Prostate HIFU

Yes he has a low grade contained prostate cancer Gleason 6... And he is having HIFU. Done at our local hospital in Harlow Essex Uk.. It stands for High Frecuency Focused Ultrasound..where they go in and burn with a lazer ultrasound the effected area of the prostate in my husbands case they will take about 40 % of the  cprostate away! So hopefully no incontince   Problems.. We shall see .. He will be monitored for the rest of his life ...if any cancer comes back I think they do the procedure again. But time will tell... My husband will probably have to have scans instead of psa tests because his psa was very low only 1.8 ...he is 61 years old even when he was being investigated for prise problems it was this low level ....but he had prostate Cancer so psa in my husbands case was not an accurate test...the only reason they investigated further wad blood in his water (actual droplets of blood) and his prostate gland was of a normal size.. He had 18 biopsys taken from the prose gland and it hurt like hell, that's when they found 3 cores of cancer... But originally they saw a small node in the prostate gland on the MRI...hence the biopsy...

so surgery on the 27th June at last.

 

hi there ES 28567

we live in the UK..my husband does  not have any problems with size of prostate... So he does not have to have this Turp procedure... However we was given a lot of information about this operation by the Uroligist after cancer was found low grade Gleason 6.. And was recommended this.., we went on to see Consultant Uroligist/Oncoligist about HIFU his name is Mr Jaspal Virdi.. It has few side affects only about 4% incontince problems .. The only thing is my husband will have to have a catheter for 1 week after op.. This is because the procedure on the gland makes it swell so hence the catheter .. So we are hoping recovery will be quick and painless..

will keep you posted.

Hi Tom

we  are in the UK so we are lucky to have our NHS even though. It's very far stretched nowadays .. However we are lucky we can have this done at no cost even though there are only about 15 centres within the UK..so it's all funded... People in the UK run our NHS down but if you are in the system you are treated well ..

just hope my husband doesn't have to have cathater for more than a week that's what we were told..but we wait in trepidation ... As my husband is a terrible patient..😫Shall keep you posted.

Many Thanks Tom

can I ask are you still Cancer free...and are you still have regular checks done.

Regards

Carolyn,

When I was originally diagnosed with Gleason 6 prostate cancer, I went on Active Surveillance for a year and a half and spent that time researching my options and interviewing doctors who did different procedures. I decided to go with HDR Brachytherapy - High Dose Rate Brachytherapy. I went through two treatment sessions spaced two weeks apart. Each was painless - got a spinal both times. No external beam radiation, no seed implants, no operation. After the second treatment I had Median Lobe swelling that cut off my urine flow, so required a catheter. Actually, I had six of them over a five week period until the swelling went down. I had BPH before the treatment, and after - still have difficulty urinating. 

Anyway, my PSA is now down to 0.2 - couldn't be happier. I continue to read all of the latest research papers that compare the effectiveness of the various treatments, and HDR and Protein Beam continue to come out on top of everything else. So, I am confident I did the right thing. You should research the 5 year survival rate of HIFU vs other treatments. For Gleason 6 just about everything is very effective. Some doctors won't even classify Gleason 6 as cancer. You haven't mentioned your husband's PSA, number of cores, percent of each core, rate of change of PSA (velocity). Maybe he can go on Active Surveillance for a while until he decides on treatment. For low risk category patients, there is no downside to waiting. 

A couple of additional notes about the HDR - no ED, everything works fine. Also, there is no external radiation passing through body tissue, so the effects on bladder and rectum are minimal. 

I get my PSA checked every three months - before treatment it was 4.6, and after treatment it fell rapidly, and as I mentioned previously, it's now down to 0.2. 

Tom

Carolyn,

I went back and read all of your comments again and I have one more important point to make. If your husband's PSA is 1.8 and he has Gleason 6 pattern, then he would be classified as very low risk, and is a perfect candidate for active surveillance. The majority of men who get a diagnosis of Gleason 6 with low PSA think they need immediate treatment, and usually have their prostate removed - in other words, they get scared and don't even realize they have a lot of time - possibly years, to research and consider their next step. 

