HIFU Focal Therapy

Hi, I have just been diagnosed with early stage localised prostate cancer.   I have not yet spoken to Oncology or Radiotherapy professors, that's due in a couple of weeks.

I am researching the options and saw HIFU Focal Therapy this on the web.  I sent a message to them on Saturday and I had a 30min call today describing the treatment.   From what I've seen, it looks like a no-brainer compared to the risks related to alternatives, including robotic surgery which sounds the best of the rest.  I don't want to wait and see and radiotherapy looks risky.

I am 66, otherwise in good health and keep fit, still working, run 8 miles most Sundays and were it not for Covid had entered 5 half marathons this year (all postponed).  I have organ confined prostate cancer Gleason 3+3=6 with a maximum core length of between 1.5 and 2cm. Prostate Cancer has been found on the Left hand Side of the Prostate Gland. (5 of 6 cores taken were positive) The biopsies taken on the Right Hand Side of the Prostate Gland were negative.  I have private health insurance and the Focal Therapy clinic think I should be a suitable candidate.

I am somewhat overwhelmed by all the alternatives, including Nanoknife which HIFU states is not as good as its treatment which they say has a very strong success rate with limited issues prevalent in the alternatives.  

Any views on this would be much appreciated, especially from anyone who has undergone HIFU Focal Therapy.  Thank you.

  • Hi Robin

    Hope the seeds op went well.

    I had my first PSA blood test post-op and will get the results in a couple of days.  I’m a bit apprehensive.  VC with the surgeon next Friday.  

    Actually I fell back in the garden today, tripped carrying a basket of logs and stabbed my hand on a steel implement,, back to the hospital tomorrow for specialist check on nerves / tendons.  Messy job, much blood!

    I consider myself lucky that I didn’t impale my back.  Sore though.

    I’m feeling better generally in recovery following the prostatectomy, running and weight piling back on...

    Keep me posted on your progress & good luck.

    Kenny

    .

  • Morning Kenny

    Sorry to hear about the accident but glad the recovery from the prostatectomy is going well.

    The seed implant op went well and can only re confirm the quality of the team and facility at Guildford.  If anyone is considering Brachytherapy then they should consider travelling there.

    The only downside to the procedure was the purgative Picolax you have to take the day before to clear out your bowel. The effects last about 24 hours, unfortunately for me they lasted 36 hours.  The op due to Covid is done under a spinal anesthetic  (less risk of infection with no tubes down your throat) which worked very well, but of course from the waist down you have no feeling for 4 hours.  Well with the purgative still working post op, you can guess the rest, very messy. I really felt sorry for the nurse.

    Now we are in the recovery phase, rattling with all the meds, but generally feeling OK although the HT is still taking its emotional toll. Over the next 3 months I can expect problems with emptying my bladder due to swelling of the prostate, but fingers crossed.  Of course I have tried to do too much exercise and paid the price. During lockdown I have got into the habit of walking to the local supermarket and come back with a rucksack full.  On the day after the op I thought I would just go and buy some decaff tea, but of course left the supermarket with 15kg on my back.  Halfway home, I just couldn't go any further and my wife had to take the bag. I am just going to have to accept it just takes time to recover. Mind you, leaving the supermarket I set the security alarm off and can only put it down to the seeds - I now have to carry a card for two years saying I am radioactive.

    Hope the PSA test comes back ultra low, which given your procedure it should, so I don't think you should be apprehensive.  Mine is in 3 months time but I am a fatalist and what will be will be.  Having met some chaps at Guildford with more advanced cancers, we should be very grateful that we both managed to catch it early.

    Keep in touch and stop carrying logs!  I am actually quite jealous, I do like a log fire but we built an eco/close to passiv house about 8 years ago and the space for the fire has remained empty, as just having a couple of guests around heats up the place with the extra body heat. Such 1st world problems :-)

    Robin

  • Hope you recover well from your accident in the garden.  Take care.

  • Hi Robin & Freefaller

    Thanks - the hospital cleaned out paint, wood & stuff from my hand - nerves were bruised but thankfully ok, and as you see I can still type!  

    Got the results this morning on my PSA post-op - <0.1 so I am delighted and greatly relieved.  I will have a virtual call with the surgeon on Friday to see what's next up.

    So far so good.

    Hope all's well with you.

    kind regards

    Kenny

  • Got the results this morning on my PSA post-op - <0.1

    Excellent news

  • Hi Robin,

    l’ve been reading your comments regarding brachytherapy at Guildford. I’ve just started on a similar path to yourself. I’m on the same hormones, bicalutamide and tamoxifen which I must take for 3 months. I have the seed implants about 10th may, and I am to continue with the hormones while the seeds are radioactive. That will be for 3 months, so total of 6 months on the hormones. My flow rate was good so no need for TURP. I’m into my 2nd week on the hormones, and no side effects so far. I run 5miles every other day and feel fine, as before. I’m a bit worried about the libido effect, it’s a bit early for me to comment on this, but I think things seem not quite the same there... 

    just wondering if you can explain the next stage. So you have just had the seed implants, on 19th feb. Did you have the epidural? I was told this is now the case because of Covid. Did you have the space OAR (gel to protect bladder from radiation)? How are you feeling now, and what do you expect over the next 3 months?

    also, my understanding is that the implants at Guildford are carried out by a team. I know Prof Langley heads that team, is that correct? 

