Diagnosed and conflicted on treatment options

Hi,

Sounds like HIFU is kind a like Proton radiation, it uses a focused beam of energy to kill the cancer.  I guess the question I have if the HIFU was not sucessful, then can other more traditional methods(surgery & radiation) be used at a later date?  I would go with the most experienced hospital & doctors that have done this thousand of times to make sure you get the best team for the HIFU.  A trial group for any kind of treatment kinda raises a flag in my brain.  Is this a proven method at the hospital that you want to go to?  Maybe choose another hospital that they do this as a routine procedure.  Keep doing your homework which will lead you to the best method to deal with your cancer.

Dave 3+4

I cannot opinion on HIFU as this procedure is old but still in its initial steps and not many report on experiences. In any case, in comparison with surgery, this is not as focal as surgery. The whole area will be involved and receive the blow, including the regional nerve system, the rectum, bladder, and seminal vesicles. The good is that one keeps the organs and tissues in place including the gland and what is within it. The kill must be assured so that the high-intensity sound waves need to be projected with due high intensity enough to kill the cells or it will just treat the wound.

I have no details of MSKCC HIFU trial but I know that in some trials doctors adapt the scope of the trial according to expected results. Guys at MSKCC would not want to have many people with nasty side effects as a conclusion of the trial. In the end, trials are good as they provide the possibility in having novel therapiesfree of charge, assisted by specialists, before, during and after the treatment, and that includes all diagnostics, tests and exams.

Here are old links regarding HIFU;

https://csn.cancer.org/node/188555

https://csn.cancer.org/node/149722

Surgery, on the other end, should be chosen if one is assured of having a contained case. Your Gleason grade 4 raises the flag on risks for existing extracapsular extensions. In your shoes I would investigate further with a PET scan.

Best,

VG

I am sorry for your diagnosis.

I assume that the MRI that you received used a 3.0 magnet with greater definition; and not the 1.5 magnet for your fusion biopsy.

Prostate cancer tends to be multi focal, that is , especially with high intermediate 4+3=7. There will probably be areas that are not identified at this time, and will be missed with HIFU.

As part of a research study I was offered targeted HIFU free of charge that I declined.(3+3=6) since I believe that in theory the procedure is a great one, however technology in my opinion is not advanced for best results. 

Aside from studying the procedure, I read a very long thread at usToo webside, that you may wish to read.   Various men who posted had this procedure, but their geasons were less aggressive than yours, and less chance of multifocal.

The side effects from surgery can be greater than any other active treatment.

There is a relatively new radiation called SBRT that many men on this board have done. This procedure hss limited side effect with comparable cure as surgery. There are various machines that deliver SBRT; cyberknife, varian , etc.

Here is a nine year study by Dr Katz, who in in NYC, and you can consult. He has has probably done more sbrt's than any other radiogist. His cure rate for intermediate is 89%

https://prostatecancerinfolink.net/2016/01/06/nine-year-outcomes-after-treatment-with-sbrt/

As a man who has been in an Active Surveillance protocol since March 09, i closely studied this procedure, and I cannot understand why Active Surveillance would be offered to a 56 yo with a 4+3=7. However if AS is selected as a treatment choice, another biopsy can be  done to determine more information about the extent of the cancer in the prostate; since your fusion biopsy was three dimensional, the doctor has the ability to go back to the exact spot(s) where the 4+3 was located, and biopsy the surrounding tissues of each  ......so if the 4+3 core only consist of what is found, then AS can be a possibliity, however again, with a 4+3 there is a great chance of metasisis in a long term AS program.

Surgery versus Radiation

Surgery is a localized treatment.

With radiation, the perimeter of the treatment can be extended beyond the prostate, so  microscopic cancer that has escaped the prostate and is just beyond the prostate will be treated. The chance of this occurring with a man diagnosed with a 4+3 is high, eventhough the MRI does not indicate this.

....................

You mentioned in one of your posts that you prefer surgery over any radiation.......if I may ask, why is that?

If your second opinion confirmed 4+3; you still have chance to be downgraded after surgery and with that in mind you would regret RP and its terrible SE especially for someone young as you are.

I was n same boat 4+3 after biopsy and wanted to stay on AS even against medical advice. Neither urologist nor RO recommendation was AS. While being squished between urologist recommendation and my wife pressure, I made mistake and went into surgery Which I heav regretted. Everything else is well known on this forum.

MK

Max Former Hodgkins Stage 3 said:

Perspective

Mike35,

If you undergo surgery, what usually happens is short-term incontinence (a few months or so, with some potential for light dribble beyond), and six months or more impotence.  Most men without ED before surgery get throught he ED afterward, within a year or thereabout.

MK1965s experience regarding potency is the worst I've ever followed here.  He has an important role here as a voice of worst-case potency outcomes for RP.  Yet even he is testing cured of the cancer (based on PSA results), and recently reported urinary continence had retured for him.  

But it deserves to be said that worst-case also means "not usual case."   For ever critic of RP here among men who have had it, I would say that 90% are pleased.  I've known many men who had RPs, and never heard any one of them complain about anything.

Take your time and consider all options well before confirming a choice,

max,

DaVinci, Jan 2015

 

Max,

I am not RPworst case as you said. I am just one of thousands and thousands of patients with bad outcome who continue to suffer loss of quality of life after RP. Erectile function recovery after RP on this forum is heavyly downplayed by some commentators like yourself and your first violins clevelandguy and Grinder. All this forum of good experiences is written by just couple of guys. 

If that is representation of surgical outcome than let’s be it.

MK

MK1965 said:

Worst case

Max,

I am not RPworst case as you said. I am just one of thousands and thousands of patients with bad outcome who continue to suffer loss of quality of life after RP. Erectile function recovery after RP on this forum is heavyly downplayed by some commentators like yourself and your first violins clevelandguy and Grinder. All this forum of good experiences is written by just couple of guys. 

If that is representation of surgical outcome than let’s be it.

MK

Mike 1965,

I'm sorry that you chose to respond with absurd, hysterical commentary.

If "thousands upon thousands" of tragic examples are out there, why is only your voice here characteristic of such a group ?  And why would RP continue to be either the most popular treatment choice today, or tied for most popular ?

If you are not the current "worst case" example of RP impotence at this Board, then who is ?  Name that person and I will read his threads today. 

I do not know what sources you use (assuming you use any), but I would be interested in the time frames that this hoard of men got their RPs performed.  Apples must be compared only to apples, not with prunes.  RP surgery today is quite unlike RP 40 years ago, exactly as with radiation technology.  And therefore statistical outcome data from decades ago cannot be used regarding modern results.

This childish back-and-forth is not at all to my taste or personality, but your post was so outrageous that it could not go unchallanged, for the well being of our new readers.

max

Hi all,

Very well said Josephg, seems your RP did not go well but your getting on with life just like we all should. I feel you should always look forward towards the next challenge.

Dave 3+4