Radical Prostatectomy Vs. HIFU

I have MRI.. 2 times.. result is cancer…then biopsy 1 time.. cancer with Gleason 7 but pattern 4: 40%… plus cribriform .. then PSMA PT SCAN ..no tracer activity within prostate gland..then Decipher 0.24 low risk …so confuse….hard to make decision but I did….want to take it out from my body. I was a good candidate for AS but
They do not know and you do not know on until they get down there and see when cancer goes out of prostate, in my case my left lobe margins did come back positive when my surgeon send my prostate tissue to check on clear margins. I have my surgery on March 9th...5 weeks ago.
I feel very good and feels like I do not have any surgery at all.
New surgery technique’s can give immediate continence and with nerve sparing. The old stories everyone has grown up about being incontinent and impotent after prostate surgery are giving way to the new technology. I even went home from surgery the same day.
all urine leakage had completely stopped on fourth day after catheter out . Surgery was done by one of the best surgeon(in my opinion) with certain technique which not all Surgeon’s are trained in. He is approaching the prostate from behind the bladder (through the pouch of Douglas), it avoids damaging the Retzius space, offering superior, often immediate, urinary control.
I had a DaVinci Robotic Single port (one incision) surgery.
My surgery was 6 hour and during the surgery he send I was in surgery the prostate tissue to check on clear margins to the hospital pathology for staining to see whether I had the clear margins.This clearly delays the closing of the surgery and in my case my left lobe margins did come back positive and the PET scan saying it was contained within the prostate really was a surprise. Many Surgeons do not bother with this and at your post surgery appointment they give you the disappointing news that you have positive margin.
The stories everyone hears about how slow prostate cancer grows are stories too. Sure many prostate cancers are slow growing but as many are not. I had state-of-the-art surgery and a surgeon who was well versed in Single Port surgery along with the Retzius sparing technique for removing the prostate.
This is only my opinion...
If anybody have any question I will glad to answer it

If you can get focal therapy to take care of it, one does it for sure. You can always do other treatments later. I had tulsa Pro, did well for 2.5 years, now looking at radiation.

Hifu and/or Tulsa may take care of it all for you, or maybe you came back 2 or 5 or 10 years from now and do something else. So do something else at that time, if it ever happens.

HIFU although not as damaging to the prostate as Radiation if salvage surgery is needed, it is still more difficult. I would certainly consult concerning the HIFU. Also as indicated in Mozir’s post above new surgical techniques can preserve your continence and sexual function. My biggest concern having had previous cancer, non Hodgkin’s lymphoma and experiencing chemo and two years later relapse and then some heart issues, one’s overall health can change on a dime, so you are in a sweet spot for surgery so don’t necessarily rule it out but do seek your other consultations for your informed decision

One other bit of transparency, Mozir and I, although 18 months apart had the same surgeon. I was beginning the process at 69 and did not want to lose the window for surgery due to health or age

Based on my research into side effects, I would absolutely choose HIFU if I was suitable for it - not a question in my mind. No radiation, no risk of secondary cancers, much reduced risk of incontinence and erectile dysfunction.

If you are considering HIFU, I would look at Tulsa Pro. It uses the same high intensity ultrasound, but in an MRI environment. It monitors the temperatures and margins in real time.

@mozir Thanks very much for your time and comments. Waiting to hear tomorrow and will need to make a decision.

@wheel1 Thanks very much for your thoughts and advice.

You read some real positive remarks about doing surgery, but I remember you wanting to be able to work at your restaurant as well as do stage work where you needed to be able to lift things that were heavy. No matter what kind of surgery you have that’s not going to be easy to do. Running the restaurant, however, would be a different story as long as you didn’t have to lift things. You could definitely get back into that restaurant within five or 6 days, As long as you didn’t have much physical stress. I did go back to work four days after surgery, but only went to three clients officers to work on their computer issues. That didn’t involve any heavy lifting. It does leave open the possibility you could get back to the restaurant soon though. I know that after seven days I was able to go back to work full-time and didn’t really have much in the way of limitations, Though I didn’t lift anything heavy for a few more weeks. I did go back right after the weekend, I could’ve gone back a couple of days earlier if it had not been a weekend.

When it comes to doing focal therapy, there are issues you need to consider. Many people after having a prostatectomy find out that their cancer is worse than they expected. If you have focal therapy, you will never know that, but your decipher score seems to imply there’s something more wrong than the test results that you’ve received show. It’s not high it’s very high almost at the top, Which is what makes me suspect there’s more wrong than you are finding out. They’ve already found that both sides of the prostate Have tumors, Maybe focal therapy is just not the right treatment. You can rely on the doctors to decide that, And maybe TulsaPro would make sense. You have to realize that only one percent of the prostate has been examined by biopsy.

I’m not sure you saw this, but this implies focal therapy is not the best thing for somebody who has a possibility of a serious case. Yes, if you have focal therapy, you can come back for more treatment, But that is not optimal for your job situation.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

What about focal therapy?
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance

A couple of members of this forum have come up with some information that would make Surgery more attractive. I’m not sure what doctor they used, but it’s possible you could use the same doctor, Or find one that uses the same techniques.

I don’t want to tell you what to pick, just pointing out different considerations to think about.