HIFU and all that it brings

Hi BM 

There are two kinds of hi fu, focul and whole gland.

If u have 3 areas, be careful, whole gland may be the best option.

Try and find someone with years of experience because it can be a tricky one to evaluate.

Also , make sure that tumour us not near the edge of gland otherwise external beam may be better.

Regards

Steve

You don't say how old you are, but you do have a cancer that is confined to the prostate -  a cancer that would always be classed as 'curable' - so I'd say you should only be considering treatments paths that can potentially cure your cancer - even though you won't ever be 100% sure that it's cured, even if it is. There are many arguments for having HIFU, but - so far - it has not proved to be curative.

You have to treat PCa as if you'll have it for life (though, of course, we all hope for cure). So if the cancer is deemed 'curable', and you're young, then go for a treatment that has a high chance of 'cure', not one that merely suppresses the disease, requiring further intervention later.

Everyone knows that cancer advances; but people tend to think of that only in terms of tumour size, numbers of metastases, location of spread. But cancer also advances at a cellular level; the prostate cancer cells become less 'differentiated' over time, until at a later stage, they're simply 'cancer cells'. This means that targeted chemotherapy - and hormone therapy - is no longer effective. Many people with stage 4 disease reach that point.

If you 'control' your disease rather than set out to cure it (where cure is an option), you face the day when the cancer cannot be controlled any more. It's not prostate cancer that kills, it's the metastases. And even its supporters don't claim that HIFU can help there.

I hope all that makes sense!

Don't get me wrong, I'll be as happy as the next man when HIFU can be deemed a curative treatment - but the relapse rate is currently too high (especially with whole-gland treatment), and we do not have nearly enough long term data. Currently, PCa treatment is often much worse than PCa, at least for the duration, so it'll be great to have an approach that is easier to endure!

Thanks, Heinous, I understand your explanation, and yes - its the cure that I want.

Apparently, figures have just been released that shows that HI FU has the same success rate as RPR now. No figures on how it compares to the radiation treatments.

My problem is that I would need HI FU on the whole gland, not the 'focused HI FU' as it nowadays.Whole gland HI FU has more side effects than focal HI FU, mainly being increased ED/impotence. I have not been told that it has higher rate of relapse than 'Focal HI FU', though. Other thing is that, with whole gland treatment, the TURP procedure was carried out at the same time. If, after all that, a high rate of relapse is high, then I have my doubts about it.

That brings me onto Brachytherapy. The implant of radiation seeds, and the side effects;- problems with scarring of the urethra? Fatigue? and other effects of radiation implants?

I do not want the RPR.

I'm approaching my 66th birthday, love running, gym, walking, in fact very active life style.

I'm really confused with all this, in fact totally the Baffledman!

Really would appreciate unbiased info from guys who has experienced HI FU (whole gland) or Brachytherapy and the impact on their lives....

???

Thanks, Grundo.

Yes, its three areas, and i've been told treatment will be as whole gland.

I have had a private consultation, as in my area, NHS do not offer HI FU. I've been told other NHS areas that do HI FU only do the 'focused' on one cell.

I'm trying to decide between HI FU and Brachytherapy, but im worried about the effects of radiation implants.

Im coming up 66, enjoy a really active lifestyle, which I hope will continue...

really knocked sideways with this...

A bit more info BM,. I did read a few weeks ago that more NHS hospitals are going to offer hi fu  after various trials, not sure when that will happen though.

Brachytherapy, offered in 2 types, low dose rate which r the radioactive implants and high dose rate which involves a different method of treatment,  implanting tubes into the prostate , and treatment inserted down the tubes then tubes removed, could be worth checking.

Why r u against the external beam RT?

Steve

Hi Grundo, I’m not against external beam RT, just that I know very little about it. It has not been offered to me as an option. I don’t know why either. I have a consultation regarding brachytherapy next week. 
im open to whatever will enable me to enjoy my lifestyle and cure the pc!

Do you mind me asking what treatment you are having, or been offered, Grundo?

please excuse me if I’ve missed something,  ive just joined this community and finding my way around....

Worth reading this abstract:
Oncological Long-term Outcome After Whole-gland High-intensity Focused Ultrasound for Prostate Cancer-21-yr Follow-up

It's 'up to' 21 years, a median of 15 years, which is on the lower end of being a useful long term study.

I had Radiotherapy in March 2017.

20 days , took up about 1.5  hours first thing  in the morning.

Some side effects, mainly due to constipation,  (but there can be others) midway thru treatment and lasted for a few weeks after treatment finished.

So, 4 years later and no side effects.

Do consider Radiotherapy but also  Brachytherapy as I have read good things about it as a treatment for PC.

Do some research online before deciding and u can always come on here with any questions.

Steve

Thanks, Heinous.... brilliant research!

The way I read that, for myself personally, is 15 year intermediate has 89% success rate.

That seems good to me, but I note that in the conclusion it says 'whole gland HI FU achieved good long term cancer control in intermediate risk patients...but a relevant salvage rate has to be reckoned with'.

That does not read quite so good to me, so i will be interested what my oncologists says regarding my options.... no1 being brachytherapy.

any thoughts with this?

Thank you, Steve.... good to hear that 4 years on, and you are doing well!