

Eddie xx 

Thank you all so much for your views 

It has hit my husband very hard like many of you on here.  He’s 61 had no symptoms what so ever, only went to doctor to get checked because I kept nagging him because I had seen lots of discussions on TV about it.  He very fit goes to gym and swims a mile 3 to 4 times a week so took it hard.

What went through my head when we found out it was cancer was how many men are walking around not knowing that may it too.

I am sure he will have surgery and have been quoted end of August to mid September will find out for sure Monday.

Many thanks everyone