    I did not intend to go down the brachytherapy route, like others on here I was really hoping that Hifu would be possible. Thing is, my pc is like a dog leg shape over 3 parts of my prostate so the hifu would not be ‘focused’ but on the whole gland. The fact that with hifu whole gland treatment, a TURP procedure use to be carried out as the norm. Weighing it all up, I decided that brachytherapy would be better for me... I think, because like all of us, we are not experts. 

    Anyway, any advice you can offer will be greatly appreciated... good luck one and all on here... 

  • Hi

    Yes your PC treatment sounds very similar. 

    I could have been a candidate for HIFU, but I discussed it with Prof. Langley who has used HIFU as a treatment in the past and he was firmly in the Brachy camp, as there are much better outcomes compared to HIFU.  As you say, we are not experts, and having discovered that the Prof is one of the leading experts, I took his advice.

    Having taken the Bicalutamide for 3 months, I am afraid that it does effect your libido, but just accept that it should be temporary. However to keep things ticking over, the Prof recommended that I took Viagra twice weekly.  It certainly has helped.  Mind you, after the seed implant you are asked to refrain from sex for 6 weeks and wear a condom for the following 6 weeks.

    After 2 months on the Bicalutamide, you will be called in for a TRUS, so that they can measure your prostate and order the seeds. My prostate had shrunk by 30% so the HT does work!

    The seed implant was carried out under a spinal anesthetic (not as heavy as an epidural) with sedation and worked very well.  I was awake for most of the operation and felt virtually nothing.  You have to take a purgative Picolax to clear your bowel the day before and I would recommend you take it earlier in the day than they suggest.  I know everyone is different but for me, the Picolax was still working on the day of the procedure, and to put it nicely, is best avoided.

    After the implant you are in a recovery room being looked after by a nurse. It takes about 4 hours for the anesthetic to wear off and you must be able to pee before they will let you out.  The care was first class and they obviously feed and water you. The Prof. also popped in for a chat a couple of times to answer any questions. The approx. timings for me were, procedure started at 11.15 am, in recovery at 12.15, 1.15pm CT scan to check seeds are in the right place and left the unit around 5pm.  During the procedure you are given an antibiotic which you continue for 5 days and during recovery you are given Tamsulosin 400mg, that you have to take daily for 3 months. and helps the bladder function.  You also need to avoid caffeine, so recommend you cut it out gradually the week before the procedure to avoid the withdrawal headaches. 

    I did not have the Space OAR, as the Prof said it was not needed. I know it is expensive at £3.5k an application, so to overcome any reluctance to use it, I offered to pay, but was told if you need it, you get it.  I know that it just dissolves in the body ,but I suspect that there may be low level repercussions, as if you have it, you are reviewed after 6 weeks, whereas my first review is 3 months (maybe worth asking about this).  My understanding is that it protects the bowel, but I could be wrong.

    Implants are carried out by a team of consultant urologists, but Prof. Langley did mine with the help of one of the other consultants. There is of course no guarantee you will get the Prof. but I picked up that he does do the Friday ones, so you may want to get a Friday date.

    It's now 4 days after the implants and I am doing OK. A bit bruised and battered below and inside the rectum, but it is getting better by the day. Blood in my pee is reducing and now passing a few clots (bit similar to post biopsy). Bladder control appears good but I am prepared for some deterioration as the radiation will cause more swelling. Generally a bit tired but just went for a 5 mile walk with a serious incline on the way back!

    Good luck with your procedure and feel free to ask anything I may have missed.

    Robin

  • Hi Robin,

    thank you for your detailed report, really answers my questions at the moment.

    Its strange to read that all the things I was thinking of doing, you have done! I was already planning to ask if I could pay for the spaceOAR, thinking that protecting my bladder and whatever else is in that vicinity would be money well spent. But you asked, and was reassured that it would be used if needed. Like you, I would be sure to carry on as normal, you carried the shopping, I was thinking I could cut the grass! I will give that picolax some thought, I knew nothing about that but now the alarm will be on for 3am that morning! Other things that come to mind... the coffee, I understood that I should cut that out straight away, so I did on day one of the hormones! I’m now drinking redbush tea, which I’ve convinced myself is nice! Also, I will be sure to look out for a Friday date with the professor, I’m falling in love with him already! 
    Then we have the viagra ... hmm.. I didn’t think I would ever need this. But they say ‘if you don’t use it, you’ll lose it’ so maybe I will need to check it out. 

    It really is all scary stuff. But reading your messages is making it easier, so thank you Robin, and I’m pretty sure I will have to take up your offer to ask more questions as they come up, if you don’t mind.

    Best wishes to you and fingers crossed you recover well