Johns Hopkins UPgraded my cancer with their 2nd opinion on my biopsy slides
All along I thought I was 4+3 and now they say 4+5.
I spent 6 weeks researching focal therapies and having consults on HIFU and NanoKnife.
I was so eager to see a downgrade to 3+4 and now another kick in the gut.
Since my PMSA is negative and its contained and only on the right side I wonder if a whole gland HIFU followed by salvage SBRT if PSA or PMSA indicates micro metastisis.
Does the concept of whole gland HIFU with the reasonable expectation of having salvage RT make sense?
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Fozzworth
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I wouldn't waste the money. Knowing several 4+3s, including myself, that tried Tulsa Pro, unsuccessfully, which is a form of HIFU. HIFU has its place but that is getting up there. Send me the money instead.
HIFU has very poor results relative to primary radiation. Even when the whole gland is treated and the prostate is just a burnt out husk, it still leaves cancer behind.
Salvage therapy of any kind carries with it a much higher risk of side effects than primary therapy.
You should be getting a PSMA PET/CT now. If there is no distant metastases on it, brachy boost therapy has the best results in treating your "high risk" PCa.
Brachy boost therapy entails external beam radiation to a larger area with a brachytherapy boost to the prostate and one year of ADT (longer ADT without the brachy boost). The POP-RT trial proved that whole pelvic radiation has superior results:
"HIFU has very poor results relative to primary radiation. Even when the whole gland is treated and the prostate is just a burnt out husk, it still leaves cancer behind." Thus declares the very authoritative Doctor TA in his never ending war on HIFU. I am 8 years post full gland HIFU ablation and doing just fine. It's a shame I am not a doctor otherwise I could make such cocksure declarations. And oh, there are never any risks with radiation, right Doc?
I found second opinions of my imaging very useful as well. I came to learn much of this is opinion. My imaging reflected a greater concern than first G opinion of 3+3. Second (JHU) and third opinions 3+4. Final after RP, 4+3. Ten years ago I considered HIFU - quickly dropped that idea.
I'd second TA's response. I was 4+5, limited to gland, no mets. Everything I read point to the best results using the traid of 1) EBRT, 2) Brachy, and 3) ADT for 18 months. Seems like now 1 year of ADT is acceptable with the Brachy.
I'm now 2 years post treatment. On quarterly checks yet, all good, feeling great. Best of luck to you.
I was 4+5 with no spread visible on PSMA scan a year ago. I started in ADT (prostap/lupron) and had 37 sessions of EBRT (VMAT) to the prostate, prostate bed and lymph nodes. That finished in April. I am still on the ADT and will come off it probably in the autumn after 21 months. That treatment stands a good chance of being curative.
As you are G9 as well, I would not mess around with unproven therapy and would go with the Standard of Care and aim for a cure.
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