Who at UCSF should my MRI results be sent to?

[kapakahi]

To recap: I've been dealing with PCa for 11 years, no mets so far. My PSA doubled so I got an Axumin scan that showed likely cancer. Then an MRI which showed the same. My previous doctor advised an MRI-guided biopsy to pinpoint the location for focal therapy and Gleason score, but the doctors who would do it here in Oregon said I didn't meet the criteria because they couldn't see anything in the MRI that they would biopsy - there's a lot of scar tissue from multiple HIFUs that make a definitive reading difficult. So I want to send the results to UCSF for a second opinion - they have much more experience in this kind of thing, and I've read their PCa success rate is stellar. Does anybody know whom at UCSF I should approach for this second opinion? Many thanks, people.

[Roberthale7318]

Dr. Aggarwal

[kapakahi in reply to Roberthale7318]

Thanks. I'm looking him up now.

[Tall_Allen]

If multiple HIFUs have failed (this is not uncommon), aren't you beating a dead horse?

I've been impressed by Antonio Westphalen, a radiologist at UCSF. You may wish to discuss with him whether a template mapping biopsy is a better idea if you want to pursue yet another HIFU.

[kapakahi in reply to Tall_Allen]

Thanks - I've never heard about template mapping biopsy - I haven't decided on another HIFU - don't know quite what to do at this stage, at least in part because I haven't had another biopsy yet (which will be about #10, I think) - I'm not sure why HIFU hasn't worked after 4 tries - could be something to do with location of the tumor(s) in the prostate - I know there was some PCa in the apex, which I was told is hard to hit effectively without destroying healthy tissue - I'm also thinking radiation, though I'm leery of extended side effects that appear long after the treatment has ended - and there seem to be so many types now with all these acronyms/initialisms, and each with their pluses and minuses and availabilities - feels like a crap shoot, hard to know what to do, but the biopsy is first

[Tall_Allen in reply to kapakahi]

For the reasons HIFU doesn't work, see:

pcnrv.blogspot.com/2016/12/...

Radiation side effects almost always appear within the first two years. It's extremely rare for an entirely new side effect to occur after that.

The types of salvage radiation after radiation failure are described in the link below. I expect they will work about as well after HIFU failure, but there isn't a lot of data.

pcnrv.blogspot.com/2017/09/...

[kapakahi in reply to Tall_Allen]

Thanks for those well-researched, well-written analyses. Much appreciated. I know HIFU isn't perfect - I guess I shy away from radiation and ADT because of what I've read here and elsewhere: they seem to go down a road of no return where the destination is inevitable. So I'm trying hard to avoid that road. I could be delusional, I know.

[Tall_Allen in reply to kapakahi]

Keep in mind that what you read from patients on sites like this are the problems, not the norm. I have no idea what you mean by "the destination is inevitable."

[kapakahi in reply to Tall_Allen]

just read up on template mapping biopsy - yow! general or spinal anesthesia? 50-60 perineal punctures, 5mm apart? I might not survive the biopsy. Sure would be raw down there for a while. I'll have to think about that - and thanks for the referral.