HIFU Info Required

Robpue,

I am sory for your diagnosis.

As you are aware HIFU is a new Active Treatment in the United States that is available to a certain group of  patients who qualify for this treatment type. There are also other choices of treatments to include Active Surveillance.

In order to understand where you currently stand, I hope that you can provide more information about your diagnosis.

How many cores were taken, how many were positive; what was the involvement, that is the percent cancer of each core that was positive. Please list your PSA history. Was the digital rectal exam normal? Any other findings in the pathology...........(Since determining Gleason scores is subjective, did you have a second opinion of your pathology by a world class pathologist that specializes in prostate cancer so you will not be over or under treated. )

Did you have any other diagnostic tests?
Did you have a T3 multiparametric MRI that can show extracapsular extention, or suspicious lesions in the prostate?

What is your age?

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I am familiar with HIFU.

Basically the procedure is MRI guided for a High Intensity Focused Ultrasound tissue ablation with Sonablate for a prostate cancer outpatient treatment. The procedure is new; there are docs that use a T3.0 magnet (the hhighest definition in clinical practice) and others who use1.5T to guide the Sonoblade. Additionally , most do the procedure in MRI real time, while the procedure is also done by locking the results of the MRI to a three dimenional biopsy machine that interfaces with the Sonoblade).

Pretty much the above describes how HIFU is administered.

Since this procedure is new, the question arises of how effective this procedure is. Does the MRI machines provide enough definintion to find all the suspicous lesion of cancer? Is current technology adequate for this procedure?

The urologist that originally did the biopsy that discovered my cancer (PSA 5.1, Biopsy 12/17/2015 showed 2/12 cores cancerous, 3+3 and 3+4), Dr Pratik Patel, recommended surgery as I was 52 at the time.  He is also on the 11 member National Urological Review Board that certifies new procedures so has a decent reputation among Urologists.  I scheduled surgery right away and then after the shock of having cancer wore off, I started doing my homework on other options.  I discussed HIFU with him and he had an interesting take on rather it would ever achieve status as a mainstream treatment in the US.  New treatments are approved in part based on their 10 year outcome as compared to other treatments.  Because it is targeted at early stage cancer, HIFU's 10 year, survivability is no different than active surveillance from his perspective so why approve a procedure that is the same as doing nothing.  Not saying I agree with that, just relaying what an Urologist thought about HIFU.     

I found out about Cyberknife on this forum and when I researched it, I discovered that the cure rates are now comparable with surgery (93% after 10 years), with significantly fewer side effects.  Because it is newer than some other options, it has only recently had statistical numbers for 10 year comparisons.  It was the side effects with surgery that had me concerned and the potential that my cancer may or may not have spread to the periphery of my prostate.  The periphery was easily treatable with Cyberknife, whereas it might require non-nerve-sparing surgery on that side of prostate which would further increase the chance of impotence.   HIFU seemed viable but follow-up care when you get it down outside the US seemed a little dicey to me.  I also didn't like having to leave the states to get treatment.  The equipment that is available in the states at this time and approved is an older generation which again made HIFU less attractive.  It is also quite expensive compared to most other options which are covered by insurance.  If the current generation was available state-side and it was covered by insurance, it seems likely to be effective with early stage cancer.  If it was mainstream and available with latest tech locally, I may well have went that route.

If CyberKnife is available near you, I would at least check it out.  Like all other doctors, they will recommend their approach I suspect but the more information you have, the more comfortable you will likely have that you made the best decision for you.  I just completed by 5 day Cyberknife treatment this week, I will know how successful over the coming months but my doctor is very confident so time will tell.  Other than the diet during the treatments, this was certainly a procedure that had minimal impact on my day to day life and once finished, I am completely back to normal routine.

Lastly, Active Surveillance may be most appropriate for you at this time if you can handle having cancer and just monitoring it without going after it directly.

In either case, with a Gleason of 6, you should have time to make a decision.  Most prostate cancer grows slowly and with your numbers, it does not seem like something that requires attention immediately.  In the end, whatever path you take, just embrace it and move forward with it.  

Live well