HIFU is being offered to me

I would really prefer to have my prostate removed.

However the surgeon that I went to see told me that would be a difficult surgery due to the possible presence of scar tissue.

I have Crohns disease. 3 years ago after peritonitis I had my sigmoid colon removed and later they were able to reconnect my descending colon to my rectal stump. The anastomosys location is low and supposedly adjacent to the prostate area.

Anyway I am going to try with another very experienced surgeon to see if he is comfortable doing the surgery.

In regards to the radiation path my concern is more damage to the rectal wall, since I already gave Crohns disease I would like to avoid damaging more my rectum niw with radiation proctitis. Although maybe they could use one of those gel spacers if the prostate is not attached solid to the fascia b/ the rectum and prostate.

I have an appointment with a radiologist in 3 days. I am very interested on his opinions regarding my rectal issues.

Another thing that I read with radiation like brachytherapy is that i would have to be away from other people in order to protect their vital organs, liver, small bowels, pancreas etc. from radiation.

All my organs are going to be really close to the radiation source not for a while but 24 hours a day. If for them this is not good I assume for me it is also not good. I really dont want to avoid prostate cancer recurrence if I may have higher odds of getting liver or pancreatic cancer down the road.

But probably there are other radiation methods that may give more localized radiation for shorter periods of time. Maybe that will be a good option.

i asked my Dr if it was a good idea to do an Oncotype or Decipher test to see how agressive the cancer is. Its weird that my Psa is only between 2 and 3 but I have Gleason 7 (4+3) and 7% free PSA.

But he told me that was not necessary.

Of course nothing is perfect and I probably will need just to choose between the lesser of two evils.

And thanks a lot for taking the time to respond my question!!….it was a very good response indeed!!!

Thanks!!!

Thanks man!!!…

This coming week (at last!!!!) I will see a very good surgeon and a very good radiologist. Yup I read about the HDR and I liked the idea. I can mot wait to see the radiologist. And I am sure everything will be ok at the end.

I spoke with the surgeon that did my colon resection and he disagrees with the idea that I can not have the prostate removed by a good surgeon. He told me that maybe it may be more difficult, but maybe not.

Whatever, it is what it is.!!!

I actually consider myself fortunate that they found the cancer with the fusion biopsy since my PSA was low. The lesion did not showed up in the Multiparametric MRI…..no Pirads lesion in the radiology report. But I signed up by chance for a study where they are using some type of program or AI thing to analize the MRI, and that one detected 2 areas of interest…..and bingo!!!…it was in one of them.!!!….just a little bit shocked since it was a G7 (4+3)

It was discussed but there was a long wait for the transperineal biopsy and I did not want to keep waiting and I was told they were very tiny perforations like when they take biopsies, that it should be ok since I am in remission and taking TNFalpha blockers. The HDR brachitherapy sounds reslly interesting. My appointment with the radiation Dr. Is in 2 days and I am sure it will be considered.

my 1st PSA 4 years ago that I have a record of was low like 1.4 before all the surgeries. I had a lot of CT scans while I was in the hosp for more than a month and later during that year, I joked that I should glow in the dark. Actually the PSA after that went up to the lows 2’s but my primary Dr prescribed testosterone since I ended the ordeal loosing a lot of weight, depressed etc. and they though it went up because of that. Last year it was between 2 and 3. Even with the PSA being less than 4 they tested the free PSA and it was 7…..4K score 20. No more testosterone. You need a biopsy

since the PC grows so slowly maybe I had something there before 2018 but I suspect between all the CT and X rays it became more aggresive. Or maybe because of the TNFalpha blocker that I have been taking for a year for Crohns….. who knows.

the TNFalpha blocker is another story. Since those infusions are “blocking” a “tumor necrosis factor” thing…maybe if it is blocked the tumor would be “happy”????…….woof too many variables in the equation!!!….I just know for sure that I want that thing “cooked” or even better “out” of my system. And of course no more Testosterone.

i still dont know about the TNF (infliximab). It is supposed to increase you chances of getting certain blood cancers or lymphoma, but I dont know about the prostate cancer.

I think I really won the lottery between Crohns and now this!!!!…lol... No one in my fathers family had PC and they lived up to their nineties…..in my mother’s family the same….. but we dont know about her fathers side.

I will ask about those 2 this Wednesday for sure.

I have UHC, hopefully they will pay for those treatments.

Bicalutamide 50 mg

thats right it should be that gel….I read the thread.

The lession can not be seem in the Mri so it should be small….it seems he thinks the cancer is kind of aggressive for him to add the hormone therspy I assume

Hi there Old Salt!!.....I assume the Gleason 4+3 was the reason.

However I wont be getting the radiation treatment for the time being. I finally found a surgeon that is willing to remove my prostate!!!.

At least this guy is willing to go in and to try.

The other surgeon just recommended HIFU or radiation.

I saw him some weeks ago but he wanted first for me to get a bone scan that took forever to schedule and finally the day before they did not had an authorization from my insurance so I had to reschedule.

The good news is that the bone scan was "clear".

I also got a higher resolution 3T multiparametric MRI to see if they could find a PIRAD lession with that one but is the same as the original 1.5 T....😕

....however the report said something about a "focus of restricted difussion in the left posterior apex showing early nodular postcontrast enhancement measuring 4mm to 5mm" likely that's the tumor....

Everything else was ok.

So I finally saw the surgeon again yesterday and he told me that of course it will not be robotic surgery but he thinks that he can do the surgery approaching the prostate from the front. But he cautioned me that if when he looks inside I have a lot of adhesions to the rectum etc then he would abort the surgery. Hopefully that will not be the case. The only thing that I did not like very much is that he told me that if that's the case that I could have NanoKnife.

He told me that the problem with the focal treatments is that if the lesion is not seen in the MRI.....well they will go and treat the area by the biopsy results but who knows if there are some cells left around....

I don't know about the NanoKnife vs Hifu. The NanoKnife sounds to me even more experimental than the Hifu. I dont know if the Insurance would cover that. At least my insurance covers the Hifu.

One thing I don't like is that they scheduled me for surgery for July 21......Another month and a half. It seems he is busy. But he wrote in the order for the scheduler to contact him....maybe I can get an earlier date?

I also told him that I was on the Casodex pills and that I had some still left and they told me that if that was the case I could just finish taking them.

One interesting thing is that in the first 1.5T MRI my prostate was 35 cc and in the last 3T one it is 27 cc......maybe an error?? and my PSA also went down to 1.7....maybe a Casodex side effect?....but so fast???

Whatever I still have more than a month to go for the surgery. In the other place I asked and they ordered a DECIPHER test for my biopsy. Hopefully it wont come back as very aggressive....I try to think that at least 5 mm seems tiny.

But I would like to get the surgery.....tomorrow.....