When I got my diagnosis I was 66 years old, had a Gleason 6 pattern and a PSA of 4.6 and my urologist recommended active surveillance, which was the correct recommendation. I then had a lot of time to interview doctors and read about all of the available treatments. Some men on active surveillance never need treatment, because there is no "progression" of the cancer. You have to monitor the change in PSA over time (velocity) and the number of biopsy cores positive and the percent of each core. Why rush to treatment if it isn't necessary? 

With low risk or very low risk situations a second biopsy is done about a year and a half later - usually 12 core, not 18. For 18 I would want to be knocked out, because after 12 cores the pain is terrible. Anyway, you and your husband need to consider whether he needs treatment AT THIS TIME, or can wait. Don't rush into anything. Don't be frightened into treatment that may not be necessary. All of the information you need to make a final decision is available on the internet. This forum is a great place for information, as you have found out. 

My very best to you both...

Tom,

Carolyn's husband had a MRI, that is how the cancer was found.  So, the doctor can see how big it is.  A very low PSA, with a MRI and biopsy finding of cancer, I am sorry to say, also is indicative of aggressive cancer.  

BTW, my husband also says to be sure to say - that after HIFU - urination is like being a 12 year old.

Dawnay,

I hate to disagree with you, but a MRI is just another way of seeing the tumors, if any. Gleason 6 pattern is NOT considered aggressive. If I were in this situation (which I was a few years ago) I would order a genetic test on the biopsy samples - for example, Oncotype DX. Oncotype DX was not available to me before my treatment, but now it is. The lab that analyzed the biopsy tissue can send the tissue to Genomic Health for up to 6 months after sampling. Then, the Oncotype DX analysis is done and then some idea of aggressiveness can be determined. 

I hate to say this, but there is an ongoing advancement in imaging that is allowing urologists to find smaller and smaller tumors and men are being frightened into treatment that they either don't need or won't need for many years. There are a number of books out about this, and as a result, urologists are backing away from recommending immediate treatment for Gleason 6 tumors. Treating early stage prostate cancer is a huge money maker for urologists, so naturally they are going to recommend immediate treatment. Over 90% of all men who find out they have Gleason 6 PCa opt for surgical removal of their prostate - usually Robotic prostatectomy. 

I have been going through this since 2010 - trouble urinating, antibiotics, medication, reading all of the prostate literature, reading books, interviewing doctors, two biopsies, active surveillance, quarterly PSA tests, and eventually treatment. I still read all of the latest research studies. 

Bottom line: when it comes to prostate cancer, you have to do your homework before rushing into any form of treatment. Interview doctors, go on forums, read research, get the biopsy tissue to a lab for genetic testing, Don't make any decisions out of fear - only facts.

Tom

 

Tom, Your advice to Carolyn96211 was spot on.

Please disagree with me at ease, I welcome all info.   I am  no authority. When reading about Gleason score, they always say 6 is  'most likely' not aggressive.  Seeing the tumor and the low PSA sounded like reason for concern to me. 

Remember, HIFU can be repeated and there's verrry little potential for trouble.    In the trials of men who had HIFU after surgery had failed there was a 80-90% cure rate.  Today the redo rate is 8%. along with no added risk of side effects.

I totally agree that people should be sure of what they are getting into, so does Carolyn, that's why she is here.

Men were jumping into surgery or radiation when they had a PSA of only 6, that is where the caution came from, because of the side effects, when they could have waited years.

My husband's PSA was also 6, yet his urologist told him that the location of the cancer was the reason to hurry.  Carolyn's husband's doctor wants a MRI every three months, he's concerned about something.   Maybe they could ask the size of the tumor, and how many, and if the tumors are on one side or both sides.  He wouldn't want to wait if there are two tumors, one on both sides. 

All I know is we can sleep at night now, not worrying.....and he is overjoyed at not having to pee 4 times a night!  Doctors treat men with BPH with HIFU, no one would treat BPH with surgery or radiation - the risks are just too high.  Other than the man who had two HIFU treatments back to back (within a couple months), I've never even heard of any side effects.

