Any experiences with HIFU localized ablation for prostate cancer?

@joenfl2017 asked a similar question here https://connect.mayoclinic.org/comment/625780/ and @poodledoc @semeon @cupman shared their experiences and may be able to answers your questions.

@jfgunion, have you just recently been diagnosed with prostate cancer?

Hi
My comments are anecdotal so they should be taken in that light. Excuse me if I repeat things you already know. Ablation for Pca is typically used for those who have a defined tumor in their prostate. To my limited knowledge ablation modalities can be by: cryo (freezing), heating and laser. I have a prostate cancer friend who opted for laser ablation at Desert Medical Imaging. It was considered experimental and therefore was not covered by Medicare or by his (good) good insurance. When my own Pca was confirmed by a ultrasound & mri guided biopsy (at Mayo Rochester), I had an anterior (front) located tumor with a Gleason score of 4+3. I asked about ablation. They were (don’t know currently) doing cryoablation experimentally. I was accepted by the committee guiding the study. However, when I asked about reoccurrence, I was told 20%s within 2 years (I think, that’s correct). That was too high a number for me to consider and I opted into proton therapy (5 sessions) over two weeks. So far (~2yrs) I am very happy with the results (my PSA is staying consistently low. )

I would say the choice of any ablation treatment should weigh the probability of recurrence, and other factors(age, general health, sexual activity levels, etc ).

I would caution against an attitude of “I just want to get done with this and move on with my life”. It seems that for many of us the ‘fight’ against prostate cancer may have multiple battles.

…Another thought might be whether you could get your doctors to support you getting one of the new nuclear PET scans (limited availability, but at UCLA and UCSF). They seem to show prostate cancer metastases better than any prior tools. That might also guide your treatment. (You didn’t mention whether your Stanford doctors are recommending a course of ADT (androgen deprivation therapy/chemical castration).

I had my treatment at age 69.5 and, when asked, I say that I am not ‘cured’, but are in remission and hope that it lasts for the rest my life (hopefully another 20+ good years).

A cancer diagnosis can be pretty scary, but, generally, prostate cancer is slow growing and that allows for time to seek out knowledge and information.

One urologist I consulted last month proposed HIFU based upon my MRI (two lesions Pi-RADS 4 with one 0.9cm and the other 0.4cm). This is the very first time that anyone I have seen has proposed this as a way of killing prostate cancer. I was told that if the cancer is not irradicated that it can be done again with radiation and surgery still being viable after the HIFU. Has anyone had any experience with this. I believe Medicare just approved it in January of this year, 2023. It has received FDA approval in a prior year but not sure what year.

It might be the right decision but you may want to get a second opinion as there are many options out there. Urologists and Radiation Oncologists lean towards recommending what they have used for years which may or may not be the best for you. I just finished my 5 radiation treatments with the MRIdian machine from Viewray. Healthy tissue impact is REALLY important regarding side effects. Good luck.

When I went to Mayo/Rochester for biopsy (11/2019) I was aware of laser ablation. I found out that Mayo wasn't, at that time, doing laser ablation, but was doing cryo ablation experimentally. I had an anterior tumor in my prostate (Gleason score 4+3). I was approved by Mayo for cryo ablation, but when I asked about reoccurrences I believe the answer was 25% in two years time. For me (age 70 at the time) that was too high a number and too soon. I rolled to Proton Beam Treatment, which I had five treatments in early February 2020, with a short course of ADT (4 months). So far my PSA is staying around .02.

My brother had HIFU in 2015. He was 67 at the time. Eight years later, he remains cancer-free. I believe there was only one doctor using that procedure then and he was based in Miami.

Fascinating. Thank you mates. Technology advancements give us all hope.

Hi! My name is Doug and I’m a very active 60 yr old male. I am scheduled for a radical prostatectomy May 9th for cancer of the prostate. My Gleason score is a 3+4= 7 with a PSA of 3.99.
A sibling sent me an article yesterday about focal laser ablation treatment as a less invasive method of treating prostate cancer. From the articles I’ve read it doesn’t seem to be effective enough to make me want to cancel my surgery. Does anyone else have experience with or has heard anything about this treatment?

Doug, my PSA was 10.2 with a Gleason of 3+4. I looked at a number of choices including having my prostate removed. I chose the mridian linac machine by Viewray and had 5 treatments ending in February. There are only 47 or so of these combo machines in the world because it provides radiation while simultaneously, its built-in MRI allows real time view while being treated. It uses 2 mm margins versus the 4 or 6 mm margins that other radiation machines use so you’re healthy tissue is less exposed and therefore your side effects should be better. Viewray.com will give you more information including locations of machines. I would make the same decision again, and my brother, who has worse prostate cancer, also used the same machine, but he did it out of Cornell Weil in New York City, and I did it out of Florida at the Orlando Cancer Institute. I also had spaceoar gel inserted, to get some separation between my rectum and prostate. Good luck and take one step at a time and get back up opinions.

@Bens1thank you for the information and I will certainly look into it. I live in Mn. and 4 hours away from Mayo Rochester so I will talk to them and see if they offer that option.
I want to be informed about all the options available yet I feel like the more I learn the more I am confused as to what to do. I’m not excited to have the radical prostatectomy, yet I don’t want to choose another option and have the cancer come back.