Deciding between HIFU and LDR BT

[Gus_Tec]

Live in Vancouver with Gleason 7 (3+4) with strong family history of PCa. PSA 3.0. I am 55 and healthy otherwise. Targeted fusion biopsy returned 5 cores from identified left-side lesion all 80-100% cancer with 5% type 4. Overall, 9 of 12 cores over came back positive and both sides of prostate but lower volume on right-side and no 4 found on right-side.

Not considering AS. On the one hand I'm a good HIFU candidate with clearly targeted main lesion. On the other lots of cancer but just grade 3. I'd spend my hopefully many long years going forward on AS after HIFU.

Treatment? Have narrowed to LDR-BT in Vancouver or HIFU with Fleshner in Toronto. I've read the literature and know the basic stats and nearly settled on HIFU. Experiences with this Doctor? With others treating HIFU despite high volume?

[Tall_Allen]

Read these:

prostatecancer.news/2016/12...

prostatecancer.news/2021/03...

Why not get it cured once and for all with the same risk of side effects?

[Gus_Tec in reply to Tall_Allen]

Thanks for your input - and for all your helpful contributions which I've read closely! In my case, I should have specified focal HIFU rather than whole gland. I've read both excellent analyses/reviews you noted above but also other stats on toxicity which push me towards HIFU. I guess for me, and for not insignificant number of others, it often comes down to balancing cancer control and side effects. I am putting more (hopefully not all) the weight on the side effects alongside hopes that imaging improvements and innovations will make a recurrence less costly.

[Tall_Allen in reply to Gus_Tec]

I understood it was focal for you - but if it doesn't work even when the whole gland is treated, what makes you think it would work focally? The oncological results are worse, not better. And what is the point of incurring any side effects at all from a therapy that doesn't cure your prostate cancer? You can be assured of no side effects if you just stick with AS.

I don't understand the trade-offs with side effects you imagine are likely. Although HIFU proponents have resisted a randomized comparative trial, reported potency preservation, urinary incontinence, and rectal side effects are the same with whole gland SBRT than with focal HIFU.

There is a good reason that the FDA rejected HIFU as a prostate cancer treatment. Canada rejected it too.

ncbi.nlm.nih.gov/pmc/articl...

[Smallfall in reply to Gus_Tec]

My biopsy, in 2017, indicated cancer only on the left side of the prostate; I had HIFU done on that side. All was good until 9 months later, when my PSA started rising. I was in Mexico for 8 months. When I got back to Cali, another biopsy indicated cancer throughout the prostate. I had HDR BT, IMRT, and 6 months of Lupron; yeah, there were side effects, but no cancer. My highest PSA in almost 3 years has been .05...I can live with that!

[Gus_Tec]

9 months? that is fast. Was the biopsy done using MRI (fusion) and was an index lesion identified in the biopsy? Great to hear the more intense treatment appears to have stopped things. Be well.

[Gmac6911]

why not high dose brachytherapy with dr crook in Kelowna? 2 treatments and rods don’t stay in. I am considering Hifu but am meeting next week with dr crook

[Gus_Tec]

I think my alternative here would be LDR BT with Keyes. She has been very helpful. I haven't seen very clear differences between the two in terms of cancer control and SE. i also know someone that was treated with HDR BT by Dr. Crook at Kelowna and was very pleased. I believe it is no longer in clinical trial stage, correct?

[Volcanologist in reply to Gus_Tec]

I had 4+ PSA, Gleason 3+4 on left side apex 2 cm lesion from targeted biopsy. 2 cm lesion identified with a mp MRI pirads 5 score. I looked at all the options including HIFU and focal laser. I decided on focal HDR BT at UCLA with Dr. Chang. No side effects and had a 8 month mp MRI and no lesions 11/18/22. PSA was .89 in December. HIFU has side effects and has a relatively high recurrence. Consider SBRT or HDR BT. Less chance of side effects. I researched all of the options on my own before talking with Dr. Scholz. I highly recommend conferring with Dr. Scholz in Marina del Ray, CA. A doc friend of mine recommended him to me. Scholz specializes in Prostate oncology at all stages. He stays current on what is best procedure and treatments for various stages/circumstances. He doesn’t do any procedures, so he has nothing to sell but his advice. He knows who the best docs are for any procedure or treatment you are considering. Ultimately, he convinced me to do HDR BT over focal laser therapy. I had already ruled out HIFU, for similar reasons I dropped focal laser therapy after conferring with Scholz. Tall has good advice about SBRT. My case is very similar to yours. Ultimately, I went with HDR BT because it can be tailored to be more focal with less risk of side effects compared to SBRT, and SBRT can be done later if the HDR BT failed. However, at the right facility, SBRT or even proton therapy have very low risk of side effects. So far I have no side effects and still have an ejaculate.

[Gmac6911 in reply to Gus_Tec]

go to prostate foundation of bc website and view video’s regarding treatment. Dr crook has supplied videos that hdr has same results versus ldr

[Gus_Tec in reply to Gmac6911]

I did check her stuff out. Relatively little distinction yet that I can see between LDR and HDR BT, but her discussion is helpful.

[CarverD]

I was 7(3+4) and interested in HIFU - based on the data I'm glad I wasn't a candidate. I'm now 2.5 years post HDR-BT and very happy with the results. Except for the loss of ejaculate I don't think I'd be any different today than if I'd never heard of PCa. Best of luck with whichever treatment you opt for.