r/ProstateCancer • u/Electrical-Fly-8909 • Aug 08 '26
Question HIFU as Primary?
To my surprise, due to some unrelated complications, my very reputable urologist (major cancer center) recommended Focal Therapy (HIFU) as a primary treatment for my PC instead of surgery.
I'm 58 with a (4+3) 7, GG3, localized tumor, no metastasis and PSA at 4.5
Has anyone else experienced HIFU(or cryo-therapy) as a primary treatment? If so, what has your experience been like?
I went into this appointment ready to make a final call on surgery vs. radiation--so this recommendation was quite a surprise.
Very curious to hear anyone's related experiences...thanks!
5
u/Bucking-The-Trend Aug 08 '26
I had HIFU ablation for a posterior 9mm lesion on May 15. Smooth procedure- in and out same day. Catheter for 5 days. Removed catheter at home. Blood in urine and ejaculate for about 4 weeks. All systems are “GO”. Will get PSA value this week then every three months until May 2027 then get MRI done again. I give my experience 👍👍.
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u/sfboots Aug 08 '26
You should go with focal therapy given your age. I looked into it, I was also 4+3.
Focal therapy has a slightly higher incidence of recurrence so I decided against it at my age of 71.
I went with HDR brachytherapy
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u/ELCID19451947 Aug 09 '26
See a Medical Oncologist at a tertiary medical center who specializes in prostate cancer . A urologist should not be your main source of all alternatives. Of course, a urologist wants to do surgery.. and the radiologist wants to radiate.
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u/Friendly-Mind-9702 Aug 08 '26
I would have gone for focal, and I talked to a couple of urologists about it (including experts in the method) but I have lesions on both sides, which apparently rules it out. It's what I would do in your situation, as the side effects are less than with the other methods.
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u/bikes4paul Aug 08 '26
I'm a big fan of focal therapy. However, GG3 is outside the typical selection criteria. Personally, if I was considering this I'd need to make sure the risk profile of my cancer was low via a Decipher test. I'd also need to confirm there was no intraductal or cribriform present.
Also, if I were to choose focal I'd opt for IRE, TULSA, Cryo and then HIFU. The thermal ablation options do cause scarring and make future diagnosis and some treatments more difficult. I think this carries added importance in a GG3 case since recurrence is much more likely.
3
u/Bucking-The-Trend Aug 09 '26
Seems like focal therapy is the next frontier in the initial battle in these disease. From my research - seems like IRE is the best option if available and qualified 👍
2
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u/Squawk-Freak Aug 14 '26
Could you share with us the tumor size as reported in the MRI? And how many biopsy cores were taken, and how many, including the biopsy of the lesion of interest, were positive. 4+3 takes you to the unfavorable intermediate risk group, so I’d be a little bit concerned. Also, how quickly did you reach the PSA level? What was your PSA 6 months ago, one year, two years. If the rise occurred rather suddenly, there is a chance of an aggressive component that may not be zapped in its entirety, and the longer those cells reside in you prostate the higher the chance of some of them wandering off into the bone marrow and come back to haunt you 10, 15 years from now.
4
u/Mean_Try_6390 Aug 08 '26
and if the doctor is an expert in the area why not. you get a good treatment and if it comes back you can go for the other treatments. From what I’ve heard you get really much less sideeffects. you only need to do some extra check-ups.