Has anyone had success with focal HIFU ?

neilm

Hello,

I have been looking at "focal" therapies. Some consider them middle ground therapy for low risk patients. Not all out radiation or surgery but a lower risk treatment for lower risk disease. While active surveillance may be enough for a low risk patient a focal therapy can give some peace of mind knowing that a tumor has been destroyed. I am looking for any stories good or bad if you received focal HIFU treatment? HIFU seems to be on the rise...

Appreciate your help!

centralPA

Hi Neilm,

I'll give you a focal therapy story, albeit for kidney cancer. My father had a tumor in his kidney, and chose the ablative therapy over having the kidney removed. They stick a cryogenic device into the tumor and freeze it, after first cutting off its blood supply. The procedure itself was pretty easy, and he got right back at his golf and whatnot.

But he had some back pain recently (a year later), bad enough he went to the ER. Turns out he now has tumors throughout his bones (pelvis, vertebrae, ribs) and lungs. Stage IV. He actually has a broken rib from the weakened bone.

Yup, the kidney cancer survived and snuck out. Sigh...

i know, different cancer in a different organ, but it has altered my thinking a bit on focal therapies.

neilm

https://csn.cancer.org/discussion/comment/1700736#Comment_1700736

Thanks CentralPA,

I am very sorry for your Dad, that is an incredibly sad story. I appreciate your sharing. I have heard mixed reviews for prostate application, it does concern me. It is a bit of a mystery why it is growing so rapidly. I noticed insurance reimbursements are improving but at the same time hear some stories of recurrence . Sometimes all of this is an educated guess..

eonore

What type of imaging is used to precisely locate the tumor for focal therapy? I am unaware of any that can do this. Unless I have misunderstood something, I see this as a problem for HIfu.

Eric

neilm

https://csn.cancer.org/discussion/comment/1700740#Comment_1700740

Hi Eric,

It appears to me HIFU uses MRI fusion with Ultrasound a bit like a guided biopsy. I think Tulsa which is similar is guided via live MRI

eonore

Neil,

Thanks for the reply. As know, the MRI is useful for identifying areas of interest for the biopsy needle. However, it is not definitive and there are numerous examples of tumors in other spots in the prostate not located but the MRi. This is why I wouldn’t want to depend on a focal therapy. Maybe someday, but not now.

Eric

JP63

I think we were more or less in the same boat…..when I was diagnosed several months ago I was thinking of having Hifu…..I posted in the forum, they offered Hifu to me….tiny cancer, localized……my insurance approved Hifu……I had the date and everything…..some forum members actually cautioned me about Hifu.

But I liked the Hifu idea.

But the problem that I see with Hifu is that it is a focal treatment. In my case a 1.5T MRI was perfectly fine. A radiologist did not see any PIRADS lession. Although an AI program saw an area of interest.

in the biopsy the cancer was 5 mm…..2 of 16 cores. But I noticed it was very close to the capsule.

although no EPE as per another 3T MRI, the location worried me. Hifu can not treat outside of the prostate I was told. No extraprostatic extension was observed in the MRI. So Hifu should be fine. But I was not completely sure. It was close to the capsule.

well I went with surgery at the end and canceled my Hifu date.

After surgery they downloaded my Gleason from 4+3 to 3+4, but now my stage was 3Ta……the cancer wEnt thru the capsule and now was outside.

anyway the surgeon cut around and the surgical margins were “clear”. So “maybe” all the cancer cells are gone….that’s what I am hoping for. My first PSA test after surgery will be in a week. If not radIation I assume.

but with Hifu all the cancers cells that were outside…..would still be growing outside of the prostate for sure since Hifu doesn’t go outside of the prostate.

location of the cancer in the prostate is important.

in my case MRI even the 3T one was not very precise regarding EPE.

eonore

JP63,

That’s a great cautionary tale for anyone thinking of HIfu. Thanks for posting.

Old Salt

From the 2022 AUA Guidelines:

Clinicians should inform patients with intermediate-risk prostate cancer considering whole gland or focal ablation that there are a lack of high-quality data comparing ablation outcomes to radiation therapy, surgery, and active surveillance. (Expert Opinion)

My personal opinion, based on reading reports on forums such as this one, is that a focal treatment will miss cancerous spots that are too small to be seen by current technology. Hence, the chance of a recurrence is pretty high.