 

As far as what I have read, I agree with Tom. An MRI does not show or even elude to the aggressiveness of the cancer. It does not even diagnose cancer, only "areas of concern". The only way to determine if an area of concern is or is not cancer is through biopsy. The nice thing about the MRI is it locates areas to be targeted for a biopsy and how big the areas of concern are but not the aggressiveness. The MRI might let you know how quickly you need to pursue action based on where the areas of concern are. As an example, if the suspicious areas look like they are about to breech the outer wall or seminal vesicle. I would slightly disagree with Tom (but more on a philosophical bases) as to active surveillance. Yes, you can probably wait and do fine (usually a good choice for much older men because they will die of something else before the cancer). However, active surveillance usually requires biopsies on a regular (every 12 to 18 months), plus blood and DRE...this is actually great for urologist because they know you will most likely eventually come see them for treatment and they make money off you like clockwork in the mean time. I personally don't think it is healthy to do so many biopsies and turn the prostate into Swiss cheese (or more accurately hamburger) plus the risk of infection and a slight possibly of helping the cancer to spread through needle tracking. And all the while the patient is wondering in the back of their mind if the cancer is spreading.

One last point regarding active surveillance, It is easier (with more options) to treat the cancer earlier and with a higher cure rate. So, while for some men, they do have the option of waiting, (short of doing procedures that will radically change a man's quality of life long term) I personally think it is better to nip it in the bud and move on. That's just my opinion. If the only two options were active surveillance or prostatectomy then I would say wait as long as you can...I might even say die with it. But with new procedure able to preserve quality of life, I say kill it and move on.

ES,

Some excellent points. I have been going through this process for almost six years - and it's still not clear what any one person should do when they have a diagnosis of Gleason 6 "cancer". I was in contact with a world famous urologist who told me that Gleason 6 tumors do not metastasize. There currently is a movement in the urological community to remove the word "cancer" from the Gleason 6 pattern. This proposal is still very controversial. 

Then, if one has Gleason 6, as I did, what to do? There are so many options. HIFU is a form of "focal therapy" - that is, it treats a portion of the prostate, not the whole gland. It has only been approved for use in the USA recently. When I was first diagnosed with Gleason 6 I wanted HIFU, but it was not covered by my insurance, and I would have had to go to the Cleveland Clinic in Toronto, Canada for treatment, and pay all expenses out of pocket. I decided to wait. Eventually, I was treated (with HDR Brachytherapy), it was all covered by my insurance, and I am now very happy with the result. 

The concern with any type of focal therapy, is that some cells are missed, and retreatment is required. Also, HIFU kills tissue with heat, so there is tissue swelling as a side effect, and a catheter is required - not such a big deal as I found out. 

And, it is NOT radiation - and that appeals to many men. So, the process CAN be repeated if necessary. 

I have no issues with HIFU as a treatment, but my concern is that many, if not most, men rush into some form of treatment right after they hear they have Gleason 6 "cancer" and they don't realize that they may not need treatment for a very long time, or, they are unaware of the different treatments that are available. That's why I believe that men should make any treatment decisions based on facts and not fear.

I eventually had my Gleason 6 treated after a second biopsy because being on Active Surveillance WAS a form of treatment, and carried with it a certain amount of anxiety. Also, the second biopsy, although not particularly painfal (thanks to a few tylenol capsules), was quite bloody, and really had an effect on my sex life. 

Some older men aren't concerned about preserving their sex life, and so ED is not an issue. For some it is a big deal. There are many side effects to consider with each form of treatment, so deciding what to do it not easy. That's why I interviewed many urologists who performed different procedures - I got a lot of information from each one. They all think that what they are trained to do is the best procedure, and they can't be all right. I really had to be my own best advocate. 

If your tooth hurts, you go to a dentist and they fill, or pull the tooth or do a root canal. Most medical issues are fairly straight forward - you have this or that problem and this is what you do. 

But, when it comes to the prostate, there are at least half a dozen things you could do, and each has its own set of side effects. So, we are left in a very confusing place. 

Tom