Any experiences with HIFU localized ablation for prostate cancer?

I found this statement on the internet recently "Laser Treatment: Men can also develop bladder trabeculation after having laser treatment for an enlarged prostate. This procedure can cause blood clots to form within the bladder."

Only one area of the 12 biopsies has gleason score of 4+3/PTI 5%
Psa is 6.12. Age 59. Anyone have experience with focal therapy? How do i read this?

First, that is a very nice graph. I like the way it presents the data. I'm sure you also have a narrative description, which may have additional detail. This is one of those things where some people would rather you hear it from the urologist as no one wants to be the bearer of bad news.
It was test results somewhat like this that lead to me being told I was not a candidate for focal therapies. [Focal therapies are targeted destruction of cancer nodules. There are various ways of doing this destruction, including targeted radiation, freezing, and heating.]
First, you have noticeable levels of cancer in multiple regions of the prostate. Second, you have a 4+3. That means the "4" grade cells were more common in one or more biopsies there than the "3" grade cells. Anything less than a 3 is not scored and they can be 3,4, or 5 depending on how abnormal the cells look.
Also, a low PSA with significant cancer is not considered a positive. For whatever reason, this can be associated with faster growing cancer.
So now I've told you what you perhaps didn't want to hear and perhaps more than you wanted to hear, but the good news is that I'm not a doctor, I have not even seen your complete case notes, and I may be completely and utterly wrong.
May God give you a peace beyond yourself and provide a way forward whatever your journey yet holds. It's been about 18 months since I got results from my MRI-guided transperineal biopsies with 20 cores that found 4+3 in one nodule. I had a radical prostatectomy about a month later.

Here is a good website to compare your odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see your odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also, that was 12 tiny needles.
Don’t assume you have one small speck of cancer.
Its just not possible to know with only 12 cores.
Alot of men have multiple negative biopsies and eventually strike PCa later

Focal therapy seems a good goal. The problem with the whole field is the most drastic treatments are almost always advised, regardless if you need focal or intermediate type treatment. It is like they mandatorially make everyone get advised the most serious treatments, the most serious surgery, the most serious radiation. Then they leave it up to you alone to find anything focal or intermediate, or basically anything less than the most serious treatments. Dr Woodrum, interventional radiology at Mayo does some more focal treatments. He can do some intermediate type treatments too, but he is been sort of mandated by research protocol/funding of this for mostly just focal. Outside Mayo there are a small group of doctors doing focal and intermediate type treatments because there is much that has to be cash paid and Medicare codes are not in just yet for many of them, though we hear it is coming. Mayo is top notch for advanced stuff. Good luck.

Hi Dan, I moved your question to this existing discussion:
- Any experiences with HIFU localized ablation for prostate cancer?
https://connect.mayoclinic.org/discussion/hifu-localized-ablation-for-prostate-cancer-e-g-at-stanford-med/
I did this so you can read previous posts and connect with members like @josgen @imbimbo @poodledoc @semeon @cupman @azdave in addition to the helpful responses from @spino @grounghogy and @bjroc.

Dan, have you decided on treatment?

I'm 64 y/o, had a 6.42 PSA and my PCP referred me to a urologist. Urologist performed a DRE and found a nodule. A TRUS was done and the biopsy result came on 1 Nov 2023 as Gleason 3+4 (grade 4 comprises 10% of the tumor) with PNI. There's only one core that is malignant, "right mid". Urologist discussed about treatments and mentioned active surveillance. I opted for active surveillance but after research and following this group, I'm having second thoughts about active surveillance. I am going to schedule an appointment with a urologic oncologist to get a second opinion. Interested with HIFU treatment but I don't see anyone doing it in Maryland.
Anybody here done HIFU treatments? I appreciate it very much if you can share your experience. Thanks.

dmagic, I am not familiar with HIFU treatments.

I think you are doing the right thing getting a second opinion.

It is a personal thing to decide on what is best for you after getting opinions and research. A lot of research shows active monitoring of certain stages of prostrate cancer are appropriate especially when older. At 64 you are not that old. I am 76 and chose radiation treatments to cure the cancer and stop it from growing and possibly spreading.

Are you familiar with a test called Decipher? It is a genetic test on the already obtained biopsies that gives a more precise diagnosis of risk of the cancer. Low, intermediate, high. My original diagnosis form biopsies was intermediate. Decipher came back low risk. This changed my treatments from hormone and radiation to radiation only.

I would get second opinions. Asked your urologist about Decipher tests, PSMA, and bone scans. Have you seen an oncologist and or radiologist for consultations also. What I had was proton pencil beam radiation 30 rounds over 6 weeks. I did this after getting two opinions from different providers, doing all research I could, and having all the test I mentioned above done to give me as much information possible.

I agree with jc76. I had a specific narrow margin photon machine and also had the decipher test which is used by doctors to evaluate treatment.

Get as many opinions as you can. It’s a process so take one day at a time.