Interesting data on focal-therapy (HIFU)...

[Don_1213]

sciencedirect.com/science/a...

"Conclusions

Focal HIFU in carefully selected patients with clinically significant prostate cancer, with six and three of ten patients having, respectively, intermediate- and high-risk cancer, has good cancer control in the medium term.

Patient summary

Focal high-intensity focused ultrasound treatment to areas of prostate with cancer can provide an alternative to treating the whole prostate. This treatment modality has good medium-term cancer control over 7 yr, although 10-yr data are not yet available."

I can't access the full paper, just this summary. Perhaps someone with access behind that paywall can give us some insight as to the accuracy of the summary. They do note that 10-year results aren't yet available.

[Tall_Allen]

"Kaplan-Meier 7-yr FFS was 69%. Seven-year FFS in intermediate- and high-risk cancers was 68% and 65%."

Those are awful results.

For comparison, 7-yr bRFS was 96% for low risk, 90% for intermediate risk using SBRT. Similarly, the 7-yr results of any radical therapy are MUCH better than that:

prostatecancer.news/2018/10...

Even when HIFU is used on the entire prostate, ⅓ of patients are not cured:

prostatecancer.news/2021/03...

[Don_1213 in reply to Tall_Allen]

Allen, no argument other treatments are more certain. I only said the paper appeared interesting, and no personal feelings for or against it, although I'm certain ALL PCa victims would hope for a less intrusive/damaging potential cure than what we have today.

One consideration that now comes to mind is treatment choices given the availability of PSMA-PET scans.

Dr. Scholz had an interesting discussion on this last week - where he gave thought to reconsider the standard of care relative to the new diagnostics available via the PSMA-PET scan. He presented the option of less care, even for high-risk patients who were found to not have metastases via the scans. This is from memory - but what I recall him saying was 20% of men with high-risk PCa need a full regime of treatment, BT/RT/ADT - but perhaps not all men simply based on Gleason and PSA numbers. He felt that around 80% of men in that category may not need more than one type of treatment (I believe he was talking RT), without the need for ADT.

My question here might be - would this also be a way to judge if a focal treatment might be successful on its own. Could the accuracy of the focal treatments be better if based on the PSMA-PET scan results?

Of course, there's no way for us to really know since the chances of us being around after the trials were completed and papers were written is about nil.

[Tall_Allen in reply to Don_1213]

PSMA PET/CTs have very limited accuracy, especially within the prostate because the PSMA PET scans so far approved are all eliminated through the urinary tract, obscuring cancer that may be there. Some have proposed using mpMRI combined with PSMA PETs that aren't urinarily excreted.

But the fact remains that intraprostatic tumors identified even by our best MRIs miss 80% of their volume. There is also a size limitation - we cannot identify with current technology lesions less than 5 mm. Because prostate tumors are known to be multifocal, we will always miss some significant ones. There is also the problems of "index lesions" - do they really exist, and incomplete thermal ablation within the ablation zone.

If you want to read more about this, see:

prostatecancer.news/2016/12...

The record has been dismal. Meanwhile, toxicity improvements in radiotherapy continue, and the toxicity is now as good as any of the claims made for focal ablation. At the same time, cure rates are excellent. So what is the need for focal ablation?

As for what you report Dr Scholz as saying...if it's true that only 20% of high risk patients need the kind of intensive therapy they are getting (and I doubt that's true), how do we identify that 20%? There is a current NRG Oncology RCT that is exploring using Decipher to identify those who get more intensive therapy (more than the current SOC) vs those who can get away with less intensive therapy (the current SOC). We'll have an answer by 2033:

clinicaltrials.gov/ct2/show...

[Don_1213 in reply to Tall_Allen]

I hope we're both here to see what the answer is.. 👍

[GP24]

I prefer LDR Brachytherapy instead.

[Hidden]

My HIFU surgeon recommended full-gland HIFU ablation and that's what I went with. Focal ablation seems half-assed to me. Zapping everything is more thorough and likely to be more successful.