Should I consider HIFU for Gleason 7 (4+3)?

[Keed]

I recently joined this club at 53. I'm Gleason 7 (4+3). My doctor tells me it's considered intermediate unfavorable. I was surprised that HIFU was offered to me as a treatment option. Are there others that were offered HIFU and/or went ahead with the treatment? My initial thought is that I am too high risk. I am still learning... so I could be wrong. I am afraid HIFU may not able to target hidden cancer cells in other parts of the prostate. My PET scan shows the cancer is contained in the one lesion. My other option is for a prostatectomy. Looking for the group here for help. What else should I be considering?

[Tall_Allen]

The option with the highest cure rate for unfavorable intermediate risk is radiation, not prostatectomy and certainly not HIFU. Get second opinions.

prostatecancer.news/2018/10...

For prostatectomy, fill in this to see your expected results:

mskcc.org/nomograms/prostat...

HIFU is not FDA-approved as a treatment for prostate cancer, only for removal of prostate tissue (like a TURP). But money-grubbing surgeons dupe patients into getting them. Read these:

prostatecancer.news/2016/12...

prostatecancer.news/2021/03...

[Popepaul in reply to Tall_Allen]

Thank you TA for the above signposting. Very helpful.

[fast_eddie in reply to Tall_Allen]

If HIFU surgery is so God-awful, why does Mayo now offer it?

mayoclinic.org/medical-prof...

I know what you'll say, Mayo surgeons are all money grubbing and want to dupe patients. Right TA? You know better than anyone, including Mayo doctors. C'mon man, lighten up on your war on HIFU. My only beef with the Mayo link is that they highlight focal ablation. Patients are better served getting full gland ablation. Whoops, now I sound like I know more than Mayo surgeons.

[Tall_Allen in reply to fast_eddie]

Ask whty Mayo patients force their patients to get the outmoded C-11 Choline PET scan. Because money-grubbing hospitals would never put profis before the patient? Patients have to be empowered by reviewing peer-reviewed journal articles, not by reading hospital ads and press releases as you do.

[fast_eddie in reply to Tall_Allen]

TA right. Mayo wrong. Got it. LOL.

[Tall_Allen in reply to fast_eddie]

Multiple peer-reviewed published journal articles of clinical trials - right.

Ads and press releases - wrong.

Get it?

LOL

[fast_eddie in reply to Tall_Allen]

Right. Every Mayo patient and man who chooses HIFU is stupid but TA is oh so smart. Got it. LOL.

[WilsonPickett]

SBRT. Do your research. Surgeons do surgery.

[CarverD]

NO to HIFU!! There are multiple types of radiation available that you should research (SBRT, EBRT, HDRB, etc) . Get a second opinion ASAP. I had HDRB preformed 4 years ago and have been very happy with the results.

[fast_eddie in reply to CarverD]

What is your justification for condemning HIFU? Personal experience or are you just parroting TA's opinion?

[CarverD in reply to fast_eddie]

See my personal response sent to your address.

[fast_eddie in reply to CarverD]

I read it. Have you considered that all those negative opinions were from urologists who had neither the equipment nor the experience to perform HIFU?

[CarverD in reply to fast_eddie]

Sorry but the first doctor to suggest I steer clear of HIFU was in fact the lead HIFU doctor at the Cancer Institute I was visiting to discuss treatment. He had plenty of experience and still strongly suggested I not use this treatment modality. It may work well for some but in my case (3 tumors: 3+3, 3+4, unknown) it was not recommended.

[doc1947g]

I was 72 years young when diagnosed after PSA 20.4 μg/L; G(4+3=7)G4. Du to many diseases like Pulmonary Emphysema, Renal deficiency. I also had Lymphoma which ended as Hypo immunoglobulin. Was put on VMAT-RT 3Gy X 20 fx = 60 Gy and Hormonotherapy (ADT) for 6 months. My PSA is now 0.01 μg/L and my testosterone went from 15.20nmol/L - 438.04ng/dL (2020/05/27) to 2.8nmol/L - 80.7576ng/dL(2024/08/06).

🐒🐵🙉🙈🙊

[Victor615]

My diagnosis was very similar to yours. I elected to do SBRT. It's been 10 months since the last treatment and I am very satisfied with the results. I would suggest surgery should be the last option due to the complications and with the significant improvements in radiation I don't think surgery is often the best choice.

[Keed in reply to Victor615]

I’ve also been researching the various radiation options and it looks like there’s has been significant advancement. I’ve been hearing about long term cancer that might develop as a result, for example in the rectum. Has that also improved?

[fast_eddie]

I had full gland HIFU ablation surgery for Gleason 8 in 2016. Tumor activity restricted to one side only but surgeon recommended full gland rather than 'focal' which I consider half-fast if you catch my drift. 8 years later I am doing fine. Take TA's condemnation of HIFU with a grain of salt. He's been conducting a war on HIFU for years now. He may sound like a doctor. He's a layman like the rest of us and has no personal experience with HIFU.

mayoclinic.org/medical-prof...

[Keed in reply to fast_eddie]

How does full gland ablation work? Does it still target what the doctor sees? How does it spread across the prostrate? My concern is missing some cancer cells and it leads to recurrence.

