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PC Treatment Options - HIFU or Robotic Prostatectomy

Jeramsam
Posts: 1
Joined: Dec 2011

I am 60 and was diagnosed with PC in mid November. At the time of the biopsy my PSA was 6.5 and had been above 6 since July. The urologist suggested taking another PSA in September and a final one in late October to see if PSA levels remained high. The July PSA is 6.7 and the September PSA is 7.4 and the October PSA is 6.5. The November biopsy resulted in 8 of 12 samples testing positive with one sample being moderately aggressive. At the moment we are considering several treatments. One treatment we are considering is HIFU. Another treatment we are considering is robotic prostatectomy. The treatment we select may be dependent on what insurance will pay. We have submitted data to the insurance company, including a cost of $30,000, to see if HIFU is covered. If HIFU is not covered then we will look at robotic which I believe will cost about $45,000 but is covered by insurance. Does anyone have any insights into HIFU vs robotic? We are still in the decision making process and are still in a state of confusion as we struggle through a learning curve.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Jeramsam,

Welcome to the forum. It would be useful for those of us who have been faced with similar treatment decisions if you could provide a bit more information about your diagnosis such as the Gleason score assigned to the positive biopsy cores, whether or not cancer could be felt during the DRE, the stage assigned to your cancer, your age and so forth.

While cost and insurance coverage is certainly a factor in making a treatment choice my number one priority when faced with my own treatment decision was quality of life and efficacy of the treatment. I had excellent medical insurance and was fortunate enough to be able to self pay if necessary for any treatment I wanted but certainly cost was a factor.

HIFU was one of the treatment options I briefly considered when I was diagnosed with low risk (Gleason 6) prostate cancer in March 2010. HIFU is not approved by the FDA for treatment of prostate cancer in the United States thus it is not covered by Medicare. Most insurance companies will not cover procedures that are not FDA approved although I believe some men have received partial reimbursement for their expenses after the fact. Men living in the USA must travel offshore (Mexico, Bahamas, or some other place) to have this procedure performed. There are at least two different methods of performing HIFU (different equipment manufacturers) and it is aggressively marketed. There are a number of studies that discuss the results of HIFU and they range from pretty good to very bad. I would suggest you look at the following link which discusses a November 2010 article in the British Journal of Urology which looked at the results of up to five or six years of HIFU for low risk, clinically localized prostate cancer using second generation Ablatherm equipment. Of concern is that the 5-year biochemical disease free survival rate was only 20%.

http://www.medscape.com/viewarticle/735487

This report ought to be disturbing to men who have either had this treatment or are considering it, particularly when you consider that it involved men with low risk prostate cancer.

Both surgery and radiation treatments have a much, much higher rate of disease free survival statistics at the five year point (about 85-90%) but as with any treatment for prostate cancer there are potential adverse side effects associated with them. As you consider your treatment options I would urge you to take the time to fully understand the potential side effects and the impact that these can have on your quality of life after treatment.

As you obviously are discovering, there is a steep learning curve associated with a prostate cancer diagnosis. I hope that you seek advice and second opinions from a variety of specialists and read as much as possible. This forum and other with similar intent are great places to start your schooling and interact with men who have travelled this path before you.

Good luck to you.

K

gkoper's picture
gkoper
Posts: 174
Joined: Apr 2009

Hello Jeramsam...I was a gleason 7 in 2009. I opted for Davinci which apparently left some unwanted cells. Imrt radiation (37 sessions) evenually brought psa to coveted zero.
I looked into HIFU and because it was not fda approved went with the aforementioned.
However, after surgery, I found that a local doctor (central Fl.) who performs clinical trial HIFU @ no charge. Criteria; gleason 6< psa 10< good general health. Have not heard of the 80% 5 year reoccurance rate. My treatment choices have left me with a diminished sex life but otherwise excellent quality of life. Hope this helps some decision process. You will find lots of good information @ this site. Keep the faith.
George

buzzz
Posts: 26
Joined: Aug 2010

If you want to read real personal stories from those of us who have had HIFU then go to concerforums.net the first thread is devoted to only HIFU.
I can't imagine putting a dollar sign on the rest of your life. One study says a low cancer free after one HIFU treatment, while other studies say 88% cancer free 5 years out. What's the % of robotic that go in for radiation? Both of those treatments are painful and humiliating and come with quality of life issues. He's young. Take your time to decide, surgeons want to hurry you up, because there are choices out there that are much better than robotic.

rch
Posts: 79
Joined: Nov 2011

Hi Jeramsam
You mentioned that 8/12 positive , which means both lobes are involved. What's the Gleason Score on the moderately aggressive one? That might impact your treatment options. If it's an intermediate risk cancer I strongly urge you to get a second AND a third opinion from both a Med Onc and a Rad. Oncologist.

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