[Seasid in reply to Keed]

Full-gland ablation using High-Intensity Focused Ultrasound (HIFU) works by destroying the entire prostate gland tissue with focused ultrasound energy. Here's a deeper look at how it works, the targeting approach, and its potential limitations:

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How Full-Gland Ablation Works

1. Preparation and Imaging:

Before the procedure, imaging (MRI, PET scan, or ultrasound) helps identify the extent and location of cancer within the prostate.

A probe is inserted into the rectum, which delivers focused ultrasound waves into the prostate.

2. Treatment Delivery:

The ultrasound waves are focused on the prostate tissue, heating it to temperatures above 85°C (185°F), causing irreversible destruction of cancer cells and surrounding prostate tissue.

The treatment is often guided in real-time using ultrasound imaging or MRI.

3. Coverage:

In full-gland ablation, the treatment covers the entire prostate, not just the cancerous lesion(s). This approach aims to eliminate any visible or microscopic cancer cells that might not have been detected on imaging.

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Targeting and Coverage

Localized Precision: HIFU is precise but depends on imaging to determine which areas of the prostate to ablate. While full-gland ablation is designed to cover the whole prostate, success depends on ensuring no "cold spots" (areas left untreated).

Microscopic Cancer: HIFU cannot directly detect and target microscopic cancer cells. The assumption is that by ablating the entire gland, the likelihood of missing hidden cancer cells is reduced.

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Spread Across the Prostate

The ultrasound waves are focused in small, overlapping zones to ensure the entire prostate is systematically treated.

Experienced practitioners carefully plan the procedure to avoid leaving untreated regions, including the peripheral zones where cancer often starts.

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Risk of Missing Cancer

While full-gland ablation aims to reduce the risk of missing cancer cells, there are limitations:

1. Microscopic Spread:

Even after full-gland ablation, microscopic cancer cells may be present outside the prostate capsule. This could lead to recurrence.

This is why HIFU is typically used for localized cancer, where imaging shows no evidence of spread beyond the prostate.

2. Operator Skill:

The success of HIFU depends heavily on the operator's experience. An experienced provider can ensure comprehensive coverage and minimize the risk of leaving untreated areas.

3. Limitations of Imaging:

Advanced imaging (e.g., MRI or PET scans) is good but not perfect. Small lesions or microscopic spread might be missed.

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Recurrence and Monitoring

After HIFU, regular PSA monitoring is critical. A rising PSA could indicate residual or recurrent cancer, necessitating additional treatment.

Some studies show higher recurrence rates with HIFU compared to surgery or radiation, particularly for intermediate- or high-risk cases. This risk is higher if cancer is already microscopic or extends beyond the prostate.

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Addressing Your Concerns

If you're worried about recurrence due to missed cancer cells:

Discuss adjuvant therapy options. Some patients combine HIFU with other treatments, like short-term hormonal therapy or follow-up radiation, to address potential spread.

Ask about the track record of HIFU outcomes for patients with your specific Gleason score and risk profile.

Compare HIFU to other treatments (e.g., surgery or radiation), which might offer more comprehensive cancer control for intermediate unfavorable risk.

Would you like more detailed comparisons of HIFU with prostatectomy or radiation therapy?

ChatGPT said

[fast_eddie in reply to Keed]

Seasid's post describes it well. A couple of caveats to add to this treatment option. Ablating the full gland causes significant swelling. A TURP (roto rooter) surgery might be considered a pre-requisite. I was a good candidate since I had already had that TURP surgery. A super-pubic catheter is also required. That's where they will poke a hole through to the bladder, above the pubic area, and secure the catheter with an expanding balloon as they would an ordinary through the penis catheter. By the way the HIFU surgeon has real time feedback on where he is ablating the tissue and what temperature it is reaching ... one little blip at a time.

[tasseo]

I had TULSA HIFU of the prostate 5 years ago after a biopsy confirming Gleason 7a on both sides. Well, my cancer came back this year and my current doctor says that is common with HIFU and other "unapproved" treatments. Now I'm looking at radiation which has high cure rate and lower side effects than surgery.

[Keed in reply to tasseo]

Did you have a full-gland ablation? Best of luck in your next treatment.

[NanoMRI]

I considered HIFU ten years ago (traveled to London, England), G 3+4 that was actually 4+3, and other methods such as CyberKnife, brachy, etc, out of fear of surgery. Reviewing two mpMRIs with docs, margins of safety were insufficient. I chose RP and remain grateful I did.

The big question is - where is all your cancer? Confined to gland, the prostate bed, the pelvic region? Imaging is inconclusive on this question. Regardless of treatment method, if the cancer is beyond the treatment field, cancer will remain, as in my case.

Seven years ago, after my unsuccessful salvage RT to the prostate bed, I had several imaging methods, only one picked up multiple pelvic lymph nodes - but it too missed some.

If I could have a do-over I would again have RP but with pelvic lymph node surgery using the frozen section pathology method, beginning with the common iliac nodes. Seven years ago I had ePLND. Hope this helps! All the best!